Surgical Satisfaction Research Articles

Effect of ADRA2A gene polymorphisms on the anesthetic and analgesic effects of dexmedetomidine in Chinese Han women with cesarean section.

It is well known that differences in drug reactions among individuals are widespread, and therefore the study of genetic polymorphisms of drug targets has become a research hotspot. Dexmedetomidine is clinically effective by acting on α2 adrenergic receptor and the impact of the adrenoceptor α2A gene (ADRA2A) polymorphisms on the anesthetic and analgesic effects of dexmedetomidine is related to the clinical application of dexmedetomidine. The present study aimed to analyze the effects of the rs1800035, rs201376588 and rs775887911 locus single-nucleotide polymorphisms of the ADRA2A on the anesthetic and analgesic effects of dexmedetomidine in Chinese Han women. A total of 434 Chinese women undergoing cesarean section were enrolled in this study. A 3-ml fasting venous blood sample was collected from all subjects for genomic DNA extraction and genotype detection. The pre-anesthetic and post-anesthetic pain threshold (PTh), pain tolerance threshold (PTTh), mean arterial pressure, heart rate, blood oxygen saturation, cortisol (Cor) content, blood glucose (Glu) content, opioid usage, patient-controlled analgesia pressing times, surgical satisfaction and postoperative adverse reactions were recorded. The visual analogue scale (VAS) and Ramsay sedation score were evaluated. PTh and PTTh in the wild-type women were higher than those in the women with mutations (P<0.05). The postoperative VAS scores of wild-type women were lower than those of mutants (P<0.05). The Ramsay sedation scores of wild-type patients at 12 h after the operation were significantly higher than in those with mutations (P<0.05). The levels of Cor and Glu in women with mutations were significantly higher than those of wild-type women at 12, 24 and 48 h after surgery (P<0.05). The satisfaction with surgery of wild-type patients was higher than that of patients with mutations (P<0.05). Gene mutations of rs1800035, rs201376588 and rs775887911 loci in the ADRA2A gene reduced the anesthetic and analgesic effect during and after cesarean section in Chinese Han women. Postoperative analgesia of mothers with mutations may require higher doses of analgesics.

From Music to Medicine: Are Pianists at an Advantage When Learning Surgical Skills?

Background: The acquisition of procedural competence is of vital importance in the training of physicians. It has been observed that medical students with extensive musical backgrounds often learn surgical techniques more rapidly than other students, raising the question of motor skill transfer from one area to another. Objective: It is the aim of this project to explore whether musicians can learn and perform surgical skills more rapidly than non-musicians. This study explores the claims that musicians’ proficiency in playing their instrument can translate into benefits when learning complex and refined motor skills in another domain. Even basic surgical skills, such as suturing, become difficult in cognitively demanding environments such as the operating room, containing a barrage of multisensory stimuli where the surgeon must triage and respond to clinically salient information. Method: Participants with piano expertise and participants with no formal music training learned how to do a surgical knot and sutures. They had two practice sessions and were tested after each session. The two test parameters measured were time to complete the task and an OSATS (Objective Structures Assessment of Technical Skills) score. Results for each group (musicians and non-musicians) were analysed and compared. Results: Musician participants performed the surgical tasks faster and received higher scores than the controls; for knot tying, the difference between the two groups was statistically significant. Gender and proficiency using chopsticks also exhibited some influence on test times and scores. Conclusion: Musical training in piano appeared to be of benefit in the initial stage of learning new simple surgical skills. This indicates that at least some aspects of a musicians’ skillset (such as fine motor control, bimanual dexterity and good hand-eye coordination) might be transferrable to an ostensibly disparate domain, and may be important for incorporation in surgical training where the skill of suturing can impact both surgical outcomes, patient safety, and patient satisfaction.

Combined lumbar plexus-sciatic nerve block in the emergency surgery for pertrochanteric fracture: an alternative technique in patients at high risk of anaesthetic complications

Introductionl’anesthésie pour la chirurgie urgente de la fracture pertrochantérienne (FPT) chez les patients à haut risque anesthésique représente souvent un véritable challenge pour les praticiens en vue du risque periopératoire majeur. Nous rapportons notre expérience avec le bibloc ou bloc combiné lombaire et sciatique plexique (BCLS) comme technique anesthésique alternative face à ce type de situation.Méthodesune étude transversale, descriptive, monocentrique, a été menée sur une période de 3 ans, incluant les patients à haut risque anesthésique présentant une FPT récente. Les deux blocs nerveux étaient réalisés au niveau plexique selon la technique classique de neurostimulation. Un mélange de 20ml de lidocaine 2% et de bupivacaine 0,5% (50/50) a été injecté au niveau de chaque bloc. Le critère d’évaluation principal était l’efficacité du BCLS apprécié par l’incidence d’échecs de la technique anesthésique, définie par la nécessité de convertir en anesthésie générale (AG). Les critères d’évaluation secondaires étaient: 1) les données techniques de la procédure anesthésique, 2) les retentissements hémodynamiques, respiratoires et neurologiques periopératoires, et 3) les résultats et les complications éventuelles en postopératoire.Résultatstrente patients ont été colligés. L’âge moyen était de 74 ± 10 ans. Le délai moyen d’admission aux urgences-intervention était de 12(5-36) heures. La durée moyenne pour la réalisation de la procédure était de 15,20 ± 3,45 minutes. Aucune conversion en AG n’a été nécessaire. Il n’y avait pas de différences statistiquement significatives entre les différentes valeurs enregistrées des paramètres hémodynamiques et respiratoires periopératoires (PAM, FC, SpO2) (p > 0,05). La durée de l’intervention était de 46 ± 5 minutes. La satisfaction des chirurgiens était de 9,7 ± 0,1. La première demande en antalgiques postopératoires était après 8(1-24) heures. Tous les patients avaient une récupération sensitivomotrice complète.Conclusionle BCLS est une alternative anesthésique pour les interventions urgentes de FPT chez les patients à haut risque anesthésique: délais opératoires réduits, efficacité anesthésique, stabilité hémodynamique et respiratoire periopératoire, absence de complications inhérentes aux autres techniques anesthésiques, passage rapide en salle de surveillance post-interventionnelle (SSPI), et analgésie postopératoire de qualité.

Virtues of Using a Double Lumen Tube for Anesthesia in Patients with Endobronchial Tumours Requiring Open Lung Resection or Bronchoplastic Procedures

Objective The benefits and risks of using double lumen tube (DLT) in open thoracotomy are not well studied and the relative contraindication for using it in cases of endobronchial tumours is not proven. In this study, we compared our experience with using DLT versus single lumen tube (SLT) for anesthesia in patients requiring an open thoracotomy for resection of endobronchial tumours. Methods A prospective observational study was performed in a single tertiary care university hospital in patients with endobronchial tumours anesthetized with single and double lumen tubes for open thoracotomy procedures over a period from 2010 till 2018. Results One hundred and six patients with endobronchial tumours were studied. There were 76 males. Median age was 32 years (14 - 62). In 96 cases, endobronchial pathology was a typical carcinoid. 58 patients were anesthetized using a DLT and 48 using a SLT. Four cases of near miss from potentially fatal intraoperative tumour migration occurred in the SLT group (p = 0.025). There was only one case of mild tumour bleeding from the DLT group and time of insertion was longer (16.2 vs. 4.5 min p Conclusions We conclude that it is safe to place a double lumen endo tracheal tube for patients with endobronchial tumours requiring open lobectomies or bronchoplastic procedures. An additional benefit of DLT use is increasing surgical satisfaction by reducing spillage and tidal volume loss during surgical anastomosis of the open airway.

Effect of Acacia catechu and alum hot sitzbath on post-operative pain in patients treated with herbal seton

BackgroundPost-operative pain is the major consequence of Kṣārasūtra, Seton technique employed in Ayurvedic management of Low anal fistula. Surgeons are forced to prescribe Opioids and NSAIDs with pronounced untoward effects. Non pharmacological measures like Balneotherapy are used to improve circulation and relieve spasm in contemporary sciences. AimTo compare the efficacy of Khadira (Acacia catechu) and Sphaṭika (Potash alum) hot sitzbath with plain hot sitzbath in patients of low anal fistula treated with Kṣārasūtra. MethodThe study was single blind, double armed; prospective, randomized control clinical trial in which 30 patients were randomly allocated into two groups of 15 each on the basis of inclusion and exclusion criteria. Group A received hot sitzbath using Acacia catechu and alum infusion twice daily for 21 days. Group B received hot sitzbath using warm water for 21 days. The assessments were made on pain, post-surgical satisfaction burning sensation, tenderness, discharge, constipation, itching and incontinence. ResultThe disease was prevalent in the 4th decade of life, more in males (86.67%) involved in sedentary work (53.33%) residing in urban domicile, consuming mixed diet (100%). Both groups showed statistically significant improvement in outcome measures like pain, burning sensation, tenderness, discharge, constipation and itching. ConclusionOn comparative analysis Acacia and Alum hot sitzbath was more effective in outcomes like pain, surgical satisfaction, burning sensation and discharge. There was no difference in the effect of both interventions with respect to outcome measures like constipation, itching and incontinence.

Preoperative psychological factors affecting surgical satisfaction of elderly patients with lumbar spinal stenosis

ObjectiveThe objective of this observational study was to investigate the effects of preoperative psychological factors on short-term patient satisfaction with surgery in elderly patients with lumbar spinal stenosis (LSS). MethodsSurgery was performed on 90 elderly patients with clinically and radiologically defined LSS: mean age at surgery, 73 years; 46 men and 44 women. Patients completed questionnaires before surgery and 1 year postoperatively. They used a self-administered the Roland Morris Disability Questionnaire (RDQ), the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), MOS 36-Item Short-Form Health Survey (SF-36), and satisfaction for surgery (VAS) were completed. At baseline, psychological factors were assessed using the Self-Rating Questionnaire for Depression (SRQ-D), Hospital Anxiety and Depression scale (HADS), Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale-20, and Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP). At follow-up, patient satisfaction was evaluated using 2 items: (1) satisfaction with surgery and (2) Would you undergo the same surgery again?. ResultsSatisfaction item 1 correlated negatively with the VAS for low back pain, leg pain, numbness, JOABPEQ social life disturbance score, SF-36 physical function score, and HADS anxiety score (p < 0.05). Satisfaction 2 correlated negatively with age at surgery, VAS of leg pain, PCS magnification score, and BS-POP score (p < 0.05). Multiple regression analysis showed significant associations between satisfaction 1 and SF-36 physical function and HADS anxiety scores, and between satisfaction 2 and PCS magnification score (p < 0.05). Statistical analysisThe preoperative factors independently associated with surgical satisfaction were analyzed utilizing Speaman’s rank correlation coefficient and multiple regression analysis. ConclusionPhysical function and anxiety were identified as preoperative factors that affected patient satisfaction with surgery. Preoperative assessment of psychological factors and interventions for anxiety may help improve patient satisfaction after surgery for LSS.

A Clinical Algorithm for Breast Cancer Patients: Exploring Reconstructive Options after Radiation

As radiation therapy is used as an adjuvant treatment in an increasing number of women during the management of breast cancer, radiation therapy and its well-known adverse effects pose additional challenges for breast reconstruction. The purpose of this review is to examine recent data on outcomes of various breast reconstruction methods in the setting of radiation therapy and help surgeons and oncologists as well as patients with their decision-making process. Breast reconstruction methods can be categorized into autologous-, implant-, and tissue expander/implant-based, each with its distinct advantages and disadvantages. Autologous and tissue expander/implant are preferred when radiation therapy is expected based on surgical, aesthetic, and patient satisfaction. Use of latissimus dorsi flaps and acellular dermal matrix with tissue expander/implant has shown several advantages to traditional methods. For patients who have a high likelihood of requiring postmastectomy radiation therapy, choosing a breast reconstruction method depends on multiple factors. Patients and surgeons should be aware of the impact of radiation therapy so that they can make a well-informed decision.

SINGLE INCISION LAPAROSCOPIC ASSISTED APPENDECTOMY IN VEDANTA INSTITUTE OF MEDICAL SCIENCES, AN EXPERIENCE OF 50 CASES.

Introduction: Laparoscopic appendectomy (LA) has advantage to diagnose and to also treat appendicitis at the same time also it has a less postoperative pain and a faster return to work and normal activity. In a classic LA, three to four incisions are required for trocars placement. Technique of Single Incision Laparoscopic Appendicectomy (SILA) has been developed to reduce abdominal trauma, improve cosmesis, reductions in postoperative pain and hospital stay. Aim of this prospective study was to test the feasibility, safety and potential advantages of SILA&#x0D; Material and Methods: Patients over the age of 18 with a diagnosis of acute abdomen, later on confirmed to acute appendicitis based on clinical findings, imaging and laboratory tests were included in the study. Outcome of the patient was assessed in the form of operative time, length of hospital stay and postoperative complications. Prophylactic antibiotics were given pre-operatively to all the patients included in the study. Technique was evaluated for operative time, post-operative pain, post-operative length of stay and complication rate. Post-operative pain was evaluated at 12 hrs, day 1 and day 2 post-operatively by using a visual analogue scale (VAS) which ranged from 0 to 10. Patients were evaluated on the 7th and 14th postoperative day for analysis of recovery, any surgical site infection, abscess formation, abdominal tenderness and aesthetic satisfaction.&#x0D; Results: Mean age in years was 27±10.48 tears. There were 22 (44%) male and 28(56%) female. Mean duration of SILA procedure was 38±3.8 minutes. Hospital stay in days was 1.8±1.1. Patient returned back to work in 9±2.4 days. Post-operative pain was evaluated at 12 hrs, day 1 and day 2 post-operatively by using a visual analogue scale (VAS) which ranged from 0 to 10. After 12 hours score was 6.5, at day 1 4.0 and at day 2 it was 1.5.&#x0D; Conclusion: Single incision appendicectomy operative time is less, pain is less and hospital stay is reduced thereby increasing the patient satisfaction and this technique is effective in terms of pain and hospital stay.&#x0D; Keywords: LA, SILA, VAS

Experience in circumcision of children aged 3-6 years under the intervention of modern holistic medical model

Objective Under the intervention of modern holistic medical model, the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years. Methods A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017. The patients were divided into control group and experimental group by completely randomized grouping, there were 1 006 cases in each group. The children in the control group were treated with a single biomedical model, which was completed according to the conventional flow-type operation. The children in the experimental group adopted the modern holistic medical model, and the full modern holistic medical model intervention was performed before, during and after the operation. The medical treatment process highlighted the overall humanistic care for the children. The age of the control group was (4.19±1.75) years old, and the age of the children in the experimental group was (4.26±1.68) years old. The operation time, the degree of surgical pain [with the pain visual analogue scale (VAS)], the postoperative complications (including postoperative hemorrhage, penile edema, infection, wound rupture), wound healing time, surgery satisfaction rate and fear level of children were compared between the two groups. Measurement data were expressed as mean±standard deviation (Mean±SD), t-test was used for comparison between groups; Chi-square test was used to compare the count data. Results In the control group, the operation time was (9.26±1.87) min, the surgical pain VAS was (2.59±0.72), postoperative bleeding was 38 (3.8%), severe penile edema was 78 (7.8%), and infection was 12 (1.2%), wound rupture was 32 cases (3.2%), the wound healing time was (20.4±2.56) d, and the surgical satisfaction rate was 67.4%. In the experimental group, the operation time of was (6.15±1.23) min, the surgical pain VAS was (1.71±0.54), postoperative bleeding was 6 cases (0.6%), severe penile edema was 12 cases (1.2%), and infection was 8 cases (0.8%), wound rupture was 2 cases (0.2%), the healing time was (15.2±3.16) d, and the operation satisfaction rate was 98.8%. The operation time, surgical pain VAS, postoperative bleeding, severe penile edema, wound splitting rate, healing time and surgical satisfaction rate were statistically significant (P 0.05). The fear level of children in the experimental group was superior to the control group at levels 0, 1, 2 and 3, the difference was statistically significant (P<0.05). Conclusions Under the intervention of modern holistic medical model, the child′s operation process is smooth, the children and parents have good subjective feelings, no obvious fear, good compliance, high satisfaction, good objective clinical effect, and positively improve the relationship between doctors and patients. The society has won a good reputation and deserves to be promoted clinically. Key words: Child, preschool; Circumcision, male; Modern holistic medical model

46. Establishing maximal medical improvement following anterior cervical discectomy and fusion

BACKGROUND CONTEXT Identifying patient characteristics that predict MMI achievement may improve surgical care and patient satisfaction. PURPOSE The purpose of this study is to identify the time point at which patients undergoing primary, single-level anterior cervical discectomy and fusion (ACDF) can be considered to have reached maximal medical improvement (MMI). STUDY DESIGN/SETTING Retrospective. PATIENT SAMPLE 69 patients undergoing ACDF. OUTCOME MEASURES Maximal Medical Improvement, Neck Disability Index. METHODS A surgical database was retrospectively reviewed between 2014-2017 for patients undergoing ACDF for degenerative pathology. Neck Disability Index (NDI) scores were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month follow-up. The minimal clinically important difference (MCID) was calculated using distribution-based methodology at the 1-year interval and validated using a nonparametric receiver operating characteristic (ROC) curve. Area under curve (AUC) analysis was used to validate predictive power. The time period at which patients achieved MCID was determined and plotted using a Kaplan-Meier survivorship curve. MMI was defined as the interval at which 90% of patients achieved MCID. A Cox hazard proportion model was used to determine whether age, body mass index (BMI), and Charlson Comorbidity Index (CCI) were associated with time to achieve MCID. RESULTS A total of 69 patients were included in the analysis. Average NDI scores were 37.9 preoperatively, 30.7 at 6 weeks, 25.1 at 3 months, 21.3 at 6 months, and 22.0 at 12 months postoperatively. The change in NDI reflective of MCID was calculated to be -11.0 (AUC=100%). In total, 51 patients (73.9%) achieved MCID within the study period, with median time to achievement being 3 months. Of these patients, 95.7% achieved MCID by 6 months postoperatively, thus allowing the establishment of MMI at this time point. No association was identified between age (HR: 1.014, p=0.606), BMI (HR: 0.984, p=0.552), or CCI (HR: 0.932, p=0.719), and time to achieve MCID. CONCLUSIONS The majority of patients undergoing ACDF achieved MCID at 3 months follow-up, while over 95% of patients who achieved MCID reached this threshold by 6 months following surgery. As such, future outcome reporting in patients undergoing ACDF should include follow-up to 6 months postoperatively. Providers can also utilize this information to better counsel patients regarding postoperative expectations following ACDF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Reverberations from our initial cases of MIS TLIF: Perilous fear of radiation exposure and recollection of our cuts and bruises

Introduction: The increasing demand of MISS TLIF is constraining young spine surgeons to acquire perilous technique. The apprehension for radiation exposure is usually suppressed by surgical satisfaction. The aim of this study was to share our experience of initial cases, occupational hazards faced and patient reported outcome measures (PROM). We intend to highlight the problems encountered in the learning curve and technical pearls we learnt. Materials and Methods: The study includes initial 30 patients of spondylolisthesis operated by MISS-TLIF. The oswestry disability index (ODI) score and Patient satisfaction score at discharge and 6-months follow up were studied. Postoperative Bridwell’s anterior fusion grading used to access fusion rate at 6th month. The occupational risks and job stress was calculated using Staff stress questionnaire and compared to staff members of other sub-speciality. We also noted the number of CARM shots taken in those initial cases. Results: There was the improvement in the mean ODI score of 61.87 ± 16.65 pre operatively to 24.23 ± 13.85 in postoperative period; (p< 0 style=

The outcome of fundoplication in patients with GERD based on abnormal impedance testing.

The role of impedance testing in selecting patients for antireflux surgery is poorly understood. The aim of this study was to compare the outcomes of patients that underwent antireflux surgery for GERD based on an abnormal pH/abnormal impedance test versus a normal pH/abnormal impedance test. Records of patients who had an abnormal off-medication impedance test (≥ 48 total reflux events) who underwent antireflux surgery were reviewed and divided into two groups: normal [pH-] or abnormal [pH+] esophageal acid exposure (DeMeester score > 14.7). Symptom resolution was compared: scale 1 (no resolution) to 5 (complete resolution). Eighty-two patients met criteria: 44 [pH+] and 38 [pH-]. There were no differences in the demographics or indications for surgery. The frequencies of heartburn and regurgitation symptoms were significantly reduced by fundoplication in both groups. Complete resolution of heartburn was more common in the [pH+] group (90%) compared to the [pH-] group (67%) [p = 0.02]. Resolution of regurgitation was similar in both groups (90% in the [pH+] group vs 79% in the [pH-] group, p = 0.20). The mean dysphagia frequency score decreased for the [pH+] group, but increased in the [pH-] group. New-onset dysphagia was more common in [pH-] patients (23%) compared to [pH+] patients (5%), (p = 0.02). Continued use of PPI medications was significantly more likely in [pH-] group (42%) compared to the [pH+] group (21%). There was no difference in surgical satisfaction rates between groups. Patients with abnormal impedance and increased esophageal acid exposure had significantly better symptom resolution, less dysphagia, and less frequent PPI use with antireflux surgery versus those with normal pH. These findings urge caution in the use of abnormal impedance values with normal esophageal acid exposure for the selection of patients for an antireflux operation.

Nationwide Prospective Cohort Study on Cataract Surgery With Multifocal Intraocular Lens Implantation in Japan

To conduct a nationwide prospective cohort study of multifocal intraocular lens (mfIOL) implantation to determine clinical outcomes and patient satisfaction and assess factors affecting patient satisfaction. Prospective, multicenter cohort study. Setting: institutional; patient population: a total of 1051 consecutive patients (1631 eyes) who underwent cataract surgery with mfIOL implantation at 65 Japanese institutions from January 2017 to June 2018. The inclusion criteria were patient age of 20 years and older and cataract surgery with mfIOL implantation. The exclusion criteria were the absence of informed consent, completed postoperative questionnaires, and no record of the IOL models implanted. the uncorrected and corrected distance visual acuities (UDVAs and CDVAs) at 5 m; uncorrected VAs at 50, 40, and 30cm; and questionnaires regarding subjective visual symptoms, spectacle independence, and surgical satisfaction were assessed 3months postoperatively. odds ratios for the overall surgical satisfaction were computed for the preoperative/postoperative factors. We analyzed data from 1384 eyes of 871 patients. The UDVAs and CDVAs, respectively, improved significantly at 3months postoperatively. The intermediate and near VAs varied with the IOL models; 68.4% of patients were almost or totally spectacle-independent; 3.9% of patients reported surgical dissatisfaction. In patients implanted bilaterally with the same mfIOLs, postoperative blurred vision and/or decreased contrast was the most important factor in the overall surgical satisfaction. MfIOLs provided good visual outcomes and high satisfaction rates in this large patient cohort. The difference in the outcomes with the extended depth-of-focus IOLs did not differ significantly from the bifocal IOLs. The postoperative blurred vision is important to the overall surgical satisfaction.

Effect of diversified education model on health awareness and satisfaction of patients undergoing ophthalmic day surgery

Objective To explore the effect of the diversified education model on the ophthalmic day surgical patients' health awareness and satisfaction. Methods By convenience sampling, the ophthalmic patients who underwent day surgery in the Day Medical Sector of a hospital from January to June 2016 were selected as the research subjects. A total of 292 ophthalmic patients admitted from January to March 2016 were put into the control group, and 292 ophthalmic patients admitted from April to June 2016 were put into the experimental group. The control group received conventional education and the experimental group received diversified education. Health Awareness Questionnaire and Nursing Satisfaction Scale were used to evaluate the effect of intervention. Results After intervention, the experimental group achieved a score of (48.16±7.12) in health awareness, higher than the control group (46.68±8.07) with a statistical difference (t=-2.34, P=0.02) . After intervention, the experimental group achieved a score of (29.88±0.91) in nursing satisfaction degree, higher than the control group (28.87±3.97) with a statistical difference (t=4.23, P<0.01) . Conclusions Diversified education model can improve the ophthalmic patients' health awareness and satisfaction, and is worthy of widely application. Key words: Ophthalmology; Day surgery; Diversified education; Health awareness; Patient satisfaction

Endoscopically assisted fixation of the custom-made total temporomandibular joint prosthesis in TMJ Yang’s system through a modified preauricular approach

This article describes the experience with the endoscopically assisted fixation of the customized total temporomandibular joint (TMJ) prosthesis in TMJ Yang’s system only through a modified preauricular approach. Twenty patients (23 joints) treated with the custom-made total TMJ prosthesis were retrospectively recruited. An endoscopically assisted technique was used through a modified preauricular approach to fix the mandibular component for all these patients. These reconstructions were evaluated by surgical records, clinical examinations, and radiographic observations. All patients had successful fixation of the prosthesis. No patient had permanent weakness of the facial nerve and malocclusion or any other severe complications. The mean operative time was 111 min per joint (range, 85–133 min). The average surgical bleeding was 195 ml per side. The mean follow-up period was 16.2 months (range, 5–32 months). The mean scores were 8.3 for surgical satisfaction and 9.2 for scar healing evaluation. All patients experienced positive clinical outcomes, with a mean 75.2% reduction in pain and 53.7% increase in mouth opening with significant differences (P<0.05). The endoscopically assisted TMJ reconstruction with the customized prosthesis in TMJ Yang’s system through the modified preauricular approach could produce good aesthetic and functional results.

Anterior Cruciate Ligament Reconstruction with Concomitant Osteochondral Allograft Transplantation versus Anterior Cruciate Ligament Reconstruction: A Comparative Matched-Group Analysis of Return to Sport and Satisfaction

Objectives: Anterior cruciate ligament (ACL) rupture is commonly associated with articular cartilage injury. Few studies have evaluated the influence of cartilage repair on the outcome of ACL reconstruction. Currently, no known study has examined the return to sport rates of concomitant ACL reconstruction and OCA. The purpose of this study is to evaluate rate and level of return to sports, as well as long-term outcomes, between a matched cohort of isolated ACL reconstruction (ACLR) versus ACL reconstruction with concomitant OCA (ACLR/OCA). Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent ACL reconstruction with concomitant OCA. Inclusion criteria were preoperative diagnosis of ACL rupture and more than 2 years of follow-up. After meeting the inclusion criteria, all ACL reconstructions with concomitant OCA were matched to two isolated ACL reconstruction patients via +/- 5 years of age at time of surgery, gender, revision status, and ACL reconstruction graft type. At final follow-up, patients were asked to complete a subjective sports questionnaire, the Marx activity scale, a visual analog scale (VAS), and a satisfaction questionnaire. Results: Seventeen ACL/OCA patients met inclusion criteria. Fourteen eligible 2:1 matched pairs (28 ACLR; 14 ACLR/OCA;), were identified for analysis. The average age at the time of surgery was 33.89 +/- 8.64 and 35.92 +/- 6.22 for the ACLR and ACLR/OCA groups, respectively (P = .44). Average follow-up was 4.09 years and 5.14 years for the ACLR and ACLR/OCA groups, respectively (P = .17). At final follow-up, the average Marx activity scalescores were 6.54 for ACRL patients and 1.57 for ACLR/OCA patients; final scores were significantly different between groups (P &lt; 0.01). The average VAS pain scores at final follow-up were 1.96 in the ACLR and 3.64 in ACLR/OCA groups with the ACLR/OCA patients displaying significantly worse final VAS pain scores (P = .03). 89.3% of ACLR patients (25 of 28) returned to at least 1 sport postoperatively compared with 57.1% of ACLR/OCA patients (8 of 14) (P=0.04). At final follow-up, 14.2% (2 of 14) of the ACLR/OCA group and 32.1% (9 of 28) of the ACLR group reported starting a new sport or activity. Average timing for full return to sports was 9.57 +/- 5.53 months and 9.27 +/- 3.25 months for the ACLR/OCA and ACLR groups, respectively (P = .86). At final follow-up, 33.3% and 57.1% of patients returned to better or same level of sport for the ACLR/OCA and ACLR groups, respectively (P = .06). Significantly more ACLR/OCA patients reported their activity level was hindered by their knee (92.8% ACLR/OCA; 60.7% ACLR). Significantly more ACLR patients reported satisfaction with their surgery compared with ACLR/OCA patients (89% vs 57%) (P &lt; 0.01), however no statistical difference was observed in satisfaction with ability to play sports between groups. Conclusion: Significantly less ACLR/OCA patients (57.1%) were able to return to at least 1 sport when compared to a matched ACLR cohort (89.3%). At final follow-up, a higher percentage of ACLR patients were able to return to pretreatment activity intensity level or better (ACLR/OCA, 33.3%; ACLR, 57.1%). ACLR/OCA patients had significantly more pain and lower Marx activity scores. Despite a lower return to sport rate, there was no statistical difference in reported satisfaction with activity level between the groups, however the ACLR/OCA groups reported significantly lower overall surgical satisfaction.

A prospective study on elective surgical inpatient satisfaction with perioperative anaesthesia service at Ayder comprehensive specialized hospital, Mekelle, Ethiopia

BackgroundPatient satisfaction is a subjective and challenging perception, linking physical, expressive, psychological, societal, and cultural factors. Dissatisfaction arises if the patient feels an inconsistency between expected and delivered care. Usually health care satisfactions are very high and according to many studies levels of satisfaction are above 85% and patient’s satisfaction in terms of anesthesia is not very different. The aim of this study was to assess patient’s satisfaction with perioperative anesthesia service and associated factors.MethodsInstitution-based cross-sectional study was conducted from December to January, 2017/8 at the Ayder Comprehensive Specialize Hospital. The data were collected using structured interviewer-administered questionnaire prepared to collect data on demographic character of the patients, determinant factors which could affect the patient satisfaction level on anesthesia service. Epi Info version 6 was used to record the data and SPSS version 20 was used for the analysis. Descriptive statistics were used to explore the socio-demographic characteristics of patients; factors possibly related to satisfaction level and overall satisfaction were summarized as frequencies and percentages.ResultsOne hundred twenty consecutive patients were originally enrolled in the study that took over 1 Month. The overall proportion of patients who satisfied with anaesthesia services was 88.33%. Nausea and vomiting, pain, shortness of breath and cold were factors which affected patient satisfaction negatively.Conclusion and recommendationCompared with the other studies done at home and abroad; the overall proportion of patients, in Ayder comprehensive specialized hospital, who responded for satisfaction with perioperative anesthesia service is low. Patient satisfaction level should be determined regularly and all bodies should work to decrease the factors which decrease the satisfaction level.

Comparison of postoperative visual performance between bifocal and trifocal intraocular Lens based on randomized controlled trails: a meta-analysis

BackgroundTo compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted.MethodsA comprehensive literature retrieval of PubMed, Science Direct and EMBASE was performed in this systematic review. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, postoperative refraction and surgical satisfaction.ResultsThere were 8 RCTs included in this study. The difference of uncorrected near VA (UNVA) between the bifocal IOLs and trifocal IOLs had no significance [MD = 0.02, 95%CI: (− 0.03,0.06)]. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 [95%CI (− 0.02, 0.10)]. Compared with trifocal group, the uncorrected intermediate visual acuity (UIVA) [MD = 0.09,95%CI:(0.01,0.17)] was significantly worse in the bifocal group. No difference was found in distance-corrected intermediate VA (DCIVA) [MD = 0.09, 95%CI: (− 0.04, 0.23)] between two groups. Analysis on AT LISA subgroup indicated the bifocal group had worse intermediate VA than trifocal group (AT LISA tri 839 M) [MD = 0.18, 95%CI: (0.12, 0.24) for UIVA and MD = 0.19, 95%CI: (0.13, 0.25) for DCIVA]. However, there was no statistically significant difference between the two groups in the uncorrected distance VA (UDVA) and corrected distance visual acuity (CDVA) [MD = 0.01, 95%CI: (− 0.01,0.04) for UDVA; MD = 0.00, 95%CI: (− 0.01,0.01) for CDVA].The postoperative refraction of bifocal group was similar to that of trifocal group [MD = -0.08, 95% CI: (− 0.19, 0.03) for spherical equivalent; MD = -0.09, 95%CI: (− 0.21, 0.03) for cylinder; MD = -0.09, 95% CI: (− 0.27, 0.08) for sphere]. No difference was found for spectacle independence, posterior capsular opacification (PCO) incidence and patient satisfaction between bifocal IOLs and trifocal IOLs. [RR = 0.89, 95% CI: (0.71, 1.12) for spectacle independence; RR = 1.81, 95% CI: (0.50, 6.54) for PCO incidence; RR = 0.98, 5% CI: (0.86, 1.12) for patient satisfaction].ConclusionPatients receiving trifocal IOLs, especially AT LISA tri 839 M, have a better intermediate VA than those receiving bifocal IOLs. Near and distance visual performance, spectacle independence, postoperative refraction and surgical satisfaction of bifocal IOLs were similar to those of trifocal IOLs.

Wide Variability in Patient-Reported Outcomes Measures After Fusion for Lumbar Spinal Stenosis: A Systematic Review.

Study Design:Systematic review.Objectives:The purpose of this study is to review outcomes reporting methodology in studies evaluating fusion for lumbar spinal stenosis.Methods:A systematic review of PubMed and Embase databases was conducted from January 2007 to June 2017 for English language studies with minimum of 2 years postoperative follow-up reporting outcomes after fusion for lumbar spinal stenosis. Two reviewers assessed each study; those meeting inclusion criteria were examined for pertinent data. Outcome measures were categorized into relevant domains: pain/symptomatology, function/disability, and surgical satisfaction. Return to work reporting was also recorded.Results:Of 123 studies meeting inclusion criteria, 76% included posterior-only fusion, 32% included posterior/transforaminal interbody fusion, and 5% included anterior/lateral interbody fusion (non-mutually exclusive). There was significant variation in patient-reported outcomes (PROs) used—studies reported 31 unique PROs assessing at least one domain: 22 evaluating pain, 23 evaluating function, and 3 evaluating surgical satisfaction. Most commonly utilized PROs were the Oswestry Disability Index (73% of studies), Visual Analog Scale (55%), and 36-Item Short Form Survey (32%). The remaining 28 measures were used in 14% of studies or fewer. PROs specific to symptoms of lumbar spinal stenosis, such as the Zurich Claudication Questionnaire, were only used rarely (7/123 studies). Only 14% of studies reported on time to return to work.Conclusions:The literature surrounding fusion in the setting of lumbar stenosis is characterized by substantial variability in outcomes reporting. Very few studies utilized measures specific to lumbar spinal stenosis. Efforts to standardize outcomes reporting would facilitate comparisons of surgical interventions.

Surgical treatment satisfaction in women with pelvic organ prolapse. Quantification and analysis

Hypothesis/aims of study. An integrated evaluation of the effectiveness of pelvic organ prolapse (POP) treatment in women requires a consistent interpretation of the criteria of treatment satisfaction. The aim of this study was to specify surgical treatment satisfaction in patients with POP.&#x0D; Study design, materials, and methods. Surgical treatment was performed in 486 patients with POP stages II–IV. In 12 months, a patient survey (using a 1-5-point scale) evaluated the level of treatment satisfaction, reasons for lowered self-reported satisfaction, and respondents’ ambivalence regarding treatment results.&#x0D; Results. One-year post-surgical treatment of POP stages 0–I are observed in 80.9% of patients. Full satisfaction (5 points) was self-reported by 61.1% of patients, 28.6% of patients indicated partial satisfaction (3–4 points), and 10.3% of patients indicated treatment dissatisfaction (1–2 points). Post-surgery stage of POP is weakly correlated with self-reported treatment satisfaction (r = –0.39; p &lt; 0.0001). Most common reasons for lower self-reported satisfaction were the emergence of new issues, fear of pathology recurrence, urinary incontinence, and pain. Five patients (1.0%) indicated that their condition “became much worse” after the surgical treatment.&#x0D; Conclusion. The treatment satisfaction range is variable. It is necessary to consider a variety of clinical, deontological, and psychological factors in the analysis of surgical POP treatment satisfaction spectrum.