Short-term Postoperative Period Research Articles

Metal sensitivities among TJA patients with post-operative pain: indications for multi-metal LTT testing.

Metal sensitivity testing is generally the diagnosis method of last resort for aseptic painful implants with elevated inflammatory responses. However, the relationship between implant-related pain and implant-debris-related metal sensitization remains incompletely understood. Although a sensitivity to nickel alone has been used as a general measure of metal allergy, it may lack the specificity to correlate sensitivity to specific implant metals and thus to select a biologically appropriate implant material. In this retrospective study, we report the incidence of pain and nickel sensitivity in patients with total joint arthroplasties (TJAs) referred for metal sensitivity testing (n=2018). We also correlated the degree of nickel hypersensitivity to implant pain levels (none, mild, moderate, and high, using a scale of 0-10) and the incidence of sensitivity to alternative implant metals in highly nickel-reactive subjects. Most patients (>79%) reported pain levels that were moderate to high regardless of implant age, whereas patients with severely painful TJAs had a statistically greater incidence of nickel sensitivity over the short-term post-operative period (≤4 years). Patients with moderate pain scores (4-7) and high pain scores (≥8) also exhibited significantly higher sensitivity to nickel compared to patients with no pain and no implant (controls) (p<0.05). Highly nickel-sensitive subjects (SI>8) also showed incidences of sensitization to alternative materials such as cobalt, chromium, or molybdenum (57%) or aluminum or vanadium alloy (52%). These data suggest that painful TJAs caused by metal sensitivity more likely occur relatively early in the post-operative period (≤4 years). The incidences of sensitivity to alternative implant metals in only a subset of nickel-reactive patients highlights the importance of testing for sensitization to all potential revision implant materials.

Comparison by Meta-Analysis of Mortality After Isolated Coronary Artery Bypass Grafting in Women Versus Men

Short- and long-term mortality in women who undergo coronary artery bypass grafting (CABG) has been evaluated in multiple studies with conflicting results. The investigators conducted a meta-analysis of all existing studies to evaluate the impact of female gender on mortality in patients who undergo isolated CABG. A comprehensive search of studies published through May 31, 2012 identified 20 studies comparing men and women who underwent isolated CABG. All-cause mortality was evaluated at short-term (postoperative period and/or at 30 days), midterm (1-year), and long-term (5-year) follow-up. Odds ratios (ORs) and 95% confidence interval (CIs) were calculated using a random-effects model. A total of 966,492 patients (688,709 men [71%], 277,783 women [29%]) were included in this meta-analysis. Women were more likely to be older; had significantly greater co-morbidities, including hypertension, diabetes mellitus, hyperlipidemia, unstable angina, congestive heart failure, and peripheral vascular disease; and were more likely to undergo urgent CABG (51% vs 44%, p <0.01). Short-term mortality (OR 1.77, 95% CI 1.67 to 1.88) was significantly higher in women. At midterm and long-term follow-up, mortality remained high in women compared with men. Women remained at increased risk for short-term mortality in 2 subgroup analyses including prospective studies (n = 41,500, OR 1.83, 95% CI 1.59 to 2.12) and propensity score-matched studies (n = 11,522, OR 1.36, 95% CI 1.04 to 1.78). In conclusion, women who underwent isolated CABG experienced higher mortality at short-term, midterm, and long-term follow-up compared with men. Mortality remained independently associated with female gender despite propensity score-matched analysis of outcomes.

Hearing Outcomes in Stapes Surgery

To compare short- and long-term hearing results following stapedectomy using 3 different oval window grafting materials with the same stapes prosthesis. Database review. Tertiary referral private practice. Subjects were ears that underwent stapedectomy for otosclerosis, with placement of fat, fascia, or vein as an oval window seal and reconstruction with a titanium bucket handle prosthesis. A total of 365 procedures met these inclusion criteria: 98 fat grafts, 135 fascia grafts, and 132 vein grafts. Outcome measures included short-term (<1 year) and long-term follow-up air-bone gap. We compared the preoperative and postoperative amount of change in air-bone gap and preoperative and postoperative amount of change in the high-frequency bone conduction average. Overall median times to short-term and long-term follow-ups were 2.2 months and 36.1 months, respectively. There were no statistically significant differences between the 3 tissue seal groups in the amount of change in air-bone gap. There was no significant difference in amount of change in high-frequency bone conduction (representing sensorineural hearing level) between the 3 tissue seal groups. Most patients in all 3 groups had an air-bone gap at long-term follow-up of ≤ 10 dB (fat, 79.5%; fascia, 78.8%; and vein, 75.6%), with 90.3% of all patients at ≤ 20 dB. In both the short-term postoperative period and long-term follow-up, there were no significant differences in hearing results among 3 types of tissue seals of the oval window in stapes surgery. Fat, fascia, and vein grafts all provide satisfactory hearing outcomes in stapedectomy.

Five-year results of a randomized clinical trial comparing a polypropylene mesh with a poliglecaprone and polypropylene composite mesh for inguinal hernioplasty

BackgroundThe aim of this study was to assess whether partially absorbable monofilament mesh could influence postoperative pain and recurrence after Lichtenstein hernioplasty over the long term.MethodsPatients were randomized into two groups that were treated with lightweight (LW) or heavyweight (HW) mesh in 15 centers in Poland. A modified suture technique was used in the lightweight mesh group. Clinical examination was performed. A pain questionnaire was completed five years after the surgery.ResultsOf the 392 patients who underwent surgery, 161 (90.81 %) of 177 in the HW group and 195 (90.69 %) of 215 in the LW group were examined according to protocol, a median of 62 (range 57–66) months after hernia repair. There was no difference in the recurrence rate (1.9 % LW vs. 0.6 % HW; P = 0.493). There were 24 deaths in the follow-up period, but these had no connection to the surgery. The patients treated with LW mesh reported less pain in the early postoperative period. After five years of follow-up, the intensity and the presence of pain did not differ between groups (5 patients in the LW and 4 patients in the HW group). Average pain, (VAS score), was also similar in the LW and HW group (2.25 vs. 2.4) at the fifth year postoperatively.ConclusionThe use of partially absorbable mesh reduced postoperative pain during the short-term postoperative period. No difference in pain or recurrence rate was observed at 60 months.

Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome

Various surgical approaches, such as uni- and bifrontal, frontolateral, and pterional approaches, have been advocated for tuberculum sellae meningiomas. The authors retrospectively reviewed the effectiveness of a bilateral subfrontal approach for tuberculum sellae meningiomas with special attention to ophthalmological outcomes and complications. Between 1993 and 2009, 34 patients underwent surgery for removal of tuberculum sellae meningiomas at Osaka City University. Tumor size ranged from 14 to 45 mm. Thirty-two of 34 patients presented with visual disturbances before the surgery. The visual functions in all patients were assessed using a visual impairment score (VIS) before and after surgery. Postoperative visual examination was performed 2 weeks after surgery. Long-term follow-up examinations were conducted 1 year after surgery. Radical resection (Simpson Grades I and II) was accomplished in 27 patients, and subtotal or partial resection (Simpson Grades III and IV) was achieved in 7. There was no deterioration in postoperative visual outcome. Twenty-nine (90.6%) of 32 patients showed improved VIS compared with preoperative VIS. The average VIS was 38.1 preoperatively, 23.5 in the short-term postoperative period, and 21.8 in the long-term postoperative period. In the short-term postoperative period, the visual function in 6 patients normalized, and visual problems persisted in the remaining 26. Six (23%) of 26 patients showed further improvement in VIS during the long-term follow-up period, and no patient exhibited a worsened VIS during this time. One patient complained of hyposmia after surgery, but there was no indication of related complications such as CSF leakage or frontal brain contusion. The bilateral subfrontal approach was previously avoided because of the relatively high rate of complications in earlier surgical series of tuberculum sellae meningiomas. However, after developments in microsurgical techniques in recent years, the bilateral subfrontal approach can now provide satisfactory visual outcomes with minimal postoperative complications. Careful preservation of the blood supply to optic apparatus and early unroofing of the optic canal using a bilateral subfrontal approach led to further improvement in long-term postoperative visual outcome.

Effects of anesthesia and surgery on serial blood gas values and lactate concentrations in yellow perch (Perca flavescens), walleye pike (Sander vitreus), and koi (Cyprinus carpio)

OBJECTIVE-To evaluate serial blood gas values and lactate concentrations in 3 fish species undergoing surgery and to compare blood lactate concentrations between fish that survived and those that died during the short-term postoperative period. DESIGN-Prospective cohort study. Animals-10 yellow perch, 5 walleye pike, and 8 koi. PROCEDURES-Blood samples were collected from each fish at 3 time points: before anesthesia, during anesthesia, and immediately after surgery. Blood gas values and blood lactate concentrations were measured. Fish were monitored for 2 weeks postoperatively. RESULTS-All walleye and koi survived, but 2 perch died. Blood pH significantly decreased in perch from before to during anesthesia, but increased back to preanesthesia baseline values after surgery. Blood Pco(2) decreased significantly in perch from before anesthesia to immediately after surgery, and also from during anesthesia to immediately after surgery, whereas blood Pco(2) decreased significantly in koi from before to during anesthesia. Blood Po(2) increased significantly in both perch and koi from before to during anesthesia, and also in koi from before anesthesia to immediately after surgery. For all 3 species, blood lactate concentrations increased significantly from before anesthesia to immediately after surgery. Blood lactate concentration (mean +/- SD) immediately after surgery for the 8 surviving perch was 6.06 +/- 1.47 mmol/L, which was significantly lower than blood lactate concentrations in the 2 nonsurviving perch (10.58 and 10.72 mmol/L). CONCLUSIONS AND CLINICAL RELEVANCE-High blood lactate concentrations following surgery in fish may be predictive of a poor short-term postoperative survival rate.

The Effects of Psychological Status of the Patients With Digestive System Cancers on Prognosis of the Disease

To assess the association between psychological status and prognosis of patients with digestive system cancer, epidemiological investigations were conducted in 2 periods to obtain information about the patients' psychological status, survival time, and quality of life. Adjusted relative risks (95% confidence interval) of 1-year survival rate for anxiety and depression were 8.43 (1.18-60.20) and 9.62 (1.76-52.63), respectively. Relations between quality of life and depression and social support were statistically significant (P <.05). This study offers evidences that psychological status in a short-term postoperative period may affect 1-year survival rate, and poor psychological status and social support after being discharged from hospitals are associated with poor quality of life.

Iloprost Pretreatment Before Unilateral Nephrectomy: An Experimental Study in Rats

To evaluate the effects of iloprost administration before unilateral nephrectomy on postoperative interleukin-6 (IL-6), nitric oxide (NO), and oxidant/antioxidant status. Malondialdehyde, glutathione, catalase and Cu-Zn superoxide dismutase were measured in the blood and remnant kidney of Adult male Wistar albino rats to assess oxidant and antioxidant status. The rats were divided into three experimental groups: sham group (S) (n = 12); unilateral nephrectomized group (N) (n = 12); an hour before unilateral nephrectomy iloprost (1 ng/mL/kg, intraperitoneal) administered group (IN) (n = 12). Iloprost administration before unilateral nephrectomy lowered oxidant parameters and IL-6 levels significantly. NO levels were increased in both N and IN groups. Iloprost pretreatment before unilateral nephrectomy can reduce oxidative stress and IL-6, which increases due to anaesthesia and surgery and causes organ damage during surgery and in the short-term postoperative period.

Anterior Cervical Decompression And Fusion: Does The Addition Of A Plate Reduce Axial Neck Pain In The Short Term?

Objectives: The aim of the current study is to examine the hypothesis that the inclusion of a plate when performing anterior cervical discectomy and fusion (ACDF) results in a more initial stable motion segment in the early postoperative period and therefore a reduction in axial neck pain. Summary of Background Data: ACDF is a commonly performed procedure with much controversy surrounding the role of anterior cervical locking plates. There is anecdotal evidence that the use of a locking plate reduces axial neck pain in the shortterm postoperative period, however this question has not been examined in the literature. Methods: Over a 42-month period, 54 patients were entered into a prospective study to examine postoperative axial neck pain scores following ACDF, with and without a plate. Results: There is a minor benefit awarded to those patients who have received a plate in terms of reduced postoperative axial neck pain on the day 7, 1 month and 3 month time periods. However there is a statistical difference only at the day 7 mark (p=0.029). Conclusions: The data does not provide strong evidence that the addition of an anterior locking plate reduces significant axial neck pain in the short-term postoperative period.

Short- and long-term skeletal relapse after mandibular advancement surgery

This study analyzes short- and long-term skeletal relapse after mandibular advancement surgery and determines its contributing factors. Thirty-two consecutive patients were treated for skeletal Class II malocclusion during the period between 1986 and 1989. They all had combined orthodontic and surgical treatment with BSSO and rigid fixation excluding other surgery. Of these, 15 patients (47%) were available for a long-term cephalography in 2000. The measurement was performed based on the serial cephalograms taken preoperatively; 1 week, 6 months and 14 months postoperatively; and at the final evaluation after an average of 12 years. Mean mandibular advancement was 4.1 mm at B-point and 4.9 mm at pogonion. Representing surgical mandibular ramus displacement, gonion moved downwards 2 mm immediately after surgery. During the short-term postoperative period, mandibular corpus length decreased only 0.5 mm, indicating that there was no osteotomy slippage. After the first year of observation, skeletal relapse was 1.3 mm at B-point and pogonion. The relapse continued, reaching a total of 2.3 mm after 12 years, corresponding to 50% of the mandibular advancement. Mandibular ramus length continuously decreased 1 mm during the same observation period, indicating progressive condylar resorption. No significant relationship between the amount of initial surgical advancement and skeletal relapse was found. Preoperative high mandibulo-nasal plane (ML-NL) angle appears to be associated with long-term skeletal relapse.

Subcutaneous dissection of soft tissues in aesthetic surgery

Recent years seem to have been witnessing a steadily increasing demand for aesthetic operations to be performed with the possibly minimum risk for human health. Along with it, they are required to be least traumatic, with neither cuts, nor subsequent cicatrices, as well as to have a short-term rehabilitation postoperative period. In order to obtain a better cosmetic therapeutic outcome in patients with aesthetic deformities of the face and body, we hereby offer a new surgical technique – subcutaneous dissection of soft tissues without external cuts. The operations in which this method is used are as follows:

Three-wall orbital decompression in Graves ophthalmopathy for improvement of vision.

Graves ophthalmopathy can result in progressive visual loss. Four patients with deteriorating vision despite steroid therapy and/or radiotherapy underwent three-wall orbital decompression through an extended subciliary incision for the preservation of vision. The authors evaluated the visual outcome and morbidity after three-wall orbital decompression for patients with Graves ophthalmopathy. Visual acuity improved for all patients without any major complications in the short-term postoperative period (4 weeks), and visual acuity maintained or improved during the follow-up period. The authors conclude that three-wall orbital decompression can be effective in improving the vision of patients with Graves ophthalmopathy whose vision failed to improve with conservative therapy.

Evaluation of factors associated with postoperative ileus in horses: 31 cases (1990–1992)

Summary Medical records of horses that underwent surgical treatment for colic between 1990 and 1992 were reviewed. Horses with a pulse rate of ≥ 60 beats/min or signs of abdominal pain, which were also accompanied by a volume of &gt; 2 L of material that refluxed from the stomach during the postoperative period (excluding horses with anterior enteritis), comprised the postoperative ileus (poi) group. Horses that had &lt; 2 L of material reflux during the postoperative period and survived &gt; 3 days after surgery comprised the reference population. The association of preoperative and intraoperative clinical variables with development of poi was evaluated by use of logistic regression analysis. Of 148 horses, 117 were assigned to the reference population, and 31 (21%) developed poi. Multiple logistic regression analysis was used to determine that pcv, pulse rate, type and location of lesion detected during surgery, and serum glucose concentration were the most important variables associated with development of poi. Time of recovery from anesthesia to development of poi was 0.5 to 120 hours (median, 13 hours). Duration of poi was 1 to 7 days (median, 1 day). Four of 31 (13%) horses with poi died. Of 148 horses, only 10 (7%) died; however, 4 of the 10 (40%) deaths in the short-term postoperative period were attributable to poi.

Postoperative pain following outpatient pediatric urologic surgery: A comparison of anesthetic techniques

Objectives. To evaluate and compare the efficacy of caudal and local nerve blocks in preventing pain following outpatient pediatric urologic surgery. Methods. Seventy-seven boys undergoing outpatient urologic surgery were randomized into one of three groups: general anesthesia alone, general anesthesia and caudal nerve block, or general anesthesia and local nerve block. Pain scores, frequency of medication, and total dosage of medication were recorded in the immediate postoperative period. Long-term pain and discomfort were measured using â 24-hour and 1-week questionnaire. Results. The caudal and local groups had lower pain scores and significantly lower medication requirements than the control group in the short-term postoperative period. The caudal group had lower pain scores than the local group in all categories; however, the only significant difference was at 24 hours postoperatively. At 1 week postoperatively, the only difference among the three groups was a lower pain score in the caudal group compared with the control group. Conclusions. This study demonstrates that for outpatient pediatric urologic procedures,both caudal and local nerve blocks significantly reduce pain and medication given in the immediate postoperative period and indicates that caudal block may decrease pain for up to 1 week following surgery.

Combined Extracapsular Cataract Extraction, Posterior Chamber Intraocular Lens Implantation, and Pars Plana Vitrectomy

ABSTRACT The surgical management of coexisting cataract and vitreoretinal disease has been controversial, particularly for eyes with a history of proliferative diabetic retinopathy (PDR) or chronic uveitis. We retrospectively studied the results of combined extracapsular cataract extraction (ECCE), posterior chamber intraocular lens (PC-IOL) implantation, and pars plana vitrectomy in 20 eyes of 16 patients. The indications for combined vitrectomy included dense, nonclearing vitreous hemorrhage attributed to PDR in 10 eyes, age-related macular degeneration in 2, and trauma in 1. The remaining 7 eyes had pars plana vitrectomy to remove inflammatory vitreous cell and debris associated with chronic uveitis. Follow up ranged from 4 to 32 months (average, 17.4 months). Visual acuity improved in 19 eyes (95%)- to 20/100 or better in 12 (60%). The improvement ranged from 1 to 13 Snellen lines (average, 4.9 lines). Postoperative visual acuity improvement averaged 7.5 Snellen lines for eyes with chronic uveitis, 7.0 lines for those with age-related macular degeneration, and 3.3 lines for those with a history of PDR. Postoperative visual acuity was less than 20/100 in 8 eyes (40%). In most cases, these latter results were attributed to macular changes associated with the underlying ocular disease. Our results confirm previous studies that have shown that combined ECCE/PC-IOL implantation and pars plana vitrectomy is a well-tolerated surgical procedure for diabetics, which can provide clear anterior and posterior segment media. In addition, our results suggest that this combined procedure can be useful in restoring vision in certain eyes with uveitis in the short-term postoperative period.