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Fu T, Kang F, Han M, Huang X, Zhu BQ, Kan BF, Wang SM, Li J. Intraoperative transcutaneous electroacupoint stimulation on early postoperative fatigue in patients with Parkinson's disease undergoing deep brain stimulation surgery. Heliyon 2024; 10:e30012. [PMID: 38707419 PMCID: PMC11068599 DOI: 10.1016/j.heliyon.2024.e30012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background In this clinical trial, we evaluated the effects of transcutaneous electroacupoint stimulation (TEAS) on postoperative fatigue (POF) in Parkinson disease (PD) patients undergoing deep brain stimulation (DBS) surgery. Methods A total 60 PD patients undergoing DBS surgery were enrolled. They were randomized to receive either electrical stimulation [alternative frequency 2/10 Hz, dense and disperse, intensity adjusted to the maximum tolerated by the participants (6-15 mAmp)] via surface electrodes (TEAS group) or surface electrodes only without electrical stimulation (Con group) at bilateral Zusanli and Sanyinjiao acupuncture points. All participants received their assigned intervention (TEAS or Con) during the 1st stage of surgery [(except during microelectrode recording (MER)] and the entire 2nd stage of surgery. Intraoperative anesthetic requirements were adjusted based on bispectral index (BIS) monitor. POF was assessed by Christensen fatigue scales (ChrFS), along with Quality of Recovery-15 (QoR-15) and mini-mental state examination (MMSE) postoperatively over a 7-day-period. We recorded the usage of rescue analgesics and anti-emetics. Results Fifty-nine patients' datasets were included for final analyses. Fewer patients in TEAS experienced severe POF (defined as ChrFS ≥6) at T3 than those in the Con group (TEAS vs. Con: 7 vs. 22, p < 0.001). During the 1st stage of surgery, more patients in Con group required dexmedetomidine infusion (TEAS vs. Con: 2 vs. 6; P < 0.01). Total dosages of propofol and remifanil during the 2nd stage of surgery were TEAS vs. Con: 374.7 ± 61.2 vs 421.5 ± 81.9; p < 0.001 and 572.3 ± 82.0 vs. 662 ± 148.2; P < 0.001, respectively. Postoperative rescue analgesics (TEAS vs. Con: 2 vs. 6; P < 0.001) were used less in the TEAS group. TEAS patients reported better POF, MMSE and QoR15 scores than those in the Con group during most of the assessment period. Conclusions Intraoperative TEAS decreased the severity of POF, reduced intraoperative anesthetic requirements and facilitated post-DBS recovery in this group of PD patients.
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Affiliation(s)
- Tong Fu
- Department of Anesthesiology, The First Hospital of the University of Science and Technology of China. Anhui Provincial Hospital, Hefei, 230031, China
| | - Fang Kang
- Department of Anesthesiology, The First Hospital of the University of Science and Technology of China. Anhui Provincial Hospital, Hefei, 230031, China
| | - Mingming Han
- Department of Anesthesiology, The First Hospital of the University of Science and Technology of China. Anhui Provincial Hospital, Hefei, 230031, China
| | - Xiang Huang
- Department of Anesthesiology, The First Hospital of the University of Science and Technology of China. Anhui Provincial Hospital, Hefei, 230031, China
| | - Bing-qing Zhu
- Department of Anesthesiology, The First Hospital of the University of Science and Technology of China. Anhui Provincial Hospital, Hefei, 230031, China
| | - Bu-Fan Kan
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230031, China
| | - Shu-Ming Wang
- Department of Anesthesiology, University of Connecticut School of Medicine. Farmington, CT, 06032, USA
| | - Juan Li
- Department of Anesthesiology, The First Hospital of the University of Science and Technology of China. Anhui Provincial Hospital, Hefei, 230031, China
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Alves CS, Dias J, Azevedo S, Sousa F, Santos M, Lino J, Meireles L. Keep Calm: Does parental preoperative anxiety affect post-tonsillectomy pain scores in children? Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08683-0. [PMID: 38739185 DOI: 10.1007/s00405-024-08683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To understand if high parental anxiety leads to increased post-tonsillectomy pain in children. METHODS Prospective study including parents of children aged 3-10 years old submitted to tonsillectomy with or without adenoidectomy. To evaluate anxiety, parents were asked to fill the State-Trait Anxiety Inventory form-Y, with postoperative pain being evaluated with the Wong-Baker FACES pain scale at postoperative days 1, 3 and 7. Parents were also asked to register the number of days during which children took analgesic and the number of analgesic intakes needed. RESULTS 41 parents were enrolled, of which 95.1% (n = 39) were female with a mean age of 35.64 years (SD 5.751), with 41 children also being enrolled, of which 85.4% of children (n = 35) underwent tonsillectomy and adenoidectomy. 43.9% (n = 18) of parents presented State anxiety scores above the cut-off level and 53.7% (n = 22) above the Trait anxiety scores above the cut-off. Children of parents with high State anxiety presented statistically higher pain scores in both the third (p = 0.035) and the seventh postoperative days (p = 0.006), with significantly longer use of analgesic medication (p = 0.043) being found, as well as a statistically higher number of analgesic intakes (p = 0.045) (Table 4). CONCLUSION The present study establishes an association between preoperative parental anxiety, postoperative pain scores and the need for longer analgesic use in children undergoing tonsillectomy. This reinforces the importance of reducing parental anxiety and opens the door for further strategies to better post-tonsillectomy outcomes.
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Affiliation(s)
| | - Joana Dias
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sara Azevedo
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | - Joao Lino
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luis Meireles
- Centro Hospitalar Universitário do Porto, Porto, Portugal
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Liang J, Wang L, Song J, Zhao Y, Zhang K, Zhang X, Hu C, Tian D. The impact of nursing interventions on the rehabilitation outcome of patients after lumbar spine surgery. BMC Musculoskelet Disord 2024; 25:354. [PMID: 38704573 PMCID: PMC11069211 DOI: 10.1186/s12891-024-07419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/05/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND This study aimed to investigate the impact of nursing interventions on the rehabilitation outcomes of patients after lumbar spine surgery and to provide effective references for future postoperative care for patients undergoing lumbar spine surgery. METHODS The study included two groups: a control group receiving routine care and an observation group receiving additional comprehensive nursing care. The comprehensive care encompassed postoperative rehabilitation, pain, psychological, dietary management, and discharge planning. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Short-Form 36 (SF-36) Health Survey, self-rating depression scale (SDS) and self-rating anxiety scale(SAS) were used to assess physiological and psychological recovery. Blood albumin, haemoglobin, neutrophil counts, white blood cell counts, red blood cell counts, inflammatory markers (IL-6, IL-10, and IFN-γ) were measured, and the incidence of postoperative adverse reactions was also recorded. RESULTS Patients in the observation group exhibited significantly improved VAS, ODI, SF-36, SDS and SAS scores assessments post-intervention compared to the control group (P < 0.05). Moreover, levels of IL-6, IL-10, and IFN-γ were more favorable in the observation group post-intervention (P < 0.05), indicating a reduction in inflammatory response. There was no significant difference in the incidence of postoperative adverse reactions between the groups (P > 0.05), suggesting that the comprehensive nursing interventions did not increase the risk of adverse effects. CONCLUSION Comprehensive nursing interventions have a significant impact on the postoperative recovery outcomes of patients with LSS, alleviating pain, reducing inflammation levels, and improving the overall quality of patient recovery without increasing the patient burden. Therefore, in clinical practice, it is important to focus on comprehensive nursing interventions for patients with LSS to improve their recovery outcomes and quality of life.
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Affiliation(s)
- Jun Liang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Liyan Wang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jialu Song
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu Zhao
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Keyan Zhang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xia Zhang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cailing Hu
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dong Tian
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, No. 99, Longcheng Street, Taiyuan city, Shanxi Province , 030032, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Bahadur A, Mallick BK, Heda A, Pathak A, Heda S, Mundhra R. Comparison of the Outcomes of Enhanced Recovery After Surgery and Traditional Recovery Pathway in Robotic Hysterectomy for Benign Indications: A Randomized Controlled Trial. J Minim Invasive Gynecol 2024:S1553-4650(24)00198-5. [PMID: 38697258 DOI: 10.1016/j.jmig.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
STUDY OBJECTIVE The present study aimed to evaluate the impact of the implementation of the enhanced recovery after surgery (ERAS) program in patients undergoing robotic hysterectomy for benign indications in comparison with conventional management. DESIGN Randomized controlled trial. SETTING North Indian tertiary care hospital. PARTICIPANTS Patients aged 40 to 60 years willing to sign the informed written consent were included, whereas cases with contraindications for neuraxial anesthesia were excluded. A total of 130 subjects undergoing robotic hysterectomy were divided into ERAS (n = 65) and conventional (non-ERAS) (n = 65) groups. INTERVENTIONS Components of the ERAS protocol included preoperative counseling, carbohydrate loading, early removal of catheter, and early ambulation. Both groups underwent optimization of medical conditions, standardized anesthesia, and venous thromboembolism prophylaxis. MEASUREMENTS AND MAIN RESULTS Outcome measures included length of hospital stay (LOHS), time to tolerance of diet, postoperative complications, readmission rates, and quality of life assessed by WHO-QOL BREF. Baseline characteristics were comparable between groups. ERAS group showed significantly lower docking time (4.82 ± 0.73 vs 5.31 ± 0.92 minutes), faster tolerance of diet (0.14 ± 0.35 vs 1.14 ± 0.35 days), and earlier resumption of ambulation (0.42 ± 0.5 vs 1.26 ± 0.44 days). Time for "fit for discharge" (1.43 ± 0.61 vs 2.97 ± 1.1 days) and LOHS (2.85 ± 1.09 vs 3.78 ± 1.29 days) were significantly lower in the ERAS group. Postoperative complications and readmission rates were comparable. Quality-of-life scores favored the ERAS group at postoperative days 1 and 30. CONCLUSION The combination of ERAS and robotic surgery improves patient outcomes, shortens hospital stays, and enhances postoperative recovery without increasing complications. This research serves as a pioneering effort in assessing the impact of ERAS on robotic hysterectomy for benign indications, providing valuable insights for future multicentric studies and supporting the integration of ERAS protocols to enhance patient outcomes and quality of life.
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Affiliation(s)
- Anupama Bahadur
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Bhawana Kumari Mallick
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Ayush Heda
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Anjali Pathak
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Sakshi Heda
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Rajlaxmi Mundhra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)..
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Huang Y, Yu N. Comparison of the safety and efficacy of robotic natural orifice specimen extraction surgery and conventional robotic colorectal cancer resection: a propensity score matching study. J Robot Surg 2024; 18:175. [PMID: 38619667 DOI: 10.1007/s11701-024-01904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/03/2024] [Indexed: 04/16/2024]
Abstract
Robotic resection is widely used to treat colorectal cancer. Although the novel natural orifice specimen extraction surgery (NOSES) results in less trauma, its safety and effectiveness are relatively unknown. In the present study, we used propensity score matching to compare the effectiveness and safety of NOSES and robotic resection for treating colorectal cancer. Present retrospective cohort study included patients who underwent robotic colon and rectal cancer surgery between January 2016 and December 2019 at the Department of Gastrointestinal Surgery, the Second Xiangya Hospital of Central South University. The intraoperative time, intraoperative bleeding, postoperative recovery, postoperative complications, and survival status of the conventional robotic colorectal cancer resection (CRR) (78 patients) and NOSES (89 patients) groups were compared. These results showed that no significant differences were observed between the two groups in terms of early postoperative complications, operation time, and the number of lymph nodes dissected. Compared with the CRR group, NOSES group had shorter postoperative exhaust time [3.06 (0.76) vs. 3.53 (0.92)], earlier eating time [4.12 (1.08) vs. 4.86 (1.73)], lesser intraoperative bleeding [51.23 (26.74) vs. 67.82 (43.44)], lesser degree of pain [80.8% vs. 55.1%], and shorter length of hospital stay [8.73 (2.02) vs. 9.50 (3.45)]. All these parameters were statistically significant (P < 0.05). However, no significant differences were observed in the 3-year overall survival rate and disease-free survival rate between both groups (P > 0.05). Collectively, robotic NOSES is a safe and effective approach for treating rectal and sigmoid colon cancers, could decrease intraoperative bleeding and postoperative complications, and accelerate the speed of intestinal function recovery.
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Affiliation(s)
- Yongpan Huang
- School of Medicine, Changsha Social Work College, Changsha, 410004, Hunan, China
- Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, Renmin Middle Road 139, Changsha, 410000, Hunan, China
| | - Nanhui Yu
- Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, Renmin Middle Road 139, Changsha, 410000, Hunan, China.
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Hristovska AM, Andersen LB, Uldall-Hansen B, Kehlet H, Troelsen A, Gromov K, Foss NB. Postoperative orthostatic intolerance following fast-track unicompartmental knee arthroplasty: incidence and hemodynamics-a prospective observational cohort study. J Orthop Surg Res 2024; 19:214. [PMID: 38561817 PMCID: PMC10983746 DOI: 10.1186/s13018-024-04639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Early postoperative mobilization is essential for early functional recovery but can be inhibited by postoperative orthostatic intolerance (OI). Postoperative OI is common after major surgery, such as total knee arthroplasty (TKA). However, limited data are available after less extensive surgery, such as unicompartmental knee arthroplasty (UKA). We, therefore, investigated the incidence of OI as well as cardiovascular and tissue oxygenation responses during early mobilization after UKA. METHODS This prospective single-centre observational study included 32 patients undergoing primary UKA. Incidence of OI and cardiovascular and tissue oxygenation responses during mobilization were evaluated preoperatively, at 6 and 24 h after surgery. Perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain during mobilization and opioid usage were recorded. RESULTS During mobilization at 6 h after surgery, 4 (14%, 95%CI 4-33%) patients experienced OI; however, no patients terminated the mobilization procedure prematurely. Dizziness and feeling of heat were the most common symptoms. OI was associated with attenuated systolic and mean arterial blood pressure responses in the sitting position (all p < 0.05). At 24 h after surgery, 24 (75%) patients had already been discharged, including three of the four patients with early OI. Only five patients were available for measurements, two of whom experienced OI; one terminated the mobilization procedure due to intolerable symptoms. We observed no statistically significant differences in perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain, or opioid usage between orthostatic intolerant and tolerant patients. CONCLUSIONS The incidence of orthostatic intolerance after fast-track unicompartmental knee arthroplasty is low (~ 15%) and is associated with decreased orthostatic pressure responses. Compared to the previously described orthostatic intolerance incidence of ~ 40% following total knee arthroplasty, early orthostatic intolerance is uncommon after unicompartmental knee arthroplasty, suggesting a procedure-specific component. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov; registration number: NCT04195360, registration date: 13.12.2019.
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Affiliation(s)
- Ana-Marija Hristovska
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark.
| | - Louise B Andersen
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Bodil Uldall-Hansen
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Nicolai B Foss
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
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Faucheron JL, Vincent D, Barbut M, Jacquet-Perrin I, Sage PY, Foote A, Bellier A, Quesada JL, Tidadini F, Trilling B. Abdominal massage to prevent ileus after colorectal surgery. A single-center, prospective, randomized clinical trial: the MATRAC Trial. Tech Coloproctol 2024; 28:42. [PMID: 38517591 DOI: 10.1007/s10151-024-02914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/18/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND There is scarce literature on the effect of mechanical abdominal massage on the duration of ileus after colectomy, particularly in the era of enhanced recovery after surgery (ERAS). The aim of this study was to determine whether abdominal massage after colorectal surgery with anastomosis and no stoma helps toward a faster return of intestinal transit. METHODS This study was a superiority trial and designed as a prospective open-label, single-center, randomized controlled clinical trial with two parallel groups. Patients scheduled to undergo intestinal resection and follow an ERAS protocol were randomly assigned to either the standard ERAS group or the ERAS plus massage group. The primary endpoint was the return of intestinal transit, defined as the first passage of flatus following the operation. Secondary endpoints included time of the first bowel motion, maximal pain, 30 day complications, complications due to massage, anxiety score given by the Hospital Anxiety and Depression (HAD) questionnaire, and quality of life assessed by the EQ-5D-3L questionnaire. RESULTS Between July 2020 and June 2021, 36 patients were randomly assigned to the ERAS group or the ERAS plus massage group (n = 19). Patients characteristics were comparable. There was no significant difference in time to passage of the first flatus between the ERAS group and the ERAS plus abdominal massage group (1065 versus 1389 min, p = 0.274). No statistically significant intergroup difference was noted for the secondary endpoints. CONCLUSION Our study, despite its limitations, failed to demonstrate any advantage of abdominal massage to prevent or even reduce symptoms of postoperative ileus after colorectal surgery. TRIAL REGISTRATION NUMBER 38RC20.021.
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Affiliation(s)
- Jean-Luc Faucheron
- University Grenoble Alpes, CNRS, Grenoble INP, TIMC, UMR 5525, VetAgro Sup, 38000, Grenoble, France.
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France.
| | - Damien Vincent
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Mihaela Barbut
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Isabelle Jacquet-Perrin
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Pierre-Yves Sage
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Alison Foote
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Alexandre Bellier
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Fatah Tidadini
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - Bertrand Trilling
- University Grenoble Alpes, CNRS, Grenoble INP, TIMC, UMR 5525, VetAgro Sup, 38000, Grenoble, France
- Colorectal Surgery Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
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Huang JQ, Xiao Y, Wang R, Gu L, Zhang LT, Gu D, Li XS, Xu C, Du GS, Xiao WD. Retrospective analysis of preoperative application of triple-modal pre-rehabilitation on postoperative recovery of colorectal cancer patients. Support Care Cancer 2024; 32:217. [PMID: 38453717 DOI: 10.1007/s00520-024-08423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/05/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To retrospectively analyze the difference between triple-modal pre-rehabilitation and common treatment in patients with colorectal cancer (CRC). METHODS A total of 145 patients with CRC diagnosed by pathology and admitted to our hospital for surgery between June 2020 and June 2022 were included in the study. All patients were divided into two groups: the triple-modal pre-rehabilitation group (pre-rehabilitation group) and the common treatment group. The triple-modal pre-rehabilitation strategy included exercise (3-5 times per week, with each session lasting more than 50 min), nutritional support, and psychological support. The study was designed to assess the potential of the pre-rehabilitation intervention to accelerate postoperative recovery by assessing the 6-min walk test, nutritional indicators, and HADS score before and after surgery. RESULTS The pre-rehabilitation intervention did not reduce the duration of initial postoperative recovery or the incidence of postoperative complications, but it did increase the patients' exercise capacity (as determined by the 6-min walk test), with the pre-rehabilitation group performing significantly better than the common group (433.0 (105.0) vs. 389.0 (103.5), P < 0.001). The study also found that triple-modal pre-rehabilitation was beneficial for the early recovery of nutritional status in surgical patients and improved anxiety and depression in patients after surgery, especially in those who had not received neoadjuvant therapy. CONCLUSION The triple-modal pre-rehabilitation strategy is of significant importance for reducing stress and improving the functional reserve of patients with colorectal cancer (CRC) during the perioperative period. The results of our study provide further support for the integration of the triple-modal pre-rehabilitation strategy into the treatment and care of CRC patients.
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Affiliation(s)
- Jing-Qiong Huang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Ying Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Rong Wang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Ling Gu
- Nursing Department, Xinqiao Hospital, Army Medical University, Chongqing, 400037, People's Republic of China
| | - Lin-Tong Zhang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Dan Gu
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Xiang-Sheng Li
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Cong Xu
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China.
| | - Guang-Sheng Du
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China.
| | - Wei-Dong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China.
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van der Wal-Huisman H, Soer R, Sidorenkov G, Heineman E, de Graeff P, van Leeuwen BL. Heart Rate Variability in Surgical Patients Experiencing Live Bedside Music; An Explorative Study. Appl Psychophysiol Biofeedback 2024; 49:157-166. [PMID: 37982975 DOI: 10.1007/s10484-023-09609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
It's known that surgery elicits a stress response involving the autonomic nervous system (ANS) which is important in general recovery but can also have detrimental effects in older patients. Music seems to positively effect postoperative recovery, although the mechanism requires further unravelling. Our objective was to explore the response of the ANS to live bedside music in older surgical patients, by using heart rate variability (HRV) as a proxy. This explorative prospective non-randomized controlled cohort study included 101 older non-cardiac surgical patients, with a median age of 70 (range 60-88 years). HRV was measured in a cohort receiving live bedside music provided by professional musicians and in a control group that did not receive music. HRV was measured pre-intervention, during the intervention, 30 min after the intervention, and again after three hours. Mixed linear modelling was used to assess the effect of the intervention compared to the control group over time. A significant change in both the low and high frequency bands (p = 0.041) and (p = 0.041) respectively, was found over time in the music group compared to the control group indicating relaxation and increased parasympathetic activity in the music group. Other measures revealed a trend but no significant effect was shown. These results provide a first glance and contribute to a better understanding of the effect of music on the recovery of older surgical patients.
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Affiliation(s)
- Hanneke van der Wal-Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, HPC BA60, P.O. Box 30.001, Groningen, RB 9700, The Netherlands.
| | - Remko Soer
- Department of Anesthesiology, Pain Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Saxion University of Applied Science, Enschede, The Netherlands
| | - Grigory Sidorenkov
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik Heineman
- Department of Surgery, University of Groningen, University Medical Center Groningen, HPC BA60, P.O. Box 30.001, Groningen, RB 9700, The Netherlands
| | - Pauline de Graeff
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Frelich M, Lečbychová K, Vodička V, Ekrtová T, Sklienka P, Jor O, Straková H, Bílená M, Formánek M, Burša F. Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective randomized controlled trial. Anaesth Crit Care Pain Med 2024; 43:101318. [PMID: 37918790 DOI: 10.1016/j.accpm.2023.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED. DESIGN Randomized, prospective, and double-blind. SETTING Patients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol. PATIENTS A total of 163 patients of both sexes aged 3-8 years were enrolled over 18 months. INTERVENTIONS Immediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient's forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40-60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration. MEASUREMENTS The primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED. MAIN RESULTS 86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067). CONCLUSION Individualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children. CLINICAL TRIAL REGISTRATION NCT04466579.
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Affiliation(s)
- Michal Frelich
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia; Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czechia
| | - Karolína Lečbychová
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia
| | - Vojtěch Vodička
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia
| | - Tereza Ekrtová
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia
| | - Peter Sklienka
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia; Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czechia
| | - Ondřej Jor
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia; Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czechia
| | - Hana Straková
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia
| | - Markéta Bílená
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia
| | - Martin Formánek
- Centre for Health Research, Faculty of Medicine, University of Ostrava, Czechia; Department of Paediatric Otorhinolaryngology, Faculty of Medicine, Masaryk University, Czechia
| | - Filip Burša
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Ostrava, Czechia; Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Czechia.
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11
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Abbitt D, Choy K, Cotton J, Jones TS, Robinson TN, Jones EL. Outpatient surgery postoperative ambulation and emergency department utilization. Surg Endosc 2024; 38:999-1004. [PMID: 38017159 DOI: 10.1007/s00464-023-10575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/19/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The ability to ambulate is an important indicator for wellness and quality of life. A major health event, such as a surgery, can derail this ability, and return to preoperative walking ability is a marker for recovery. Self-reported walking measurements by patients are subject to bias, thus wearable technology such as activity monitors have risen in popularity. We evaluated postoperative ambulation using an accelerometer in outpatient general surgery procedures with the hypothesis that those patients with less postoperative ambulation were at risk for adverse outcomes. METHODS A retrospective review of patients undergoing outpatient abdominal surgeries from November 2016 to July 2019 at a Veteran Affairs Medical Center. Patients wore an accelerometer preoperatively and postoperatively to measure their ambulation (steps/day). Outcome measures were 30-day readmissions and Emergency Department (ED) utilization. Postoperative ambulation was defined as daily percentages of their preoperative baseline. Patients without preoperative baseline data, > 3 missing days or any missing days prior to reaching baseline were excluded. RESULTS One-hundred-six patients underwent outpatient abdominal surgery. Twenty-two patients were excluded. Patients stratified into adult (18-64 years, 44 patients, 52%) and geriatric (≥ 65 years, 40 patients, 48%) cohorts. Geriatric patients were less likely to meet their preoperative baseline by postoperative day 7, 35% vs 61%, p = 0.016. Adult patients who failed to meet their preoperative baseline in first postoperative week had higher ED utilization; 4 (24%) vs 1 (4%), p = 0.04. Geriatric patients who failed to meet their baseline trended toward increased ED utilization; 5 (19%) vs. 1 (7%), p = 0.31. CONCLUSION Patients aged < 65 who fail to return to their preoperative daily step count within one week of outpatient abdominal surgery are 6× more likely to be seen in the ED. Postoperative ambulation may be able to predict ED utilization and recovery after outpatient surgery.
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Affiliation(s)
- Danielle Abbitt
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, C-305, Aurora, CO, 80045, USA.
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA.
| | - Kevin Choy
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, C-305, Aurora, CO, 80045, USA
| | - Jake Cotton
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, C-305, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, C-305, Aurora, CO, 80045, USA
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
| | - Thomas N Robinson
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, C-305, Aurora, CO, 80045, USA
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, C-305, Aurora, CO, 80045, USA
- Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA
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12
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Hogenbirk RNM, Wijma AG, van der Plas WY, Hentzen JEKR, de Bock GH, van der Schans CP, Kruijff S, Klaase JM. Actual physical activity after major abdominal cancer surgery: Far from optimal. Eur J Surg Oncol 2024; 50:107949. [PMID: 38215551 DOI: 10.1016/j.ejso.2024.107949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Enhanced recovery after surgery protocols emphasize the importance of early postoperative mobilization. However, literature quantifying actual physical activity after major abdominal cancer surgery is scarce and inconclusive. MATERIAL AND METHODS A single-center prospective cohort study was conducted at the University Medical Center Groningen from 2019 to 2021. Patients' postoperative physical activity was measured using an accelerometer, with the primary aim of assessing daily physical activity. Secondary aims were identifying patient-related factors associated with low physical activity and studying the consequences of low physical activity in terms of complication rate and length of hospital stay. RESULTS 143 patients included (48 % male; mean age 65 years), 38.5 %, 24.5 %, 19.6 %, and 14 % underwent pancreatic, hepatic, colorectal, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, respectively. Median daily step count was low; from median 71 steps on the first to 918 steps on the seventh postoperative day. An association between physical activity and age (OR 3.597, p = 0.013), preoperative weight loss ≥10 % (OR 4.984, p = 0.004), Eastern Cooperative Oncology Group performance status ≥2 (OR 4.016, p = 0.001), midline laparotomy (OR 2.851, p = 0.025), and operation duration (OR 1.003, p = 0.044) was found. An association was observed between physical activity and the occurrence of complications (OR 3.197, p = 0.039) and prolonged hospital stay (β 4.068, p = 0.013). CONCLUSION Postoperative physical activity is low in patients undergoing major abdominal cancer surgery and is linked to postoperative outcomes. Although physical activity should be encouraged in all patients, patient-specific risk factors were identified that can aid early recognition of patients at risk of low physical activity.
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Affiliation(s)
- Rianne N M Hogenbirk
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Allard G Wijma
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Willemijn Y van der Plas
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Judith E K R Hentzen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cees P van der Schans
- Department of Health Psychology and Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Center of Expertise Healthy Ageing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Zeng HJ, Liu JJ, Yang YC. Clinical observation of gastrointestinal function recovery in patients after hepatobiliary surgery. World J Gastrointest Surg 2024; 16:76-84. [PMID: 38328324 PMCID: PMC10845271 DOI: 10.4240/wjgs.v16.i1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/21/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The liver is an important metabolic and digestive organ in the human body, capable of producing bile, clotting factors, and vitamins. AIM To investigate the recovery of gastrointestinal function in patients after hepatobiliary surgery and identify effective rehabilitation measures. METHODS A total of 200 patients who underwent hepatobiliary surgery in our hospital in 2022 were selected as the study subjects. They were divided into a control group and a study group based on the extent of the surgery, with 100 patients in each group. The control group received routine treatment, while the study group received targeted interventions, including early enteral nutrition support, drinking water before gas discharge, and large bowel enema, to promote postoperative gastrointestinal function recovery. The recovery of gastrointestinal function was compared between the two groups. RESULTS Compared with the control group, patients in the study group had better recovery of bowel sounds and less accumulation of fluids in the liver bed and gallbladder fossa (P < 0.05). They also had shorter time to gas discharge and first meal (P < 0.05), higher overall effective rate of gastrointestinal function recovery (P < 0.05), and lower incidence of postoperative complications (P < 0.05). CONCLUSION Targeted nursing interventions (early nutritional support, drinking water before gas discharge, and enema) can effectively promote gastrointestinal function recovery in patients undergoing hepatobiliary surgery and reduce the incidence of complications, which is worthy of promotion.
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Affiliation(s)
- Hua-Jun Zeng
- Department of General Practice, Nanyang First People's Hospital, Nanyang 473000, Henan Province, China
| | - Jing-Jing Liu
- Department of Anesthesiology, Chinese People’s Armed Police Force Hospital of Beijing, Beijing 100027, China
| | - Ying-Chun Yang
- Department of Anesthesiology, Beijing Fengtai Hospital, Beijing 100071, China
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14
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Wang B, Hu L, Hu X, Han D, Wu J. Exploring perioperative risk factors for poor recovery of postoperative gastrointestinal function following gynecological surgery: A retrospective cohort study. Heliyon 2024; 10:e23706. [PMID: 38205292 PMCID: PMC10776945 DOI: 10.1016/j.heliyon.2023.e23706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose To investigate perioperative risk factors that affect the recovery of postoperative gastrointestinal function in patients undergoing gynecological surgery and to establish a preoperative risk prediction scoring system. Methods In this retrospective cohort study, characteristics and perioperative factors of patients who underwent elective gynecological surgery at Union Hospital from January 2021 to March 2022 were extracted from electronic medical records. Patients were grouped according to the Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system to compare collected data. Results In total, clinical data from 208 gynecological patients were extracted. The incidence of poor postoperative gastrointestinal recovery was 7.21 %. The number of previous abdominal surgeries (0.73 ± 0.06 vs 1.20 ± 0.24, p = 0.044), the incidence of malignant disease (20.2 % vs 53.3 %, p = 0.003), postoperative maximum WBC count (9.15 vs 12.44, p = 0.005) and postoperative minimum potassium (3.97 ± 0.36 vs 3.76 ± 0.37, p = 0.036) were not only associated with poor postoperative gastrointestinal recovery, but also malignant disease (p = 0.000), postoperative maximum WBC count (p = 0.027) and postoperative minimum potassium (p = 0.024) were significantly associated with the severity of postoperative gastrointestinal function. An increased number of previous abdominal surgeries and malignant primary disease could increase the risk of an I-FEED score >2 as independent risk factors. Conclusion Patients with poor postoperative GI function had poorer postoperative recovery outcomes. A preoperative score prediction system was established, in which patients with ≥2 points had a 19.4 % risk of poor postoperative gastrointestinal recovery. Higher-quality prospective studies should be performed to achieve more precise risk stratification and to construct a more accurate prediction system.
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Affiliation(s)
- Beibei Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Li Hu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Xinyue Hu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Dong Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Jing Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
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Yu WX, Hao YQ, Lu C, Li H, Cai YZ. Efficacy and risk factors for anxiety and depression after mini-incision hip arthroplasty for femoral head osteonecrosis. World J Psychiatry 2023; 13:1016-1026. [PMID: 38186734 PMCID: PMC10768488 DOI: 10.5498/wjp.v13.i12.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a prevalent orthopedic issue, leading to the collapse and fragmentation of the femoral head in its advanced stages, which can severely impair patients' quality of life. Total hip arthroplasty (THA) is a clinical intervention frequently used to alleviate ONFH symptoms and reinstate hip functionality. The conventional surgical technique is invasive and comes with an extended recuperation period, posing significant challenges for patients. With the progression of medical technology, the use of the mini-incision technique in minimally invasive THA (MITHA) has become more prevalent. However, comparative studies examining the effectiveness of these two surgical procedures in treating ONFH remain scarce. Furthermore, understanding patients' psychological well-being is crucial given its profound influence on postoperative recuperation. AIM To evaluate the impact of mini-incision MITHA on ONFH treatment and to identify the risk factors associated with postoperative anxiety and depression. METHODS A retrospective study was conducted on 125 patients treated for ONFH at Xi'an Hong Hui Hospital between February 2020 and January 2022, with the term "consecutive" indicating that these patients were treated in an unbroken sequence without any selection. Among these, 60 patients (control group) underwent traditional THA, while 65 patients (observation group) were treated with mini-incision MITHA. Variations in the visual analog scale (VAS) score and the Harris hip score were monitored. Additionally, shifts in pre- and posttreatment Hamilton anxiety (HAMA) and Hamilton depression (HAMD) scale scores were recorded. Patients with both postoperative HAMA and HAMD scores of ≥ 8 were identified as those experiencing negative emotions. Logistic regression was utilized to analyze the determinants influencing these negative emotional outcomes. Comparative analyses of surgical and postoperative metrics between the two groups were also conducted. RESULTS Posttreatment results indicated a significantly higher VAS score in the control group than in the observation group, while the Harris score was considerably lower (P < 0.0001). The observation group benefited from a notably shorter operation duration, reduced blood loss, diminished incision size, and a decreased postoperative drainage time (P < 0.0001), accompanied by a reduced hospital stay and lower treatment costs (P < 0.0001). The control group had elevated posttreatment HAMA and HAMD scores in comparison to the observation group (P < 0.0001). Multivariate logistic regression revealed that being female [odds ratio (OR): 4.394, 95%CI: 1.689-11.433, P = 0.002], having a higher postoperative VAS score (OR: 5.533, 95%CI: 2.210-13.848, P < 0.0001), and having higher treatment costs (OR: 7.306, 95%CI: 2.801-19.057, P < 0.0001) were significant independent determinants influencing postoperative mood disturbances. CONCLUSION Compared to conventional THA, mini-incision MITHA offers advantages such as reduced operation time, minimal bleeding, and a shorter incision in ONFH patients. Moreover, factors such as sex, postoperative pain (reflected in the VAS score), and treatment costs significantly impact postoperative anxiety and depression.
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Affiliation(s)
- Wen-Xing Yu
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Yang-Quan Hao
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Chao Lu
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Hui Li
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
| | - Yuan-Zhen Cai
- Osteonecrosis and Joint Reconstruction Ward, Xi’an Hong Hui Hospital, Xi'an Jiaotong University, Xi’an 710054, Shaanxi Province, China
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Co EL, Hameed M, Sebastian SA, Garg T, Sudan S, Bheemisetty N, Mohan B. Narrative Review of Probiotic Use on the Recovery of Postoperative Patients with Esophageal Cancer. Curr Nutr Rep 2023; 12:635-642. [PMID: 37605086 DOI: 10.1007/s13668-023-00490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW This narrative review discusses the significance of probiotic therapy in the postoperative care of patients with esophageal cancer and its role as an adjunct therapy to other treatment modalities for esophageal cancer. RECENT FINDINGS As such, there is an emerging need to address any malnutrition and gastrointestinal problems occurring in these patients which tend to have a strong negative impact on their prognosis. Probiotic effects on esophageal cancer biomarkers suggest that there is a positive correlation between these two factors. However, the beneficial effects remain controversial and warrant further investigation. Probiotics, now being widely utilized as postoperative therapy in some carcinomas of the gastrointestinal tract such as gastric cancer and colorectal cancer, have been shown in some clinical studies to positively impact the nutritional status of patients with esophageal cancer. Postoperative care among patients suffering from esophageal cancer is a very crucial aspect in the survival of these patients.
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Affiliation(s)
- Edzel Lorraine Co
- University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - Maha Hameed
- Department of Internal Medicine, Florida State University/Sarasota Memorial Hospital, 1700 S Tamiami Trial, Sarasota, FL, 34239, USA.
| | | | - Tulika Garg
- Government Medical College and Hospital, Chandigarh, India
| | | | | | - Babu Mohan
- Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Triemstra L, de Jongh C, Tedone F, Brosens LAA, Luyer MDP, Stoot JHMB, Lagarde SM, van Hillegersberg R, Ruurda JP. The Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial. Eur J Surg Oncol 2023; 49:107095. [PMID: 37913608 DOI: 10.1016/j.ejso.2023.107095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery. METHODS The CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications and cardiovascular, gastrointestinal, infectious, pulmonary, and other complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman's rho-test and compared with standard Fisher's z-transformation. RESULTS Between 2015 and 2018, 211 patients underwent laparoscopic (n = 106) or open (n = 105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0-23.5] versus 0 [IQR 0-22.6]; p = 0.755) and subgroups of complications (p > 0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (rs = 0.646 versus rs = 0.628; p = 0.001, difference clinically irrelevant), and reoperations (rs = 0.590 versus rs = 0.599; p = 0.070), and weak correlations for ICU-stay (rs = 0.446 versus rs = 0.440; p = 0.189). CONCLUSIONS The CCI is a composite scoring system based on the CDC and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, following abdominal surgery other than gastrectomy. Implementing CCI showed no clinically relevant benefit and caused additional workload compared to CDC for assessing complication burden. Therefore, using the CCI alongside the CDC after gastric cancer surgery is not recommended.
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Affiliation(s)
- Lianne Triemstra
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands
| | - Cas de Jongh
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands
| | - Fabrizio Tedone
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands
| | | | - Misha D P Luyer
- Catharina Hospital Eindhoven, Department of Surgery, Eindhoven, the Netherlands
| | - Jan H M B Stoot
- Zuyderland Medical Center, Department of Surgery, Sittard, the Netherlands
| | | | | | - Jelle P Ruurda
- University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands.
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Perrin T, Bonnomet F, Diemunsch S, Drawin L, Pottecher J, Noll E. Early perioperative quality of recovery after hip and knee arthroplasty: a retrospective comparative cohort study. Int Orthop 2023; 47:2637-2643. [PMID: 37542539 DOI: 10.1007/s00264-023-05903-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Increasing our knowledge about postoperative global Quality-Of-Recovery (QoR) after THA and TKA is important to improve perioperative medicine, in particular for preoperative patient information and benchmarking of postoperative patient status. METHODS This study is a single centre, retrospective cohort study of prospectively collected data, conducted in Strasbourg University Hospital, Strasbourg, France. The main outcome was the modified French version of the QoR-15 (mQoR-15F) score monitored preoperatively, at postoperative day one, three, 14 and 28. We questioned the hypothesis: would THA and TKA recovery patterns differ and would postoperative health status eventually overreach the preoperative reference? RESULTS The mQoR-15F was statistically higher in the THA group compared to the TKA group in POD 1 and 28 (112 ± 17 vs. 107 ± 17; p < 0.01 and 131 ± 12 vs. 127 ± 15; p = 0.02, respectively). The mean postoperative time delay to reach preoperative mQoR-15F was seven and 16 days for THA and TKA patients, respectively. CONCLUSION Early postoperative health status after THA and TKA differs significantly; TKA being associated with a larger early decrease of global health status compared to THA. Both THA and TKA groups global health status overreached preoperative levels after one and two weeks postoperatively. These surgery-specific recovery profiles may favor improved patient information to steer advised operative decision and set specific recovery goals as part of enhanced recovery pathways.
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Affiliation(s)
- Thomas Perrin
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - François Bonnomet
- Department of Orthopedic and Trauma Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Sophie Diemunsch
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - Leopold Drawin
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - Julien Pottecher
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France
| | - Eric Noll
- Department of Anesthesiology, Intensive Care & Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière 67098, Strasbourg, France.
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Lee E, Jee YJ, Jung J, Lee MH, Hong SO. Extraction of mandibular third molars: relationship of preoperative anxiety with body mass index, serum high-sensitivity C-reactive protein levels, and visual analog scale scores and predictors of postoperative complications. J Korean Assoc Oral Maxillofac Surg 2023; 49:252-261. [PMID: 37907340 PMCID: PMC10618665 DOI: 10.5125/jkaoms.2023.49.5.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives Patients undergoing oral surgery exhibit high anxiety, which may elevate their cortisol levels and affect postoperative recovery. Overweight patients are often encountered in the dental clinic due to the increasing prevalence of overweight. We aimed to investigate the relationships between preoperatively assessed body mass index (BMI), serum cortisol and high-sensitivity C-reactive protein (hs-CRP) levels, and visual analog scale (VAS) scores and preoperative anxiety in patients undergoing mandibular third molar (MM3) extraction and to identify predictors of postoperative complications. Patients and Methods We analyzed 43 patients (age, 20-42 years) undergoing MM3 extraction. At the first visit, patients completed the Modified Dental Anxiety Scale (MDAS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaires. Their BMI and VAS scores were also calculated. The participants underwent blood tests 1 hour before MM3 extraction. On the first postoperative day, the participants' VAS scores and serum hs-CRP levels were reevaluated. Results We found that BMI was significantly correlated with preoperative VAS scores. Further, BMI and preoperative hs-CRP levels were significantly correlated among women and patients undergoing extractions of fully impacted MM3s. No correlations were found between serum cortisol and other variables. The preoperative MDAS and VAS scores were significantly positively correlated, especially among patients undergoing extractions of fully impacted MM3s. Multiple linear regression showed that BMI and the eruption status of the MM3 were significant predictors of postoperative hs- CRP levels and VAS scores, respectively. Conclusion In MM3 removals, patients with higher BMI showed elevated hs-CRP and higher VAS scores before surgery. Patients with higher anxiety among those undergoing extractions of fully impacted MM3s showed higher preoperative VAS scores. The two main predictors of postoperative complications were BMI and MM3 eruption status.
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Affiliation(s)
- Eunjee Lee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
| | - Yu-Jin Jee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Kyung Hee University, Seoul, Korea
| | - Jaewoong Jung
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
| | - Mu Hang Lee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
| | - Sung ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea
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Chen Z, Hong B, He JJ, Ye QQ, Hu QY. Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms. World J Gastrointest Surg 2023; 15:2222-2233. [PMID: 37969702 PMCID: PMC10642466 DOI: 10.4240/wjgs.v15.i10.2222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment. Surgery is the main treatment for these patients, but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction, leading to further deterioration of the nutritional status. Early enteral nutrition support is hypothesized to be helpful in improving this situation, but the exact effects have yet to be studied in depth. AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors, with the expectation that by improving the nutritional status of patients, the recovery process would be accelerated and the incidence of complications would be reduced, thus improving the quality of life. METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed. Fifty-three of these patients received complete parenteral nutrition support as the control group for this study. The other 68 patients received early enteral nutritional support as the observation group of this study. The clinical indicators comparing the two groups included time to fever, time to recovery of postoperative bowel function, time to postoperative exhaustion, and length of hospital stay. The changes in immune function and nutritional indexes in the two groups were compared. Furthermore, we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients. Finally, the occurrence of postoperative complications between the two patient groups was also compared. RESULTS The postoperative fever time, postoperative bowel function recovery time, postoperative exhaustion time, and hospitalization time were all higher in the control group than in the observation group (P < 0.05). The levels of CD3+, CD4+, immunoglobulin (Ig) A, IgM, and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively, while CD8+ was lower than in the control group (P < 0.05). Total protein, albumin, prealbumin, and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively (P < 0.05). The SF-36 scores of patients in the observation group were significantly higher than those in the control group (P < 0.0001). The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group (P = 0.021). CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable, and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery. This program can not only improve the immune function of the patient and protect the intestinal function, but it can also help to improve the quality of life of the patient. However, this program will increase the incidence of complications in patients. Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer. The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.
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Affiliation(s)
- Zhi Chen
- Department of Rehabilitation, Xiangshan First People’s Hospital Medical and Health Group, Ningbo 315700, Zhejiang Province, China
| | - Bo Hong
- Department of Gastroenterology, Xiangshan First People’s Hospital Medical and Health Group, Ningbo 315700, Zhejiang Province, China
| | - Jiang-Juan He
- Center of Nursing Management, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Qian-Qian Ye
- Department of Rehabilitation, Xiangshan First People’s Hospital Medical and Health Group, Ningbo 315700, Zhejiang Province, China
| | - Qiao-Yi Hu
- Department of Nutrition, Xiangshan First People’s Hospital Medical and Health Group, Ningbo 315700, Zhejiang Province, China
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Yi Y, Dong L, Zhang N, Mo S, Xie Y, Hu X. Fast track surgery for children with congenital pseudarthrosis of the tibia: A prospective interventional study. Int J Orthop Trauma Nurs 2023; 53:101051. [PMID: 37858520 DOI: 10.1016/j.ijotn.2023.101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the effect of fast-track surgery combined with a clinical nursing pathway on the recovery and complications of congenital pseudarthrosis of tibia. METHODS 82 children with congenital pseudarthrosis of tibia admitted from January 2019 to December 2020 were selected as the study subjects. The control group received routine clinical nursing pathway while the intervention group received a fast-track surgery combined with a clinical nursing pathway. The fasting and water deprivation time were arranged according to the pre operation time, and the accelerated rehabilitation nursing models such as progressive diet management, multi-functional analgesia, and early sequential functional exercise were given after the operation. After collecting data on perioperative diet, postoperative recovery, postoperative complications, and family satisfaction from both groups of patients in a large hospital in China, a comparative analysis was conducted. RESULTS The retention time of negative pressure drainage tube, urinary catheter and hospital stay in the intervention group were shorter than those in the control group (P < 0.05); The incidence of complications in the intervention group (5%) was significantly lower than that in the control group (21.42%) (P = 0.029). The family satisfaction of the intervention group (95.00%) was higher than that of the control group (80.95%). CONCLUSION Strengthening the concept of fast-track surgery nursing in the combined operation of congenital pseudarthrosis of tibia can shorten the hospitalization time of children, reduce the occurrence of postoperative complications and improve their family satisfaction.
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Affiliation(s)
- Yinzhi Yi
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China; Hunan Provincial Key Laboratory of Pediatric Orthopedics, Hunan Children's Hospital, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China.
| | - Lin Dong
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China.
| | - Ni Zhang
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China.
| | - Shasha Mo
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China.
| | - Yonghong Xie
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China.
| | - Xiongke Hu
- Department of Pediatric Orthopedics, Hunan Children's Hospital, Pediatric Academy of University of South China, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China; Hunan Provincial Key Laboratory of Pediatric Orthopedics, Hunan Children's Hospital, No.86, Ziyuan Road, Yuhua District, Changsha, Hunan, 410000, China.
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Laird A, Bramley L, Barnes R, Englin A, Winderlich J, Mount E, Nataraja RM, Pacilli M. Effects of a Preoperative Carbohydrate Load on Postoperative Recovery in Children: A Randomised, Double-Blind, Placebo-Controlled Trial. J Pediatr Surg 2023; 58:1824-1831. [PMID: 37280132 DOI: 10.1016/j.jpedsurg.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/27/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Nausea and vomiting are common causes for prolonged postoperative length of hospital stay (LOS) in children. A preoperative carbohydrate load may reduce postoperative nausea and vomiting by improving the perioperative metabolic state. The aim of this study was to determine if a preoperative carbohydrate-containing drink would lead to an improvement in the perioperative metabolic state and consequently reduce the incidence of postoperative nausea, vomiting and LOS in children undergoing day-case surgical procedures. METHOD Randomised, double-blind, placebo-controlled trial involving children aged 4 to 16-years undergoing day-case surgical procedures. Patients were randomised to receive a carbohydrate-containing drink or a placebo. During the induction of anaesthesia, a venous blood gas, and blood glucose and ketone levels were measured. Postoperatively, the incidence of nausea, vomiting, and LOS were documented. RESULTS 120 patients were randomised with 119/120 (99.2%) undergoing analysis. Blood glucose level was higher in the carbohydrate group; 5.4 mmol/L [3.3-9.4] versus 4.9 mmol/L [3.6-6.5] (p = 0.01). Blood ketone level was lower in the carbohydrate group; 0.2 mmol/L versus 0.3 mmol/L (p = 0.003). The incidence of nausea and vomiting was not different (p > 0.9 and p = 0.8, respectively). LOS in the carbohydrate group was 26 min shorter than the placebo group (p = 0.02). CONCLUSION Although a preoperative carbohydrate load may provide a more stable metabolic state at the induction of anaesthesia, we did not find a reduction in postoperative nausea and vomiting. A preoperative carbohydrate load has also minimal effects on the postoperative LOS. TYPE OF STUDY Randomised clinical trial. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Ashleigh Laird
- Department of Paediatrics and Surgery, School of Clinical Sciences, Monash University, 246 Clayton Road, Melbourne, Australia
| | - Lynsey Bramley
- Department of Nutrition and Dietetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Richard Barnes
- Department of Anaesthetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Anna Englin
- Department of Anaesthetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Jacinta Winderlich
- Department of Nutrition and Dietetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Elizabeth Mount
- Department of Nutrition and Dietetics, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics and Surgery, School of Clinical Sciences, Monash University, 246 Clayton Road, Melbourne, Australia; Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatrics and Surgery, School of Clinical Sciences, Monash University, 246 Clayton Road, Melbourne, Australia; Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Melbourne, Australia.
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Haakseth L, Öster C, Wanhainen A, Mani K, Jangland E. Patients' health and quality of life after complex endovascular aortic repair: A prospective cohort study. J Vasc Nurs 2023; 41:132-143. [PMID: 37684091 DOI: 10.1016/j.jvn.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 09/10/2023]
Abstract
RATIONALE Complex endovascular aortic repair often involves multiple major procedures over time with a high risk of complications and little time for recovery. This exposes patients to great stress, both physically and mentally, with potentially long-lasting effects. There is limited knowledge about these effects and who is most at risk - information on this could help vascular nurses and other healthcare professionals anticipate and meet care needs. AIM To investigate the health and quality of life effects of complex endovascular aortic repair, in relation to patients' demographic and health characteristics. DESIGN A prospective cohort study. METHODS Patients undergoing elective complex endovascular aortic repair were consecutively recruited from one university hospital during one year (n=25). Self-report questionnaires on health disability (WHODAS 2.0), quality of life (WHOQoL-BREF) and symptoms of anxiety and depression (HADS) were filled out preoperatively and repeated one and six months postoperatively. Prospective changes in health and quality of life, and associations with patient demographics and preoperative health characteristics, were assessed. Ethical approval was obtained prior to study performance. RESULTS Overall, patients had significantly greater health disability at one month (WHODAS 2.0 score median 31.5, range 1.1-63.0) than preoperatively (median 13.6, range 0.0-41.3) (n=22, p=.017); the majority had recovered at six months (median 11.4, range 3.3-58.7) (n=18, p=.042). No significant effects were seen in quality of life and symptoms of anxiety and depression (p>.05). However, the participants showed heterogeneity, with certain individuals not recovered at six months (n=8). Factors associated with worse six-month outcomes were being female, age < 70 years, postoperative complications, and history of anxiety or depression. CONCLUSIONS Complex endovascular aortic repair have limited long-term negative effects on patients' health and quality of life. However, some patients are not recovered at six months postoperatively, which could be explained by individual characteristics. To improve recovery outcomes, vascular nurses and other health care professionals should be aware of the possible recovery trajectories and factors associated with impaired recovery, and use them to anticipate and meet the patients' individual care needs.
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Affiliation(s)
- Linda Haakseth
- Department of Surgical Sciences, Nursing, Uppsala University, Entrance 15, Uppsala University Hospital, Uppsala 75185, Sweden.
| | - Caisa Öster
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing, Uppsala University, Entrance 15, Uppsala University Hospital, Uppsala 75185, Sweden
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Abstract
BACKGROUND AND OBJECTIVES Globally, older adults are undergoing spine surgery for degenerative spine disease at exponential rates. However, little is known about their experiences of living with and having surgery for this debilitating condition. This study investigated older adults' understanding and experiences of living with and having surgery for degenerative spine disease. RESEARCH DESIGN AND METHODS Qualitative methods, grounded theory, guided the study. Fourteen older adults (≥65 years) were recruited for in-depth interviews at 2 time-points: T1 during hospitalization and T2, 1-3-months postdischarge. A total of 28 interviews were conducted. Consistent with grounded theory, purposive, and theoretical sampling were used. Data analysis included open, axial, and selective coding. RESULTS A conceptual model was developed illustrating the process older adults with degenerative spine disease experience, trying to get their life back. Three key categories were identified (1) Losing Me, (2) Fixing Me, and (3) Recovering Me. Losing Me was described as a prolonged process of losing functional independence and the ability to socialize. Fixing Me consisted of preparing for surgery and recovery. Recovering Me involved monitoring progression and reclaiming their personhood. Conditions, including setbacks and delays, slowed their trajectory. Throughout, participants continually adjusted expectations. DISCUSSION AND IMPLICATIONS The conceptual model, based on real patient experiences, details how older adults living with and having surgery for degenerative spine disease engage in recovering who they were prior to the onset of symptoms. Our findings provide a framework for understanding a complex, protracted trajectory that involves transitions from health to illness working toward health again.
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Affiliation(s)
- Andrea L Strayer
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Barbara J King
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Yang M, Li Q, Zhou Y, Zhu YQ, Cui YX, Chen Y, Zhou XK, He MF. Risk factors for hypokalemia and its association with postoperative recovery in patients scheduled for radical gastrectomy: a retrospective study. BMC Anesthesiol 2023; 23:285. [PMID: 37608299 PMCID: PMC10463583 DOI: 10.1186/s12871-023-02246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Hypokalemia is common in patients of various operations, especially gastrointestinal surgery, which seriously affects the safety and enhanced recovery after surgery. Our study aims to explore the risk factors of preoperative hypokalemia of radical gastrectomy for gastric cancer and analyze its impact on postoperative recovery. METHODS A total of 122 patients scheduled for radical gastrectomy from September, 2022 to December, 2022 were retrospectively analyzed. According to the serum potassium level before skin incision, patients were divided into hypokalemia group (n = 64) and normokalemia group (n = 58). Factors including age, gender, BMI, ASA classification, glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), creatinine, blood urea nitrogen (BUN), albumin, hypertension history, whether taking calcium channel blockers, β-receptor blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor antagonist (ARB), thiazide diuretics and other drugs, anemia history, diabetes mellitus history, inability to eat or intestinal obstruction, vomiting, diarrhea, hypokalemia on admission and whether under cooperation with clinical nurse specialist were compared between groups. Univariate logistic regression analysis was used to determine risk factors for hypokalemia with p < 0.2 included as a cutoff. Multivariate logistic regression was used to analyze the influencing factors of preoperative hypokalemia for the indicators with differences. A receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the regression model. Primary exhaust time and defecation time after surgery were compared between the two groups. RESULTS The use of ACEI or ARB [OR 0.08, 95% CI (0.01 to 0.58), p = 0.012] and thiazide diuretics [OR 8.31, 95% CI (1.31 to 52.68), p = 0.025], inability to eat for more than 3 days or intestinal obstruction [OR 17.96, 95% CI (2.16 to 149.43), p = 0.008], diarrhea for more than 48 h [OR 6.21, 95% CI (1.18 to 32.61), p = 0.031] and hypokalemia on admission [OR 8.97, 95% CI (1.05 to 77.04), p = 0.046] were independent influencing factors of hypokalemia before skin incision. Primary postoperative exhaust time and defecation time was significantly longer in the hypokalemia group than in the normokalemia group, no matter after laparoscopic radical gastrectomy (p = 0.044, p = 0.045, respectively) or open radical gastrectomy (p = 0.033, p = 0.019, respectively). CONCLUSION Early attention and management of serum potassium in patients undergoing radical gastrectomy can better reduce perioperative adverse reactions and promote recovery of gastrointestinal function.
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Affiliation(s)
- Min Yang
- Department of Anesthesiology and Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Jiangsu, Jiangsu, 210029, China
| | - Qian Li
- The First Clinical Medical College, Nanjing Medical University, Nanjing Jiangsu, 210006, China
| | - Yan Zhou
- Department of Anesthesiology and Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing Jiangsu, Jiangsu, 210029, China
| | - Yun-Qing Zhu
- The First Clinical Medical College, Nanjing Medical University, Nanjing Jiangsu, 210006, China
| | - Yu-Xuan Cui
- The First Clinical Medical College, Nanjing Medical University, Nanjing Jiangsu, 210006, China
| | - Yu Chen
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing Jiangsu, 210029, China
| | - Xiao-Kai Zhou
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing Jiangsu, 210029, China.
| | - Ming-Feng He
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing Jiangsu, 210029, China.
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Li W, Wang Y, Zhang Z, Chen W, Lv H, Zhang Y. A risk prediction model for postoperative recovery of closed calcaneal fracture: a retrospective study. J Orthop Surg Res 2023; 18:612. [PMID: 37608314 PMCID: PMC10463340 DOI: 10.1186/s13018-023-04087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To explore the risk factors for postoperative recovery of closed calcaneal fracture and develop a prediction model. METHODS We retrospectively enrolled patients with closed calcaneal fracture from January 1, 2017 to December 31, 2020. Patients treated from 2017 to 2019 were selected as a training cohort and those in 2020 as a validation cohort. The outcome variable was the postoperative recovery evaluated by the Creighton-Nebraska calcaneal fracture scoring system. Multivariate logistic regression analysis was used to screen the risk factors of postoperative recovery. A risk prediction model was constructed in the training cohort and the corresponding nomogram was drawn. The model was validated internally using bootstrapping and externally by calculating the performance in the validation cohort. RESULTS A total of 659 patients with closed calcaneal fracture met the inclusion and exclusion criteria, which were divided into the training cohort (n = 509) and the validation cohort (n = 150). 540 cases (81.9%) patients recovered well after calcaneal fracture surgery. According to multivariate logistic regression analysis, female (OR = 2.525, 95% CI 1.283-4.969), > 60 years (OR = 6.644, 95% CI 1.243-35.522), surgery within 8-14 days after fracture (OR = 2.172, 95% CI 1.259-3.745), postoperative infection (OR = 4.613, 95% CI 1.382-15.393), and weight-bearing time longer than 3 months after surgery (4-6 months, OR = 2.885, 95% CI 1.696-4.907; 7-12 months, OR = 3.030, 95% CI 1.212-7.578; > 12 months, OR = 15.589, 95% CI 3.244-74.912) were independent risk factors for postoperative recovery of calcaneal fractures. The C-indices were 0.750(95% CI 0.692-0.808) in the training cohort and 0.688(95% CI 0.571-0.804) in the external validation cohort, and the C-index of internal validation was 0.715. The Hosmer-Lemeshow test showed good fitting of the model (all P > 0.05), which was consistent with the results of the calibration plots. Decision Curve Analysis indicated that the clinical effectiveness was the best when the threshold probability was between 0.10 and 0.45. CONCLUSIONS Patients with female, > 60 years, surgery within 8-14 days after fracture, postoperative infection, and weight-bearing time longer than 3 months after surgery are more likely to have poor postoperative recovery. The risk prediction of fracture patients through this model might be translated into clinical guidance and application. Trial registration This study was registered on the Chinese Clinical Trial Registry (Registration number: ChiCTR-EPR-15005878).
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Affiliation(s)
- Wenjing Li
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
| | - Yan Wang
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
| | - Zenglei Zhang
- Rehabilitation Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
| | - Wei Chen
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
| | - Hongzhi Lv
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
| | - Yingze Zhang
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 China
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Feinberg J, Zivanovic O, Hannon M, McCready T, Desai P, Kim SH, Aviki EM, Mueller JJ, Jewell EL, Roche KL, Gardner GJ, Chi DS, Sonoda Y, Brown CL, Abu-Rustum NR, Cracchiolo JR, Leitao MM, Broach V. Patient-reported symptoms after minimally invasive hysterectomy and association with postoperative complications. Gynecol Oncol 2023; 175:163-168. [PMID: 37390597 PMCID: PMC10939506 DOI: 10.1016/j.ygyno.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To describe patient-reported postoperative symptoms and to evaluate the use of digital symptom tracking and alerts to detect postoperative complications. METHODS We retrospectively reviewed patients who underwent a minimally invasive hysterectomy and enrolled in our Recovery Tracker program from 4/5/17-12/31/21. The Recovery Tracker is an at-home virtual tool used to track patient-reported postoperative symptoms for 10 days. Predefined thresholds for "red" and "yellow" alerts are based on symptom severity and timing. Data on patient demographics, surgery, and postoperative course were collected to evaluate the association of alerts with complications and compare outcomes of patients who did/did not enroll in the program. RESULTS Of 2362 eligible patients, 1694 (71.7%) enrolled in the Recovery Tracker program. Pain was the most severe symptom, followed by fatigue. Eighty-seven patients experienced 102 complications (5.1% complication rate) and 32 experienced 39 grade ≥ 2 complications (1.9% severe complication rate). Excluding complications that occurred prior to Recovery Tracker use, 1673 patients experienced 28 grade ≥ 2 complications. Of 345 patients (20.6%) who triggered a red alert, 13 (3.8%) had a grade ≥ 2 complication. Of 1328 patients (79.4%) with no red alerts, 15 (1.13%) had a grade ≥ 2 complication. Relative risk of a grade ≥ 2 complication if a red alert was triggered was 3.25 (95% CI: 1.6-6.9, P = .002). Rate of severe complications was significantly higher among patients who did not use the tool (3.3% vs 1.9%; P = .04). CONCLUSIONS The Recovery Tracker tool may assist in early identification of postoperative symptoms after minimally invasive hysterectomy.
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Affiliation(s)
- Jacqueline Feinberg
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Michael Hannon
- Patient-Reported Outcomes Center, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor McCready
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Priyanka Desai
- Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah H Kim
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA.
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Zhang J, Wang F, Dang J, Zheng H, Ren B, Liu C, Zuo R, Wang R, Liu T, Wang Z. Effect of Intraoperative Infusion of Esketamine on Quality of Postoperative Recovery in Patients Undergoing Laparoscopic Bariatric Surgery: A Randomized Controlled Trial. Pain Ther 2023; 12:979-992. [PMID: 37171754 PMCID: PMC10289955 DOI: 10.1007/s40122-023-00519-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION This study aims to evaluate the efficacy of esketamine on postoperative recovery quality after laparoscopic bariatric surgery. METHODS Patients (n = 74) scheduled for laparoscopic bariatric surgery were randomly divided into two groups: the esketamine group (group E: 0.5 mg/kg/h infusion, i.e., 0.2 mL/kg/h) or the control group (group C: 0.2 mL/kg/h normal saline infusion). The infusions were stopped 20 min before the end of the procedure. The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day 1 (POD 1). The secondary outcomes included QoR-40 scores on PODs 2 and 7, Numeric Rating Scale (NRS) on PODs 1, 2, and 7, time to extubation, additional postoperative analgesic use, length of hospital stay, and time to first exhaust. Additonally, the safety indices were also recorded, including hemodynamic profile, perioperative anesthesia index (Ai), utilization of vasoactive drugs or urapidil, and side effects. RESULTS All in all, 70 of the 74 patients completed the study, 35 in each group. The difference of QoR-40 scores on POD 1 was both statistically and clinically significant [difference 7.21, 95% confidence interval (CI) 5.17, 9.25, p < 0.001]. The difference of QoR-40 on POD 2 was statistically significant but clinically insignificant (difference 4.81, 95% CI 2.69, 6.92, p < 0.001). The difference of NRS scores on POD 1 was statistically significant (difference -1.23, 95% CI -2.36, -0.10, p = 0.033). Compared with group C, group E had a lower utilization rate of phenylephrine and higher Ai values (p < 0.05). There was no statistical difference between the two groups on other measures. CONCLUSION Continuous ketamine infusion seems to be safe and well tolerated in laparoscopic bariatric surgery. It improved the quality of postoperative recovery and reduced pain on POD 1. In spite of the increased Ai value during the surgery, it also provided better hemodynamics with less usage of phenylephrine.
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Affiliation(s)
- Jingyue Zhang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Fan Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Jingjing Dang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Huiwen Zheng
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Baiqing Ren
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Chao Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Ronghua Zuo
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Rui Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Tianya Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Zhiping Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, 221004 China
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Ji J, Yang Y, Chen Z, Zhang W, Jiang S, Shen X, Zhang J, Lin L, Qu M, Wang Y, Gao X. How education level affects postoperative rehabilitation and follow-up: a single-center experience. BMC Urol 2023; 23:123. [PMID: 37464331 DOI: 10.1186/s12894-023-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Radical prostatectomy remains the fundamental treatment for prostate cancer, and improving patients' compliance with postoperative follow-ups is essential for improving patients' quality of life. This study investigates the effect of education levels on patients' recovery and follow-up after radical prostatectomy. METHODS Data from 1,112 patients undergoing radical prostatectomy between 2011 and 2020 were collected using medical records, and "pc-follow" systems were used to collect patients' baseline information, education level, pathological information, number of outpatient visits, the time interval between each visit, and PSA test data. RESULTS Regarding postoperative outpatient data, there was no difference in the number of outpatient visits among the different education level groups in Shanghai (P = 0.063). A significant difference was found in the interval between outpatient visits among the groups (P < 0.001). Furthermore, significant differences were detected in the number and duration of outpatient clinic visits among the education level groups in all patients (P = 0.016, P = 0.0027). By contrast, no significant difference was found in the recovery time of urinary continence between all patients and those in Shanghai, grouped according to education level (P = 0.082, P = 0.68). For all patients and patients in the Shanghai area, the number of PSA follow-ups increased gradually with an increasing level of education (P < 0.001, P = 0.0029). CONCLUSIONS Education level affected the number of postoperative clinic visits, compliance, and the number of PSA tests. However, no significant effect on the recovery of urinary continence was found. Further, clinicians must increase their focus on patients with low education levels to achieve equitable access to health services for all patients.
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Affiliation(s)
- Jin Ji
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yuchen Yang
- Nursing Department, Naval Hospital of Eastern Theater Command, PLA, Zhoushan, China
| | - Zeyu Chen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Wenhui Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Shaoqin Jiang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xianqi Shen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Jili Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Lu Lin
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Min Qu
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Yan Wang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China.
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Dong W, Ding Z, Wu X, Wan R, Liu Y, Pei L, Zhu W. The association between neuropeptide oxytocin and neuropsychiatric disorders after orthopedic surgery stress in older patients. BMC Geriatr 2023; 23:416. [PMID: 37420191 PMCID: PMC10329356 DOI: 10.1186/s12877-023-03989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/22/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The health outcomes of geriatric patients exposed to surgery were found to be enhanced by social support and stress management. The aim of this study was to characterise the relationship between oxytocin and neuropsychiatric disorders after surgery. METHODS A total of 132 geriatric patients aged ≥ 60 years received orthopedic surgery in the First Affiliated Hospital of Harbin Medical University (Harbin, China) were enrolled in the present study. The salivary levels of stress hormone cortisol and oxytocin were measured by enzyme-linked immunosorbent assay for the screening of the stress state and oxytocin function. Moreover, the Depression Anxiety and Stress Scale (DASS), the Geriatric Anxiety Inventory (GAI), the Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were conducted to identify the severity of anxiety and depression. The association between oxytocin and mental health was performed by linear regression analyses in older patients receiving orthopedic surgery. Finally, the Duke Social Support Index (DSSI) was selected to measure the social support and the potential link to mental outcomes. RESULTS The scores from questionnaires showed that female patients with higher social support and higher levels of oxytocin demonstrated better stress-reducing responses as reflected by lower cortisol and decreased anxiety and depression symptoms. Regression analyses revealed that there was a significant association between oxytocin and scores in DASS, GAI, GDS, MADRS and DSSI, suggesting a potential link between peripheral oxytocin function and mood outcomes after orthopedic surgery. CONCLUSIONS Our findings reveal that oxytocin enhances the stress-protective effects of social support and reduces anxiety and depression states under stressful circumstances, particularly in older women receiving orthopedic surgery.
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Affiliation(s)
- Wanru Dong
- Drug Safety Evaluation Center, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Zengbo Ding
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Xiao Wu
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Ran Wan
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ying Liu
- College of Pharmacy, Hainan Medical College, Haikou, 570100, China
| | - Liubao Pei
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Weili Zhu
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China.
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李 敏, 江 志, 许 睿, 邵 明, 毛 珏, 曾 月, 朱 婷. [Application and Effect Evaluation of Precision Nursing Care of Enhanced Rehabilitation After Surgery in the Perioperative Period of Colorectal Cancer]. Sichuan Da Xue Xue Bao Yi Xue Ban 2023; 54:746-751. [PMID: 37545068 PMCID: PMC10442614 DOI: 10.12182/20230760505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Indexed: 08/08/2023]
Abstract
Objective To examine the effect of perioperative precision nursing care of enhanced recovery after surgery (ERAS) on the postoperative recovery, stress response, and psychological state of colorectal cancer patients. Methods A total of 100 patients undergoing elective laparoscopic colorectal cancer surgery were randomly assigned to an experimental group and a control group, with 50 patients in each group. The experimental group received systematic, standardized, and specialized precision nursing care in three stages, the preoperative, intraoperative, and postoperative stages, while the control group received routine nursing care. The main outcome indicators compared between the two groups included the time of the first postoperative passage of flatus and stool, ambulation, liquid-diet meal, postoperative length-of-stay, and C-reactive protein (CRP), interleukin-6 (IL-6), and homeostatic model assessment of insulin resistance (HOMR-IR) measured 1 day before surgery and 1, 3, and 5 days after surgery. Secondary outcome indicators included the anxiety and depression levels of patients measured upon admission to the hospital and 48 h after surgery by Self-rating Anxiety Scale (SAS) and Self-rating Sepression Scale (SDS), respectively. Results In the experimental group, the time of the first postoperative passage of flatus and stool, ambulation, and liquid-diet meal and the postoperative length-of-stay were all lower than those in the control group. The postoperative CRP and IL-6 levels of the two groups were significantly higher than the preoperative levels, and the control group had higher CRP and IL-6 levels than the experimental group did, all showing significant difference ( P<0.05). The two groups presented different stress states at different points of time after surgery, with the CRP and IL-6 levels reaching the highest 3 days after surgery and then dropping to some degree afterwards. The HOMR-IR of the patients in the experimental group was significantly lower than that of the control group and the difference was significant at both 1 d and 3 d after surgery ( P<0.05). Comparison of the difference in the anxiety and the depression scores in the two groups showed significant difference ( P<0.05). Before discharge, patient satisfaction of the experimental group was significantly higher than that of the control group ( P<0.05). Conclusion The implementation of ERAS precision nursing care can effectively promote the postoperative recovery of colorectal cancer patients, reduce the perioperative stress response, alleviate anxiety and depression, improve patient satisfaction, and hence should be extensively applied in clinical practice.
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Affiliation(s)
- 敏 李
- 南京中医药大学附属医院 江苏省中医院 普外科 (南京 210029)Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - 志伟 江
- 南京中医药大学附属医院 江苏省中医院 普外科 (南京 210029)Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - 睿 许
- 南京中医药大学附属医院 江苏省中医院 普外科 (南京 210029)Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - 明月 邵
- 南京中医药大学附属医院 江苏省中医院 普外科 (南京 210029)Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - 珏霞 毛
- 南京中医药大学附属医院 江苏省中医院 普外科 (南京 210029)Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - 月 曾
- 南京中医药大学附属医院 江苏省中医院 普外科 (南京 210029)Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
| | - 婷婷 朱
- 南京中医药大学附属医院 江苏省中医院 普外科 (南京 210029)Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China
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Ki M, Kim DC, You SW, Oh J, Jang J, Yoo HH. Appropriateness of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans to measure preoperative anxiety and the effect of preoperative anxiety on postoperative quality of recovery. Anesth Pain Med (Seoul) 2023; 18:260-269. [PMID: 37691595 PMCID: PMC10410555 DOI: 10.17085/apm.23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. METHODS Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. RESULTS There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett's test of sphericity was < 0.001. Cronbach's alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). CONCLUSIONS The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.
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Affiliation(s)
- Minjong Ki
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Dong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seon Woo You
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jeongmin Oh
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jieun Jang
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Hyo Hyun Yoo
- Department of Medical Education, Jeonbuk National University Medical School, Jeonju, Korea
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Tanaka A, Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Takazawa A, Komatsu Y, Ideta H, Ishida T, Takahashi J. Muscle strength and functional recovery for soft-tissue sarcoma of the thigh: a prospective study. Int J Clin Oncol 2023:10.1007/s10147-023-02348-4. [PMID: 37133781 DOI: 10.1007/s10147-023-02348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aimed to investigate changes in muscle strength and functional outcome before and after surgery for soft-tissue sarcoma of the thigh and to examine the timing of recovery. METHODS From 2014 to 2019, 15 patients who underwent multiple resections of the thigh muscle for soft-tissue sarcoma of the thigh were included in this study. The muscle strength was measured with an isokinetic dynamometer for the knee joint and with a hand-held dynamometer for the hip joint. The functional outcome assessment was based on the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D), and maximum walking speed (MWS). All measurements were conducted preoperatively and at 3, 6, 12, 18, and 24 months postoperatively, and the ratio of postoperative to preoperative value was used. A repeated-measures analysis of variance was performed to compare changes over time and to investigate the recovery plateau. Correlations between changes in muscle strength and functional outcomes were also examined. RESULTS The muscle strength of the affected limb, MSTS score, TESS, EQ-5D, and MWS were significantly decreased at 3 months postoperatively. The recovery plateau was subsequently reached at 12 months postoperatively. The changes in muscle strength of the affected limb and functional outcome showed a significant correlation. CONCLUSIONS The estimated postoperative recovery for soft-tissue sarcoma of the thigh is 12 months after surgery.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yukiko Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirokazu Ideta
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takaaki Ishida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Yuan YJ, Xue FS, Cheng Y. Letter to the Editor Regarding "Effect of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block on Postoperative Recovery in Elderly Patients Undergoing Laparoscopic Gastric Cancer Surgery: A Randomized Controlled Trial". Pain Ther 2023; 12:885-888. [PMID: 37067683 PMCID: PMC10199969 DOI: 10.1007/s40122-023-00509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/28/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
- Yu J Yuan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
| | - Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
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Ding X, Zhang H, Liu H. Early ambulation and postoperative recovery of patients with lung cancer under thoracoscopic surgery-an observational study. J Cardiothorac Surg 2023; 18:136. [PMID: 37041603 PMCID: PMC10091666 DOI: 10.1186/s13019-023-02263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery guidelines in China recommend early ambulation within 24 h after surgery. The aims of this audit were to investigate the early ambulation of patients with lung cancer under thoracoscopic surgery, and to explore the influence of different ambulation time on postoperative rehabilitation of patients. METHODS Using observational study method, observe and record of 226 cases under the thoracoscope surgery early ambulation of patients with lung cancer. Data collected included postoperative bowel movements, chest tube extubation time, length of hospital stay, postoperative pain and the incidence of postoperative complications. RESULTS The time of first ambulation was (34.18 ± 17.18) h, the duration was (8.26 ± 4.62) min, and the distance was (54.94 ± 46.06) m. The time of first postoperative defecation, the time of chest tube extubation and the length of hospital stay were significantly shortened in patients who ambulate within 24 h, and the pain score on the third day after surgery was decreased, and the incidence of postoperative complications was reduced, with statistical significance (P < 0.05). CONCLUSION Early ambulation within 24 h after thoracoscopic surgery for lung cancer patients can promote the recovery of intestinal function, early removal of chest tube, shorten the length of hospital stay, relieve pain, reduce the incidence of complications, and facilitate the rapid recovery of patients.
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Affiliation(s)
- Xiaoyun Ding
- Department of Thoracic Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Huijun Zhang
- Department of Thoracic Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Huahua Liu
- Department of Thoracic Surgery, Huashan Hospital Fudan University, Shanghai, China.
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Fang L, Chen X, Zhang H, Bao X, Duan G, Cao T, Jin M, Li H. Laryngeal mask general anaesthesia versus spinal anaesthesia for promoting early recovery of cervical conisation: A randomised, controlled clinical study. Heliyon 2023; 9:e15121. [PMID: 37095968 PMCID: PMC10121804 DOI: 10.1016/j.heliyon.2023.e15121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
Background Although both spinal and general anaesthesia provides good anaesthesia for cervical conization, spinal anaesthesia delays the return of lower limb movements and urinary function, whereas general anaesthesia requires the patient to be unconscious. It is unclear which anaesthetic technique is more conducive to early postoperative recovery in patients undergoing cervical conization. Patients and methods 140 patients undergoing cervical conization underwent either laryngeal mask general anaesthesia (LMA, n = 70) or spinal anaesthesia (SA, n = 70). In the LMA group, an i-gel mask was used for airway management. In the SA group, spinal anaesthesia was received with 0.75% ropivacaine (15 mg) in the L3-4 interval. The quality of recovery score (QoR-15) was the primary endpoint of the study. Secondary endpoints included incidence of adverse 24-h analgesia (NRS>3); return of lower limb activity; first bed activity and feeding; and the number of catheters removed at 6, 12 and 24 h postoperatively. Result The LMA group significantly improved QoR-15 scores (136.62 ± 11.02 vs 119.97 ± 12.75; P < 0.001); and reduced the incidence of poor analgesia (NRS >3) within 24 h postoperatively (20% vs 42.8%, P = 0.006); reduced time in bed (15.62 ± 3.83 h vs 18.27 ± 5.57 vs, P = 0.001); improved patient satisfaction (86% vs 27%; P < 0.001); and catheters removal within 24 h (70/70 vs 42/70, P < 0.001). Conclusion LMA general anaesthesia can facilitate early postoperative recovery in patients undergoing cervical conization compared with conventional spinal anaesthesia. Trial registration Chinese Clinical Trial Registry (ID: ChiCTR1800019384), http://www.chictr.org.cn/listbycreater.aspx (08/11/2018).
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Affiliation(s)
- Liang Fang
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xiyuan Chen
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Haolin Zhang
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xiaohang Bao
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ting Cao
- Department of Gynecology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Man Jin
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Hong Li
- Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing, China
- Corresponding author. Department of Anaesthesiology, Second Affiliated Hospital, Army Medical University, People's Liberation Army of China(PLA), No.83 Xinqiao Street, Shapingba District, Chongqing, 400037, China.
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Héroux J, Bessette PO, Belley-Côté E, Lamarche D, Échavé P, Loignon MJ, Patenaude N, Baillargeon JP, D'Aragon F. Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review. BMC Anesthesiol 2023; 23:91. [PMID: 36964490 PMCID: PMC10037794 DOI: 10.1186/s12871-023-02038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/08/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Peripheral nerve block is a common anesthetic technique used during orthopedic upper limb surgery. Injection of local anesthetics around the target nerve inhibits the action of voltage-dependent sodium channels, inhibiting neurotransmission of pain impulses and providing motor immobility. Compared to general anesthesia, it could improve functional recovery by inhibiting nociceptive impulses and inflammation, thus reducing postoperative pain and immobilization and improving postoperative rehabilitation. This systematic review evaluates the impact of peripheral nerve block versus general anesthesia on postoperative functional recovery following orthopedic upper limb surgery. METHODS We searched CENTRAL, MEDLINE, CINHAL, EMBASE, and Scopus trial databases from inception until September 2021 for studies comparing peripheral nerve block to general anesthesia. We collected data on functional recovery, range of motion, patient satisfaction, quality of life, and return to work. We pooled studies using a random-effects model and summarized the quality of evidence with the GRADE approach. RESULTS We assessed 373 citations and 19 full-text articles for eligibility, and included six studies. Six studies reported on functional recovery, but failed to detect a significant superiority of peripheral nerve block over general anesthesia (3 RCT studies, N = 160; SMD -0.15; CI at 95% -0.60-0.3; I2 = 45%; p = 0.07; low quality of evidence and 3 observational studies, N = 377; SMD -0.35; CI at 95% -0.71-0.01; I2 = 64%; p = 0.06; very low quality of evidence). CONCLUSIONS Current literature is limited and fails to identify the benefit of peripheral nerve block on functional recovery. More studies are needed to assess the impact on long-term recovery. Considering the potential impact on clinical practice and training, a prospective study on functional recovery is ongoing (NCT04541745). TRIAL REGISTRATION PROSPERO ID CRD42018116298. Registered on December 4, 2018.
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Affiliation(s)
- Jennifer Héroux
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
| | | | - Emilie Belley-Côté
- Divisions of Cardiology and Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Daphnée Lamarche
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pablo Échavé
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Josée Loignon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Patenaude
- Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Patrice Baillargeon
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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Linton SC, Kwon S, De Boer C, Zeineddin S, Figueroa A, DeTella M, Zbihley C, Abdullah F, Ghomrawi HMK. Discordance between Subjective and Objective Assessments of Activity after Pediatric Appendectomy. J Surg Res 2023; 283:751-7. [PMID: 36463814 DOI: 10.1016/j.jss.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/03/2022] [Accepted: 11/02/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Physical activity recovery after pediatric surgery can be assessed using objective measures such as step counts, but practice currently relies on subjective assessment by proxy. It is unclear how subjective and objective assessments of activity relate. We compared caregiver assessment of return to normal physical activity after pediatric appendectomy to step count recovery measured by a Fitbit. METHODS Pediatric patients who underwent appendectomy were recruited between 2020 and 2022 to be monitored for 21 d with a Fitbit. Patients were grouped by the postoperative day (POD) (7, 14, or 21) their caregiver first reported their activity was "back to normal." Objective return to normal step count was estimated for each group by modeling the inflection point from increasing steps to a plateau. These measures were determined discordant if the subjective report remained outside the modeled 95% confidence interval (CI) for the day the group plateaued. RESULTS Thirty-nine simple appendicitis and 40 complicated appendicitis patients were recruited. Among simple appendicitis patients, daily steps plateaued on POD 10.8 (95% CI 7.4-14.3), POD 14.0 (95% CI 11.0-17.1), and POD 11.1 (95% CI 6.9-15.3) for the day 7, day 14, and day 21 groups, respectively. Complicated appendicitis groups plateaued on POD 12.8 (95% CI 8.7-16.9), POD 15.2 (95% CI 11.1-19.3), and POD 16.7 (95% CI 12.3-21.0), respectively. Significant discordance was observed between subjective and objective assessments for the day 7 and day 14 simple groups and for the day 7 complicated group. CONCLUSIONS There was significant discordance between caregiver and accelerometer-assessed activity recovery after pediatric surgery. Development of objective measures of recovery could help standardize assessment of children's recovery after surgery.
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Hou Y, Kang F, Liu H, Yang C, Han M, Huang X, Guan X, Wang SM, Li J. Perioperative transcutaneous electrical acupoint stimulations as part of an enhanced recovery after surgery protocol for living donors undergoing nephrectomy: A randomized, controlled clinical trial. Heliyon 2023; 9:e14423. [PMID: 36950567 PMCID: PMC10025023 DOI: 10.1016/j.heliyon.2023.e14423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/24/2023] Open
Abstract
Objective Living kidney donors (LKDs) experience perioperative anxiety. We designed the following study to evaluate the anxiolytic effect of transcutaneous electrical acupoint stimulation (TEAS) during the perioperative period in a group of LKDs undergoing laparotomy nephrectomy. Methods LKDs were randomly assigned to either the TEAS or control group. Participants in the TEAS group received 30min of intervention (6-15 mA, 2-100 Hz), at Yintang (EX-HN-3), bilateral Taichong (LR3) and Neiguan (PC6) one day before surgery (D0), before induction of anesthesia (D1) and one day after surgery (D2). The participants in the control group received the same placement of electrodes but without electrical stimulation. Venous blood was collected before each intervention. Anxiety levels and recovery profiles were recorded. Results LKDs in the TEAS group had lower anxiety level than those in the control group at D1, D2 and three days after surgery (D3). The percentage differences were: 33.3%, 25.0%, and 22.2%; [95% confidence interval (CI), (-55.1%, -11.6%), (-47.4%, -2.6%), and (-42.3%, -2.2%); P = 0.005, P = 0.034, and P = 0.035; respectively]. LKDs who received TEAS had better sleep quality and short-term recovery profiles than those in the control group. The plasma levels of 5-hydroxytryptamine (5-HT) and melatonin (MT) in the TEAS group were significantly higher than those in the control group at D1 and D2 (5-HT: P = 0.001, and P < 0.001; MT: P = 0.006, and P = 0.001). At the 3-month follow up, fewer LKDs in the TEAS group had incisional pain when compared to the control group (P = 0.032). Conclusions Perioperative TEAS decreased perioperative anxiety and facilitated postoperative recovery in the LKDs, and potential decreased the development of chronic pain. Trial Registration: Registered at ChiCTR2000029891, http://www.chictr.org.cn/listbycreater.aspx.
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Affiliation(s)
- Yu Hou
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Hongtao Liu
- Department of Kidney Transplantation, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Chengwei Yang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Xiang Huang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Xiaohong Guan
- Department of Kidney Transplantation, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Shu-Ming Wang
- Department of Anesthesiology, University of Connecticut School of Medicine, Farmington, CT, USA
- Corresponding author.
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
- Corresponding author.
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Bamps S, Raymaekers V, Roosen G, Put E, Vanvolsem S, Achahbar SE, Meeuws S, Wissels M, Plazier M. Lateral Lumbar Interbody Fusion (Direct Lateral Interbody Fusion/Extreme Lateral Interbody Fusion) versus Posterior Lumbar Interbody Fusion Surgery in Spinal Degenerative Disease: A Systematic Review. World Neurosurg 2023; 171:10-18. [PMID: 36521760 DOI: 10.1016/j.wneu.2022.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Degenerative diseases of the lumbar spine are often treated with posterior interbody fusion surgery (posterior lumbar interbody fusion [PLIF]) for spinal instability or intractable back pain with neurologic impairment. Several lateral, less invasive procedures have recently been described (lateral lumbar interbody fusion [LLIF]/direct lateral interbody fusion/extreme lateral interbody fusion [XLIF]). The aim of this systematic review is to compare structural and functional outcomes of lateral surgical approaches to PLIF. METHODS We conducted a MEDLINE (PubMed), Web of Science, ScienceDirect, and Cochrane Library search for studies focusing on outcomes and complications comparing LLIF (direct lateral interbody fusion/XLIF) and PLIF. The systematic review was reported using the PRISMA criteria. RESULTS In total, 1000 research articles were identified, of which 5 studies were included comparing the outcomes and complications between the lateral and posterior approach. Three studies found significantly less perioperative blood loss with a lateral approach. Average hospital stay was shorter in populations who underwent the lateral approach compared with PLIF. Functional outcomes (visual analog scale score/Oswestry Disability Index) were similar or better with LLIF. In most of the included studies, complication rates did not differ between the posterior and lateral approach. Most of the neurologic deficits with XLIF/LLIF were temporary and healed completely within 1 year follow-up. CONCLUSIONS A lateral approach (XLIF/LLIF) is a good and safe alternative for PLIF in single-level degenerative lumbar diseases, with comparable functional outcomes, shorter hospital stays, and less blood loss. Future prospective studies are needed to establish the role of lateral minimally invasive approaches in spinal degenerative surgery.
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Affiliation(s)
- Sven Bamps
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.
| | - Vincent Raymaekers
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium; Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Gert Roosen
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Eric Put
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Steven Vanvolsem
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Salah-Eddine Achahbar
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Sacha Meeuws
- Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium; Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Maarten Wissels
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Mark Plazier
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
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Thiel B, Godfried MB, van Emst ME, Vernooij LM, van Vliet LM, Rumke E, van Dongen RTM, Gerrits W, Koopman JSHA, Kalkman CJ. Quality of recovery after day care surgery with app-controlled remote monitoring: study protocol for a randomized controlled trial. Trials 2023; 24:102. [PMID: 36759858 PMCID: PMC9909143 DOI: 10.1186/s13063-023-07121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at home after day care surgery might improve patient's recovery. Currently patient experiences with smartphone applications are promising; however, we do not know whether remote monitoring with such an application also improves the patient's recovery. This study aims to evaluate the experienced quality of recovery after day care surgery between patients provided with the smartphone application for remote monitoring and patients receiving standard care without remote monitoring. METHODS This non-blinded randomized controlled trial with mixed methods design will include 310 adult patients scheduled for day care surgery. The intervention group receives the smartphone application with text message function for remote monitoring that enables patients to record pain and nausea. An anaesthesia professional trained in empathetic communication, who will contact the patient in case of severe pain or nausea, performs daily monitoring. The control group receives standard care, with post-discharge verbal and paper instructions. The main study endpoint is the difference in perceived quality of recovery, measured with the QoR-15 questionnaire on the 7th day after day care surgery. Secondary endpoints are the overall score on the Quality of Recovery-15 at day 1, 4 and 7-post discharge, the perceived quality of hospital aftercare and experienced psychological effects of remote monitoring during postoperative recovery from day care surgery. DISCUSSION This study will investigate if facilitating patients and healthcare professionals with a tool for accessible and empathetic communication might lead to an improved quality of the postoperative recovery period. TRIAL REGISTRATION The 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial' is approved and registered on 23 February 2022 by Research Ethics Committees United with registration number R21.076/NL78144.100.21. The protocol NL78144.100.21, 'Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial', is registered at the ClinicalTrials.gov public website (registration date 16 February 2022; NCT05244772).
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Affiliation(s)
- B. Thiel
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - M. B. Godfried
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - M. E. van Emst
- grid.440209.b0000 0004 0501 8269Department of Anaesthesiology, OLVG Hospital (Oost), Amsterdam, 1090 HM the Netherlands
| | - L. M. Vernooij
- grid.7692.a0000000090126352Department of Anaesthesia and Intensive Care, University Medical Centre Utrecht (UMCU), Utrecht, 3508 GA The Netherlands
| | - L. M. van Vliet
- grid.5132.50000 0001 2312 1970University Leiden, Wassenaarseweg 52, Leiden, 233 AK the Netherlands
| | - E. Rumke
- grid.5132.50000 0001 2312 1970University Leiden, Wassenaarseweg 52, Leiden, 233 AK the Netherlands
| | - R. T. M. van Dongen
- grid.413327.00000 0004 0444 9008Department of Anaesthesiology, Canisius Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, Nijmegen, 6532 SZ The Netherlands
| | - W. Gerrits
- grid.413327.00000 0004 0444 9008Department of Anaesthesiology, Canisius Wilhelmina Hospital (CWZ), Weg door Jonkerbos 100, Nijmegen, 6532 SZ The Netherlands
| | - J. S. H. A. Koopman
- Department of Anaesthesiology, Maasstad Ziekenhuis, Maasstadweg 21, Rotterdam, 3079 DZ The Netherlands
| | - C. J. Kalkman
- grid.7692.a0000000090126352Department of Anaesthesia and Intensive Care, University Medical Centre Utrecht (UMCU), Utrecht, 3508 GA The Netherlands
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Rinne JKA, Miri S, Oksala N, Vehkaoja A, Kössi J. Evaluation of a wrist-worn photoplethysmography monitor for heart rate variability estimation in patients recovering from laparoscopic colon resection. J Clin Monit Comput 2023; 37:45-53. [PMID: 35394583 PMCID: PMC9852147 DOI: 10.1007/s10877-022-00854-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/25/2022] [Indexed: 01/24/2023]
Abstract
To evaluate the accuracy of heart rate variability (HRV) parameters obtained with a wrist-worn photoplethysmography (PPG) monitor in patients recovering from minimally invasive colon resection to investigate whether PPG has potential in postoperative patient monitoring. 31 patients were monitored for three days or until discharge or reoperation using a wrist-worn PPG monitor (PulseOn, Finland) with a Holter monitor (Faros 360, Bittium Biosignals, Finland) as a reference measurement device. Beat-to-beat intervals (BBI) and HRV information collected by PPG were compared with RR intervals (RRI) and HRV obtained from the ECG reference after removing artefacts and ectopic beats. The beat-to-beat mean error (ME) and mean absolute error (MAE) of good quality heartbeat intervals obtained by wrist PPG were estimated as - 1.34 ms and 10.4 ms respectively. A significant variation in the accuracy of the HRV parameters was found. In the time domain, SDNN (9.11%), TRI (11.4%) and TINN (11.1%) were estimated with low relative MAE, while RMSSD (34.3%), pNN50 (139%) and NN50 (188%) had higher errors. The logarithmic parameters in the frequency domain (VLF Log, LF Log and HF Log) exhibited the lowest relative error, and for non-linear parameters, SD2 (7.5%), DFA α1 (8.25%) and DFA α2 (4.71%) were calculated much more accurately than SD1 (34.3%). The wrist PPG shows some potential for use in a clinical setting. The accuracy of several HRV parameters analyzed post hoc was found sufficient to be used in further studies concerning postoperative recovery of patients undergoing laparoscopic colon resection, although there were large errors in many common HRV parameters such as RMSSD, pNN50 and NN50, rendering them unusable.ClinicalTrials.gov Identifier: NCT04996511, August 9, 2021, retrospectively registered.
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Affiliation(s)
- Juha K A Rinne
- Department of Surgery, Päijät-Häme Central Hospital, Tampere University, Lahti, Finland.
| | - Seyedsadra Miri
- Finnish Cardiovascular Research Center - Tampere, Tampere University, Arvo Ylpön Katu 34 (33520 Tampere), P.O. Box 100, FI-33014, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34 (33520 Tampere), P.O. Box 100, FI-33014, Tampere, Finland
| | - Niku Oksala
- Finnish Cardiovascular Research Center - Tampere, Tampere University, Arvo Ylpön Katu 34 (33520 Tampere), P.O. Box 100, FI-33014, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34 (33520 Tampere), P.O. Box 100, FI-33014, Tampere, Finland
- Vascular Centre, Tampere University Hospital, Elämänaukio 2 (33520 Tampere), P.O. Box 2000, 33521, Tampere, Finland
| | - Antti Vehkaoja
- Finnish Cardiovascular Research Center - Tampere, Tampere University, Arvo Ylpön Katu 34 (33520 Tampere), P.O. Box 100, FI-33014, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34 (33520 Tampere), P.O. Box 100, FI-33014, Tampere, Finland
- PulseOn Ltd, Tekniikantie 12, 02150, Espoo, Finland
| | - Jyrki Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Tampere University, Lahti, Finland
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Gendia A, Rehman M, Cota A, Gilbert J, Clark J. Can virtual reality technology be considered as a part of the surgical care pathway? Ann R Coll Surg Engl 2023; 105:2-6. [PMID: 36374265 PMCID: PMC9773243 DOI: 10.1308/rcsann.2022.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Virtual reality (VR) is emerging as a new technology in the healthcare sector. It has been shown to enhance the patient's experience and satisfaction in various settings. This review aims to give a brief description of the use of VR and establish validity of its applications to improve the patient's pathway through surgery. METHODS A literature search was conducted using the PubMed and Embase™ databases to identify fields in which VR technology has been trialled in relation to surgery. The search terms 'virtual reality' and 'surgery' were employed. RESULTS Although benefits relating to VR use have been identified in mental health, obesity management, and physical and cognitive rehabilitation, those in surgery have been less well documented. There are, however, some important but limited benefits reported in managing surgery related stress and improving preoperative patient education as well as VR being an adjunct to some level of postoperative analgesia. CONCLUSIONS The current applications of VR in relation to surgical care fall into four main categories: preoperative education, supporting mental health, postoperative pain management, and pre and postoperative patient optimisation. Future studies and validation of VR applications should be carried out so the technology can be utilised throughout the entire patient pathway as VR surgical care bundles.
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Affiliation(s)
- A Gendia
- Royal Cornwall Hospitals NHS Trust, UK
| | - M Rehman
- Northampton General Hospital NHS Trust, UK
| | - A Cota
- Royal Cornwall Hospitals NHS Trust, UK
| | - J Gilbert
- Royal Cornwall Hospitals NHS Trust, UK
| | - J Clark
- Royal Cornwall Hospitals NHS Trust, UK
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Johnson JE, Bleicher J, Blumling AN, Cain BT, Cohan JN, Savarise M, Harris AHS, Kaphingst KA, Huang LC. The Influence of Rural Healthcare Systems and Communities on Surgery and Recovery: A Qualitative Study. J Surg Res 2023; 281:155-163. [PMID: 36155272 PMCID: PMC10473841 DOI: 10.1016/j.jss.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 08/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Successful recovery after surgery is complex and highly individual. Rural patients encounter greater barriers to successful surgical recovery than urban patients due to varying healthcare and community factors. Although studies have previously examined the recovery process, rural patients' experiences with recovery have not been well-studied. The rural socioecological context can provide insights into potential barriers or facilitators to rural patient recovery after surgery. METHODS We conducted semi-structured qualitative interviews with a purposeful sample of 30 adult general surgery patients from rural areas in the Mountain West region of the United States. We used the socioecological framework to analyze their responses. Interviews focused on rural participants' experiences accessing healthcare and the impact of family and community support during postoperative recovery. Interviews were transcribed verbatim and coded using content and thematic analysis. RESULTS All participants commented on the quality of their rural healthcare systems and its influence on postoperative care. Some enjoyed the trust developed through long-standing relationships with providers in their communities. However, participants described community providers' lack of money, equipment, and/or knowledge as barriers to care. Following surgery, participants recognized that there are advantages and disadvantages to receiving family and community support. Some participants worried about being stigmatized or judged by their community. CONCLUSIONS Future interventions aimed at improving access to and recovery from surgery for rural patients should take into account the unique perspectives of rural patients. Addressing the socioecological factors surrounding rural surgery patients, such as healthcare, family, and community resources, will be key to improving postoperative recovery.
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Affiliation(s)
- Jordan E Johnson
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | - Brian T Cain
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jessica N Cohan
- Department of Surgery, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Mark Savarise
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Alex H S Harris
- VA HSR&D Center for Innovation to Implementation, Palo Alto VA Health Care System, Washington, District of Columbia
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
| | - Lyen C Huang
- Department of Surgery, University of Utah, Salt Lake City, Utah; Huntsman Cancer Institute, Salt Lake City, Utah
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Leung VWY, Baldini G, Liberman S, Charlebois P, Stein B, Feldman LS, Fiore JF Jr, Lee L. Tolerating clear fluids diet on postoperative day 0 predicts early recovery of gastrointestinal function after laparoscopic colectomy. Surg Endosc 2022; 36:9262-72. [PMID: 35254522 DOI: 10.1007/s00464-022-09151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/17/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION A high proportion of colorectal surgery patients within an enhanced recovery pathway (ERP) do not experience complications but remain hospitalized mainly waiting for gastrointestinal (GI) recovery. Accurate identification of these patients may allow discharge prior to the return of GI function. Therefore, the objective of this study is to determine if tolerating clear fluid (CF) on postoperative day (POD) 0 was associated with uncomplicated return of GI function after laparoscopic colorectal surgery. METHODS Pooled data from three prospective studies from a single specialist colorectal referral center were analyzed (2013-2019). The present study included adult patients that underwent elective laparoscopic colectomy without stoma. Postoperative GI symptoms were collected daily in all three datasets. The main exposure variable, whether CF diet was tolerated on POD0, was defined as patients drinking at least 300 mL of CF without any nausea, anti-emetics, or vomiting (CF+ vs CF-). The main outcome measure was time to GI-3 (tolerating solid diet and passage of gas or stools). RESULTS A total of 221 patients were included in this study, including 69% CF+ and 31% CF-. The groups were similar in age, gender, and comorbidities, but the CF- patients were more likely to have surgery for inflammatory bowel disease. CF+ patients had faster time to GI-3 (mean 1.6d (SD 0.7) vs. 2.3d (SD 1.5), p < 0.001). The CF+ group also experienced fewer complications (19% vs. 35%, p = 0.009), shorter mean LOS (mean 3.6d (SD 2.9) vs. 6.2d (SD 9.4), p = 0.002), and were more likely to be discharged by the target LOS (66% vs. 50%, p = 0.024). CONCLUSION Toleration of CF on POD0 was associated with faster return of GI function, fewer complications, and shorter LOS. This may be used as a criteria for potential discharge prior to full return of GI function after laparoscopic colectomy within an ERP.
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Pook M, Elhaj H, El Kefraoui C, Balvardi S, Pecorelli N, Lee L, Feldman LS, Fiore JF. Construct validity and responsiveness of the Duke Activity Status Index (DASI) as a measure of recovery after colorectal surgery. Surg Endosc 2022; 36:8490-8497. [PMID: 35212822 DOI: 10.1007/s00464-022-09145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/15/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Returning to preoperative levels of physical function is highly valued by patients recovering from surgery. The Duke Activity Status Index (DASI, a 12-item questionnaire) may be a simple yet robust tool to assess postoperative recovery of functional capacity. This study assessed construct validity and responsiveness of the DASI as a measure of recovery after colorectal surgery. METHODS Data from a trial on early mobilization after colorectal surgery were analyzed. Patients completed the DASI questionnaire preoperatively and at postoperative weeks (POW) 2 and 4. Construct validity was assessed by testing the primary a priori hypotheses that postoperative DASI scores (1) are higher in patients without vs with postoperative complications and (2) correlate with six-minute walk test distance (6MWD). Exploratory analyses assessed the association between DASI scores and (1) preoperative physical status [higher (ASA ≤ 2) vs lower (ASA > 2)], (2) stoma creation (no stoma vs stoma), (3) age [younger (≤ 75 years) vs older (> 75 years)], (4) time to readiness for discharge [shorter (≤ 4 days) vs longer (> 4 days)], and (5) surgical approach (laparoscopic vs open). Responsiveness was assessed by testing a priori hypotheses that DASI scores are higher (1) preoperatively vs at POW2 and (2) at POW4 vs POW2. Mean differences in DASI scores were obtained using linear regression. The association between DASI and 6MWD was assessed via Pearson correlation. RESULTS We analyzed data from 100 patients undergoing colorectal surgery (mean age 65; 57% male; 81% laparoscopic). Mean DASI scores were 47.9 ± 12.1 preoperatively, 22.4 ± 12.7 at POW2, and 33.2 ± 15.7 at POW4. The data supported our two primary construct validity hypotheses, as well as 3/5 exploratory hypotheses. Both responsiveness hypotheses were supported. CONCLUSIONS Our findings support that the DASI questionnaire can be a useful tool to assess postoperative recovery of functional capacity in research and clinical practice.
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Affiliation(s)
- Makena Pook
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Charbel El Kefraoui
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Saba Balvardi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Nicolo Pecorelli
- Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.
- Department of Surgery, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Ave, R2-104, Montreal, QC, H3G 1A4, Canada.
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Rineau E, Dumartinet B, Samson E, Dollfus A, Aubourg C, Lasocki S. Sufentanil sublingual tablet system for enhanced recovery after total knee arthroplasty: a prospective observational case study. Perioper Med (Lond) 2022; 11:50. [PMID: 36195919 PMCID: PMC9531461 DOI: 10.1186/s13741-022-00284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative pain is one of the main factors that delays recovery after prosthetic knee surgery. The use of sufentanil sublingual tablet systems (SSTS) can effectively relieve postoperative pain, but their value in facilitating early mobilization has been little studied so far. Our aim here was to assess whether their use could facilitate recovery after knee arthroplasty in an enhanced recovery program. CASE PRESENTATION In a prospective observational single-center study, thirty patients operated on for primary knee arthroplasty in the enhanced recovery pathway were included. Patients who received the SSTS (n=15) were compared with those who received an intravenous morphine patient-controlled analgesia (PCA) (n=15). Our recovery program included in particular the use of an adductor canal block, periarticular infiltration of local anesthetic by the surgeon, removal of the venous cannula from the recovery room if possible, the use of an SSTS when available or an IV morphine PCA otherwise, and early physiotherapy. Recovery parameters including the Timed-Up and Go test, pain scores at rest and on exertion, knee flexions, complications, and lengths of hospital stay were not significantly different between the two groups. However, the postoperative opioid consumption in morphine equivalents was significantly greater in the SL-sufentanil group and these patients had their venous cannula removed earlier than in IV-morphine group. CONCLUSION In our center, the use of a SSTS was suitable for treating postoperative pain after knee arthroplasty, but it did not improve early recovery in comparison with a morphine PCA.
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Affiliation(s)
- Emmanuel Rineau
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France.
| | - Benjamin Dumartinet
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Emmanuel Samson
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Apolline Dollfus
- Department of Anesthesiology and Intensive Care, University Hospital of Rennes, Rennes, France
| | - Corentin Aubourg
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
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Brandon CA, Friedman S, Rosenblum N, Escobar CM, Stewart LE, Brucker BM. The PSR13, a tool for evaluating patient-perceived recovery after vaginal prolapse repair surgery. Int Urogynecol J 2022. [PMID: 36166063 DOI: 10.1007/s00192-022-05372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Surgical recovery is the return to preoperative functional, psychologic, and social activity, or a return to normalcy. To date, little is known about the global post-surgical recovery experience from the patients' perspective. The aim of this study was to validate the Post-Discharge Surgical Recovery scale 13 (PSR13) in women undergoing vaginal prolapse repair procedures and evaluate the patient-perceived postoperative recovery experience over a 12-week period. METHODS Fifty women undergoing vaginal prolapse repairs completed the PSR13 and global surgical recovery scale (GSR) at 1, 2, 4, 6, and 12 weeks post-surgery. Validity, the minimal clinically important difference (MCID), and responsiveness to change over time of the PSR13 was evaluated using descriptive statistics and linear regression models. The proportion of patients deemed fully recovered at each time point (defined as PSR13 score ≥ 80) was also assessed. RESULTS The PSR13 correlated significantly (p < 0.001) with the single-item recovery scale and showed excellent internal consistency reliability (Cronbach α = 0.91, range 0.77 to 0.93). The MCID was estimated at 7.0 points. The PSR13 scores improved at varying rates over time, with the greatest amount of patient-perceived recovery occurring between 4 and 6 weeks after surgery. The proportion of patients deemed fully recovered at 6- and 12- weeks postoperatively was 37% and 56%, respectively. CONCLUSIONS The PSR13 is a useful instrument to assess overall return to normalcy from the patient's perspective and can be applied to evaluate the recovery experience among women undergoing vaginal prolapse repairs, in both the research and clinical setting.
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Linton SC, De Boer C, Tian Y, Alayleh A, Bouchard ME, Figueroa A, Kwon S, Holl JL, Ghomrawi HM, Abdullah F. Effect of consumer-grade wearable device data on clinician decision making during post-discharge telephone calls after pediatric surgery. J Pediatr Surg 2022; 57:137-142. [PMID: 34732297 DOI: 10.1016/j.jpedsurg.2021.09.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND During post-discharge telephone calls after pediatric surgery, clinicians must rely on parents/caregivers' assessment of symptoms, which can be inaccurate and often lead to unnecessary emergency department (ED) visits. Physiology (heart rate and physical activity) data from consumer-grade wearables, e.g., Fitbit™, may inform clinical decision making, yet there has been little study of clinician interpretation of this data. This study assessed whether wearable data availability, during simulated telephone calls about postoperative, post-discharge pediatric patients, affects clinician decision making. METHODS Three simulated telephone call scenarios were presented to a diverse group of pediatric surgery clinicians. The scenarios were based on actual postoperative patients (scenarios 1 and 3 have worrisome symptoms and scenario 2 has non-worrisome symptoms) who had worn a Fitbit™ postoperatively. Each scenario was presented to clinicians (1) without any wearable data; (2) with "concerning" wearable data; and (3) with "reassuring" wearable data. Clinicians rated their likelihood, on a scale of 1-10, of recommending an emergency department (ED) visit for the three instances of each scenario, 10 being definitely ED. RESULTS Twenty-four (24) clinicians participated in the study. When presented with "reassuring" wearable data, clinicians' likelihood of recommending an ED visit decreased from a median score of 6 to 1 (p < 0.001) for scenario 1 and from 9 to 3 (p < 0.001) for scenario 3. When presented with "concerning" wearable data, the median likelihood of recommending an ED visit increased from 1 to 6 (p = 0.003) for scenario 2. CONCLUSION This study showed that wearable data affect clinicians' decision making and may be useful in triaging postoperative, post-discharge pediatric patients. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Samuel C Linton
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States; Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States
| | - Christopher De Boer
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States; Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yao Tian
- Surgical Outcomes Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amin Alayleh
- Rosalind Franklin University of Medicine and Science, Chicago, IL, United States
| | - Megan E Bouchard
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States
| | - Angie Figueroa
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States
| | - Soyang Kwon
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division, University of Chicago, Chicago, IL, United States; Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, United States
| | - Hassan Mk Ghomrawi
- Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States; Department of Medicine, Rheumatology division, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States; Department of Pediatrics, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States
| | - Fizan Abdullah
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, United States; Department of Surgery, Northwestern School of Medicine, Northwestern University, Chicago, IL, United States.
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Redmond S, Tilburt J, Cheville A; Mayo Clinic NOHARM Research Team. Non-pharmacological Options in Postoperative Hospital-Based and Rehabilitation Pain Management (NOHARM): Protocol for a Stepped-Wedge Cluster-Randomized Pragmatic Clinical Trial. Pain Ther 2022; 11:1037-53. [PMID: 35657564 DOI: 10.1007/s40122-022-00393-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Opioids may be necessary for guideline-concordant acute perioperative pain management, but their use carries risks for unintended prolonged use and addiction. Guidelines recommend use of validated non-pharmacological pain care (NPPC) approaches in conjunction with prescribed opioids and other analgesics. Our protocol outlines a population-level, pragmatic trial that will test a bundled intervention comprised of an electronic health record (EHR) portal-based conversation guide, EHR clinical decision support (CDS), and a suite of self-management educational and support materials to encourage and advance NPPC use. METHODS We are conducting a stepped-wedge, cluster-randomized pragmatic trial spanning seven surgical specialties across six geographically diverse locations within the Mayo Clinic Enterprise. Thirty two surgical practices across six locations (Rochester, Minnesota; Mankato, Minnesota; La Crosse, Wisconsin; Eau Claire, Wisconsin; Phoenix, Arizona; Jacksonville, Florida) comprise 22 distinct practice clusters that are randomly assigned to one of five steps using constrained randomization. Steps "go live" by initiating the intervention at 7-month intervals between March 2021 and July 2023. Patients over 18 years of age who are scheduled for qualifying procedures within "live" consenting practices are sent a Healing After Surgery guide via their patient portals pre-operatively, directing them to identify their preferred NPPC modalities among 13 approaches. These selections create CDS options for care teams to support patients with self-management materials that reinforce safe NPPC use. PLANNED OUTCOMES Patients' clinical, demographic, and outcome data will be abstracted from the Epic EHR. Primary outcomes will be the Patient Reported Outcomes Measurement Information System (PROMIS) pain interference and physical functioning computer adaptive tests (CAT) collected at 1, 2, and 3 months postoperatively via the patient portal. We will mail printed versions of the 6-item PROMIS short forms to portal non-responders to minimize bias. Secondary outcomes will include the PROMIS anxiety CAT, opioid consumption, and self-reported NPPC use. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04570371.
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