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Combined vascular malformation affecting the facial region is an extremely rare clinical entity that is debilitating both functionally and emotionally. Treatment warrants a multidisciplinary approach with the aim of removing the vascular anomalies and ameliorating any functional facial disfigurement. Here, we present a case of a 40-year-old female with combined vascular malformation of the face who was treated successfully with surgical intervention accompanying significant resolution of facial disfigurement.
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INTRODUCTION: Varicose veins are a common vascular problem with a high prevalence, yet they are often neglected. The main objective of this study was to explore the patient satisfaction after varicose vein surgery, along with its predicting factors. To our knowledge, no similar study has been conducted in Nepal to date. METHODOLOGY: This retrospective cross-sectional study included patients who underwent varicose vein surgery at Dhulikhel Hospital from September 2019 to February 2020. The satisfaction level after the surgery was assessed using a 10-point Likert scale questionnaire during a telephone interview with their verbal consent. Descriptive statistics and linear regression were performed to identify the predicting factors of patient satisfaction. RESULTS: Among a total of 84 patients interviewed, 53.6% were male. The mean age of the participants was 43.13 ± 13.62 years. The mean patient satisfaction score was 42 ± 5.5, with nursing service, discharge teaching and hospital service being the highest scoring items in terms of patient satisfaction. Linear regression revealed age ≤40 years as a predictor of higher patient satisfaction (ß=0.258, p=0.015) while early stage of varicose veins (ß=-0.233, p=0.026) and duration of post-operative follow-up (ß=-0.25, p=0.021) were negative predictors of patient satisfaction. This means that patients with C2-C3 venous disease and longer duration of postoperative follow-up tended to have lower satisfaction scores. CONCLUSION: The overall patient satisfaction following varicose vein surgery was very good, and the major predictors of better satisfaction were age ≤40 years, C4-C6 clinical classification of venous disease and the shorter duration of follow-up after surgery.
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Satisfação do Paciente , Varizes , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Feminino , Resultado do Tratamento , Estudos Retrospectivos , Nepal , Estudos Transversais , Varizes/cirurgia , Hospitais , Veia Safena/cirurgiaRESUMO
Background Acute appendicitis is one of the most common causes of acute abdomen requiring surgical treatment. Accurately diagnosing appendicitis and identifying complicated appendicitis can be difficult at times. Objective To evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to differentiate between uncomplicated and complicated appendicitis. Method This was a prospective hospital-based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from July 2021 to December 2022. Patients with the clinical diagnosis of acute appendicitis who had undergone emergency appendectomy were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 218 patients were included in the study. Male: female ratio was 1.18:1. Mean age of patients was 28.58 ± 16.65 (3-78) years. A significant correlation was found between increasing neutrophil count and neutrophil-to-lymphocyte ratio with complicated appendicitis. However, no significant correlation was found between White Blood Cell counts and complicated appendicitis. Neutrophil-to-lymphocyte ratio > 12.6 was found to be associated with complicated appendicitis. Conclusion A simple, cost-effective, and yet perfect test is not available for identifying complicated appendicitis. Increased Neutrophil count and neutrophil-to-lymphocyte ratio can indicate complicated appendicitis. Elevated WBC counts alone has no role in differentiating complicated appendicitis. According to the results of our study, an neutrophil-to-lymphocyte ratio of 12.6 can help to differentiate complicated from uncomplicated appendicitis.
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Apendicectomia , Apendicite , Linfócitos , Neutrófilos , Humanos , Apendicite/diagnóstico , Apendicite/cirurgia , Apendicite/sangue , Masculino , Feminino , Nepal , Adulto , Estudos Prospectivos , Pessoa de Meia-Idade , Adolescente , Idoso , Adulto Jovem , Hospitais Universitários , Criança , Pré-Escolar , Contagem de Leucócitos , Contagem de LinfócitosRESUMO
Background Laparoscopic Cholecystectomy (LC) is the gold-standard surgery for symptomatic cholelithiasis with low mortality and morbidity. Objective The main objective of this study is to study the outcomes of laparoscopic cholecystectomy in Dhulikhel Hospital over the period of seven years. Method The records of all the patients who underwent laparoscopic cholecystectomy in Dhulikhel Hospital from January 1, 2015, to December 31, 2021 were reviewed. Patient demographics, indication of surgery, hospital stay, and number of conversions to open cholecystectomy were collected. The percentage, mean and median were calculated for socio-demographic information and Chi-square test was performed to measure the association between socio-demographic characteristics, duration of hospital stay, and operative procedure. Result Out of 2106 patients who underwent laparoscopic cholecystectomy from January 1, 2015, to December 31, 2021, 584 (27.73%) were male, and 1522 (72.27%) were female. The female-to-male ratio was 2.6:1. The median age of the patients was 40 years (IQR=52-30). Most common indications for surgery were symptomatic cholelithiasis in 1740 (82.62%) patients along with chronic cholecystitis in 268 (12.73%) patients, and Post ERCP Cholecystectomy in 92 (4.37%) patients. Median hospital stay was three days. Out of 2106 cases, 24 cases were converted to open cholecystectomy. Conclusion Laparoscopic cholecystectomy is the gold standard treatment for benign diseases of the gallbladder and can be performed safely as day care surgery to reduce the cost, length of hospital stay, and long waiting list in low and middle-income countries.
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Colecistectomia Laparoscópica , Colelitíase , Tempo de Internação , Centros de Atenção Terciária , Humanos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistectomia Laparoscópica/métodos , Masculino , Nepal , Feminino , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Pessoa de Meia-Idade , Tempo de Internação/estatística & dados numéricos , Colelitíase/cirurgia , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Background Pneumothorax is a condition in which air or other gas is present in the pleural cavity. Mainstay of management of pneumothorax is to remove the air from the pleural space usually done by chest tube insertion. There is still uncertainty whether minimal invasive management with pigtail catheter is sufficient for the management of pneumothorax. Objective To find the effectiveness, safety, tolerability, efficacy of pigtail catheters and large bore chest tubes. Method Prospective comparative study was done in Dhulikhel Hospital between August 2019 till August 2021. Chest tube insertion used to be the only available treatment modality till December 2020 (15 months). Following January 2021 after obtaining ethical clearance for use of pigtail insertion for pneumothorax, this treatment modality was done (8 months). Result Among 76 patients, 52(68.4%) underwent a large bore chest tube and 24 (34.6%) pigtail catheter patients. Mean age of the patients was 48 years (SD 18.01). Duration of hospital stay and length of hospital stay was more in large bore catheters and less in pigtail catheters. Eight hours post tube placement of the expansion of the lungs was present in pigtail and was statistically significant. Pain killer used in pigtail catheters was limited to Non-steroidal anti-inflammatory drugs, for large bore catheter opioids were added and were statistically significant. Conclusion Pigtail catheter is nearly effective as compared to traditional wide bore catheters.
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Tubos Torácicos , Pneumotórax , Humanos , Pessoa de Meia-Idade , Tubos Torácicos/efeitos adversos , Pneumotórax/terapia , Estudos Prospectivos , Resultado do Tratamento , Drenagem/métodos , Catéteres , Anti-InflamatóriosRESUMO
INTRODUCTION AND IMPORTANCE: Klippel-Trenaunay Syndrome (KTS) is a rare congenital vascular disorder characterized by capillary malformation, varicosities, and tissue overgrowth. It usually affects the unilateral lower extremities manifesting commonly as pain, localized rise of temperature, and venous tortuosity. However, in severe cases, ulceration, cellulitis, and chronic lymphatic malformation may be present. Management is mostly supportive and involves the use of compression stockings. CASE PRESENTATION: Here, we report a case of KTS with a persistent lateral marginal vein of Servelle managed with radiofrequency ablation along with sclerotherapy of selected perforators. On a two-year follow-up, the symptoms had resolved and Doppler ultrasonography revealed resolution of the defective vein along with the absence of incompetent perforators. CLINICAL DISCUSSION: In cases with venous malformation with the persistence of embryonic avalvular venous structures, like the lateral marginal vein of Servelle, surgical intervention is warranted especially at a younger age to reduce the risk of future thromboembolic events and recurrence. CONCLUSION: Varicosities of the lateral marginal vein of Servelle can be managed successfully by radiofrequency ablation and adjunct sclerotherapy in selected cases.
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Background Lung cancer is one of the leading cause of cancer related death. Most common histopathology of lung cancer is non-small cell carcinoma of which adenocarcinoma is the most common. There are limited number of studies done in Nepal to know different aspects of lung cancer. Objective To know demographic parameters of patients diagnosed as lung cancer in a university hospital. The study also aims to know the different histopathological diagnosis of lung cancer. Method All the patients presenting to outpatient department (Cardio Thoracic and Vascular unit) of Dhulikhel Hospital, if are diagnosed as cancer of lung/bronchus will be included in the study. The duration of the study was January 2017 to December 2021. The details on age, gender, presenting symptoms, histopathology of lung cancer, operability will be included in database and will be analyzed. Result There were total of 127 patients diagnosed as lung cancer. Male:female ratio was 1.7:1. Overall mean age was 63.23 years (SD 13.5 years, Range 19-89 years). Non small cell carcinoma was the most common type of lung cancer with 83.7%. In non small cell carcinoma, most common type was Squamous cell carcinoma followed by undifferentiated and Adenocarcinoma. Only five (3.93%) cases were in operable stage. Conclusion Despite the fact that lung cancer is one of the most common cancer, patients usually present late and moslty are not in operable stage. This study shows that squamous cell carcinoma is the most common histopathology in lung cancer cases.
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Adenocarcinoma , Carcinoma de Células Escamosas , Neoplasias Pulmonares , Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Pacientes Ambulatoriais , Nepal/epidemiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Hospitais Universitários , Estudos RetrospectivosRESUMO
Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe lifethreatening hemoptysis, particularly when other treatment options are unavailable or ineffective.
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Embolização Terapêutica , Embolia Pulmonar , Tuberculose Pulmonar , Adulto , Humanos , Masculino , Artérias Brônquicas , Hemoptise/etiologia , Hemoptise/terapia , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/terapiaRESUMO
Background Varicose vein is one of the commonest problems that patients visit to a vascular out patient services (OPD). It causes a great deal of morbidity in today's population. Objective To see the correlation between the size of great saphenous and Saphenofemoral junction incompetence. Method From January 2019 till January 2020, 396 patients with symptomatic or clinically diagnosed varicose veins were screened for Saphenofemoral junction reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral measurements. Best saphenous vein diameter cutoff for predicting reflux was determined using receiver operating characteristics curve analysis. Result Out of 792 limbs, the Great Saphenous Venous System was involved in 452 limbs, the Short Saphenous Venous System was involved in 151 limbs and significant perforators were present in 240 limbs. Mean great Saphenous Vein diameter of diseased limb (Reflux Positive) was 5.68 mm and 4.0 mm in control group (Reflux Negative). Mean Saphenofemoral junction diameter was 8.23 mm in diseased limbs and 6.16 mm in control limbs. Receiver operating characteristics curve showed great saphenous vein diameter at femoral condyle of 4.5 mm as best cut-off value for diagnosis of sapheno femoral junction reflux. Conclusion Great Saphenous Vein diameter at femoral condyle of 4.5 mm is the best cut-off value for diagnosis Saphenofemoral junction reflux. The Sensitivity and specificity of this cut off value is 81.8% and 71% respectively.
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Veia Safena , Varizes , Humanos , Veia Femoral , FêmurRESUMO
Intrathoracic schwannoma are highly vascular nerve sheath benign tumors arising from neural crest derived schwann cells of the intercostal nerves. Common clinical presentation is palpable mass but in our case patient presented with shortness of breath which is rare presentation in Schwannoma. Imaging studies of the patient showed the lesion in left lung, however surgical finding showed mass to arise from chest wall and it was confirmed to be schwannoma by histopathological examination.
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Neurilemoma , Humanos , Neurilemoma/patologia , Neurilemoma/cirurgia , DispneiaRESUMO
End Stage Renal Disease is a last stage of Chronic Kidney Disease which is characterized by Glomerular Filtration rate of less than 15 ml/min/1.73 m2 . Hemodialysis is the most commonly used modality for treatment of Chronic Kidney disease. Among the access for hemodialysis arteriovenous fistula is the most common modality. However most common problems of fistula are significant stenosis of more than 50% which is characterized by limb swelling, pigmentation, tortuous veins, and difficulty maintaining flow during dialysis from AV fistula. These can be managed either by minimal intervention or with surgical intervention. Very few hospitals in Nepal and other countries have an angiographic suite to perform minimal intervention include angiogram with angioplasty. So in this case we try to address the use of C-Arm to perform angiogram or fistulogram and even angioplasty for the management of significant stenosis or complications of arteriovenous fistula.
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Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Insuficiência Renal Crônica , Angiografia , Angioplastia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Constrição Patológica , Hospitais Universitários , Humanos , Nepal , Diálise Renal , Resultado do TratamentoRESUMO
Background There is currently no data showing the prevalence of peripheral arterial disease in Nepal, although they have a high incidence of risk factors in their population such as diabetes, hypertension, and high volume of smoke inhalation. Objective To quantify a gap in medical education curriculum in Nepal as it pertains to medical trainees that have a lack of exposure to peripheral arterial disease (PAD) in a clinical setting as well as improve lecture quality on peripheral arterial disease. Method A survey was sent out to 615 medical trainees in Nepal with a survey completion rate of 44%. The results indicate that both medical students and intern doctors feel most confident in their ability to diagnose peripheral arterial disease and comfortable ordering a workup for peripheral arterial disease when their education includes both a dedicated lecture and care of a patient. Result The self-reported ability to diagnose peripheral arterial disease increased in medical students from 21.9% in the lecture only group to 44.4% in the group who had both lecture and cared for a patient. The current curriculum at the Kathmandu University School of Medical Sciences only allows two hours in the medical school to cover all vascular topics and is taught with a traditional PowerPoint method. Conclusion To improve this area of curriculum, we recommend increasing the allotted time for lectures as well as demonstrate on live patients the evaluation for peripheral arterial disease.
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Doença Arterial Periférica , Estudantes de Medicina , Humanos , Nepal/epidemiologia , Faculdades de Medicina , Currículo , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , FumaçaRESUMO
Background Health information system is an integral component of a country's capacity to integrate, process, report, and use information in improving health services. Objective This study aims to assess the infrastructure and capacity of the national Health information system to address cardiovascular diseases in Nepal. Method We adopted the United States Agency for International Development manual "The Health System Assessment Approach: A How-To Manual", Version 2.0. Three topical areas: input, process and output, were identified. Stepwise approach for Health information system assessment was done. A desk review and key informant interview was performed. Audio recordings were transcribed in Nepali language and intercoder reliability was checked. Result The upgraded District Health Information Software 2.3 provides a comprehensive online data management solution. Sustainable funding to upgrade the system exists. Annual report provides performance of all the components of the health care delivery system. Data were reviewed quarterly. However, no dedicated section for cardiovascular diseases in the Health information system is present. Private health facilities are poorly represented. Strategic planning, management, and evaluation of the Health information system are lacking. Inadequacy of timeliness, completeness, and periodicity of the reporting still exist. Conclusion A separate section of cardiovascular diseases in the Health information system is required. Better reporting of private sectors and its inclusion in databases is of utmost importance. Adaptation in the recently introduced federal structure is key for development of Health information system in the country.
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Doenças Cardiovasculares , Sistemas de Informação em Saúde , Doenças Cardiovasculares/epidemiologia , Serviços de Saúde , Humanos , Avaliação das Necessidades , Nepal , Reprodutibilidade dos TestesRESUMO
A varicose vein is a common venous condition which affects the great saphenous vein and small saphenous vein causing symptoms of pain, edema, itchiness, pigmentation, and ulceration. There are various modalities of the treatment of varicose veins; however, radiofrequency ablation is among the tested and proven treatments for varicose veins. With every case, there can be some unexpected or interesting scenarios which can pose both technical and surgical difficulties. The main objective of this paper is to introduce these scenarios which can occur despite following the standard protocol and methods both preoperatively and intraoperatively. In these scenarios, the surgeon quickly need to decide how to deal with the aberrations. Based on extensive literature and consensus of a team of three vascular surgeons, lists of interesting scenarios were prepared along with their definition. Any occurrences of such scenarios were noted in the operation theatre note. Here, we describe 39 (6.38%) interesting cases among 611 cases of radiofrequency ablation that was performed in Dhulikhel Hospital, Kathmandu University Hospital, from January 2014 until December 2019. Despite following the proper protocol, we can face many unexpected challenges preoperatively, peroperatively, and postoperatively. From this article, we concluded that vigilance of all the factors and proper Doppler ultrasonography can help in identifying most of these scenarios and aid in making proper surgical planning.
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INTRODUCTION: Diaphragmatic eventration can be congenital or acquired. Diagnosis is delayed due to no symptoms or very mild ones and is generally done by imaging modalities. This condition is managed by plication of the affected part of diaphragm by various surgical approaches. PRESENTATION OF CASE: A forty seven years lady presented with one year long history of abdominal pain, bloating and fullness after meals who was being treated in line of peptic acid disorder. She had developed bilateral foot drop after typhoid fever at seventeen years of age. Clinical examination and imaging with chest x-ray, chest ultrasound and computed tomography scan suggested eventration of left hemidiaphragm. Plication of eventration of left hemidiaphragm was done via mini thoracotomy of the left thorax. There were no postoperative complications and she was discharged on the sixth postoperative day. DISCUSSION: Acquired eventration of diaphragm is commonly due to traumatic phrenic nerve palsy but rarely can be associated with a history of infection causing nerve palsies. Thoracic ultrasound is an emerging modality for diagnosis supporting X-rays and CT Scans. Plication of eventration with minimally invasive techniques has less number of hospital stay and less pain compared to open approaches. CONCLUSION: Non-traumatic diaphragmatic eventration due to acquired phrenic nerve palsy following an unknown febrile illness is a rare case to be reported in Nepal. The aim of treatment is expansion of intra-thoracic space which is done by plication of the diaphragm.
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Background Varicose vein is one of the most common venous diseases which affect superficial veins especially of lower limb. This disease is characterized by prominent dilated veins, feeling of heaviness, itchiness, pigmentation, ulceration depending upon the stage of the disease. Objective This study was conducted to know how Body Mass Index, Age and Gender influence staging of varicose veins in our context. Method This is a cross sectional hospital based study conducted at Dhulikhel Hospital, Kathmandu University Hospital from April 2018 to March 2019. Patients with signs and symptoms of varicose vein were included in the study. Informed consent was taken from each patient and data collection done by filling the proforma. Result This study comprised 135 lower limbs with varicose vein from 108 patients. Male:Female ratio was 1.4:1. Mean age of patients was 44.47±12.65 (17-81) years. Significant correlation was found between increasing age and progression in Clinical staging of Varicose vein according to Clinical classification (p<0.05). Mean Great Saphenous Vein diameter at knee was found significantly higher in patients with more than five years of symptoms Mean Body Mass Index was not very different in different Clinical stage of Varicose veins. Conclusion This study showed that the Clinical Staging of Clinical Etiological Anatomical and Pathophysiological classification of varicose vein is significantly related to age. The mean diameter of Great Saphenous Vein at the level of Knee is significantly related to the duration of symptoms. However, the influence of Body Mass Index and gender on stages of varicose vein could not be established.
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Varizes , Adulto , Instituições de Assistência Ambulatorial , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veia Safena , Varizes/diagnóstico por imagemRESUMO
Background There are various methods of endoluminal ureteral stone fragmentation. Among various modalities Laser lithotripsy and Pneumatic lithotripsy are commonly used and have shown comparable outcomes. Objective To compare the efficacy and outcome of laser and pneumatic lithotripsy in a patient with lower ureteric calculi. The comparison will be done in stone free rate, migration of stone and complication of the procedure. Method This is a prospective comparative study in a cohort of patients at University Hospital with Lower Ureteric stone. Ninety patients were randomized in to two groups (Laser Lithotripsy Vs Pneumatic Lithotripsy) during the study period. The purpose of this study was to measure the immediate stone free rate, intra-operative complications, mean operative time, post-operative complication and if any stone retention after six weeks follow up. Result Both the groups were similar in Age and Gender. Immediate stone free rate was slightly higher in Laser lithotripsy group (97.77%) in comparison to Pneumatic lithotripter group (84.44%) with p=0.507 which is not statistically significant. There was statistical difference in terms of stone migration rate, mean operation time in favor of Laser Lithotripsy group (p<0.01, in both parameters). There were no immediate complications in both the group however there were three cases of short segment ureteric strictures (6.66%) in case of Pneumatic lithotripsy on six weeks follow up which was managed conservatively. Conclusion Both LASER lithotripter and Pneumatic lithotripter are equally efficacious modality of endoluminal URSL in lower ureteric stone with similar Stone Free Rate. Laser lithotripsy showed lower frequency of stone migration and had shorter procedure time.
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Lasers de Estado Sólido , Litotripsia , Cálculos Ureterais , Humanos , Lasers de Estado Sólido/uso terapêutico , Nepal , Estudos Prospectivos , Resultado do Tratamento , Cálculos Ureterais/terapia , UreteroscopiaRESUMO
Aortic aneurysms are abnormal dilatation of aorta. The risk factors include male sex, age > 65, smoking, coronary artery disease and hypertension. Here we report a case of infra-renal abdominal aortic aneurysm (AAA) of diameter 6 cm. The patient sucessfully underwent aorto-biiliac bypass surgery using Dacron Y graft. During abdominal aortic aneurysm surgery anesthetic challenge is also of paramount importance and should be considered.
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Aneurisma da Aorta Abdominal , Hipertensão , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Rim , Masculino , Nepal , Fatores de RiscoRESUMO
Background Cardiopulmonary resuscitation is the foundational technique for the emergency treatment of cardiac arrest and the standardized training of it has been emphasized more than ever. Competence of the nurses in this lifesaving procedure is a critical factor in patient outcome from cardiac arrest and can largely prevent sudden death. Objective Many evidences suggest lack of knowledge on proper cardiopulmonary resuscitation among nurses so the aim of this study was to assess the knowledge on 2015 American Heart Association guidelines update for cardiopulmonary resuscitation among nurses working at University hospital and to identify the relationship between the level of knowledge and selected variables. Method Two hundred and sixty nurses working in Dhulikhel hospital participated in the study. A cross-sectional descriptive study was conducted using a predesigned questionnaire based on 2015 guidelines updates for cardiopulmonary resuscitation that incorporated total of 20 questions. Result Total 260 participated in the study and all were female. Only one third of the nurses had good knowledge regarding 2015 guidelines update for cardiopulmonary resuscitation. No significant results existed between the knowledge score and age of the nurses, duration of work experience. However, significant results existed between the knowledge score and qualification, designation of the nurses and previous training on cardiopulmonary resuscitation. Conclusion One third of the nurses had good knowledge regarding 2015 guidelines update for cardiopulmonary resuscitation in this study. Thus, knowledge and practical approach has to be updated with current guidelines in cardiopulmonary resuscitation in order to improve the safety and effectiveness of patient care.
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Reanimação Cardiopulmonar , Parada Cardíaca , American Heart Association , Estudos Transversais , Feminino , Parada Cardíaca/terapia , Hospitais Universitários , Humanos , Estados UnidosRESUMO
Background Cardio-thoracic surgery involves open and minimally invasive techniques. Enhanced recovery after surgery is used for early recovery from surgery. Enhanced recovery after surgery decreases hospital stay duration. Patients undergoing Enhanced recovery after surgery after video assisted thoracic surgery use less pain killers and have less hospital cost. There has not been any study on outcomes on patient who follow physiotherapy protocol designed in our setting. Objective To find the physiotherapy outcomes in patients undergoing thoracic enhanced recovery after surgery (T-ERAS) based 14 step protocol locally designed at Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH). Method This is a retrospective cross sectional observational study. All the cases who underwent cardiothoracic surgery were classified based on the approach of chest surgery performed into groups Sternotomy, Thoracotomy and Video Assisted Thoracic Surgery (VATS) groups. Patients were advised for Thoracic Enhanced recovery after surgery based on the protocol that has been devised at Dhulikhel Hospital. The recovery of patients based on activities they could perform was noted and analyzed. Result Both ICU stay and hospital stay in number of days were highest in thoracotomy (6.04 days) group while that was lowest in video assisted thoracic surgery group (1.67 days). There is a similar recovery until step 5, i.e. 2 days and rapid progression in further steps in video assisted thoracic surgery group while it is much slower in both sternotomy and thoracotomy groups. Conclusion Postoperative mobilization and physiotherapy enhance early healing and decrease hospital stay. Mean hospital stay and ICU stay were shorter for video assisted thoracic surgery cases compared to Thoracotomy and Sternotomy groups and the mean days to achieve different steps varied within the protocol between groups compared.