RESUMO
OBJECTIVE: This meta-analysis aims to evaluate the effectiveness of adaptive support ventilation (ASV) in facilitating postoperative weaning from mechanical ventilation in cardiac surgery patients. DESIGN: A systematic review and meta-analysis to assess ASV in weaning postoperative cardiac surgery patients. Outcomes included early extubation, reintubation rates, time to extubation, and lengths of intensive care units and hospital stays. SETTING: We searched electronic databases from inception to March 2023 and included randomized controlled trials that compared ASV with conventional ventilation methods in this population. PARTICIPANTS: Postoperative cardiac surgery patients. MEASUREMENTS AND MAIN RESULTS: A random effects model was used for meta-analysis, and trial sequential analysis (TSA) was conducted to assess result robustness. The meta-analysis included 11 randomized controlled trials with a total of 1027 randomized patients. ASV was associated with a shorter time to extubation compared to conventional ventilation (random effects, mean difference -68.30 hours; 95% confidence interval, -115.50 to -21.09) with TSA providing a conclusive finding. While ASV indicated improved early extubation rates, no significant differences were found in reintubation rates or lengths of intensive care unit and hospital stays, with these TSA results being inclusive. CONCLUSIONS: ASV appears to facilitate a shorter time to extubation in postoperative cardiac surgery patients compared to conventional ventilation, suggesting benefits in accelerating the weaning process and reducing mechanical ventilation duration.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Respiração Artificial , Desmame do Respirador , Humanos , Desmame do Respirador/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Respiração Artificial/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/tendências , Extubação/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do TratamentoAssuntos
Analgésicos Opioides , Metadona , Humanos , Estudos Retrospectivos , Metadona/uso terapêutico , Masculino , Feminino , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Pessoa de Meia-Idade , Cuidados Intraoperatórios/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Resultado do Tratamento , Adulto , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/tendênciasRESUMO
Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH30 ) is a validated and readily obtainable patient-centred outcome measure that integrates much of the peri-operative patient journey. However, the minimal difference in DAH30 that is clinically important to patients is unknown. We designed and administered a 28-item survey to evaluate the minimal clinically important difference in DAH30 among adult patients undergoing inpatient surgery. Patients were approached pre-operatively or within 2 days postoperatively. We did not study patients undergoing day surgery or nursing home residents. Patients ranked their opinions on the importance of discharge home using a Likert scale (from 1, not important at all to 6, extremely important) and the minimum number of extra days at home that would be meaningful using this scale. We recruited 104 patients; the survey was administered pre-operatively to 45 patients and postoperatively to 59 patients. The mean (SD) age was 53.5 (16.5) years, and 51 (49%) patients were male. Patients underwent a broad range of surgery of mainly intermediate (55%) to major (33%) severity. The median minimal clinically important difference for DAH30 was 3 days; this was consistent across a broad range of scenarios, including earlier discharge home, complications delaying hospital discharge and the requirement for admission to a rehabilitation unit. Discharge home earlier than anticipated and discharge home rather than to a rehabilitation facility were both rated as important (median score = 5). Empirical data on the minimal clinically important difference for DAH30 may be useful to determine sample size and to guide the non-inferiority margin for future clinical trials.
Assuntos
Diferença Mínima Clinicamente Importante , Alta do Paciente/tendências , Cuidados Pós-Operatórios/tendências , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/normas , Cuidados Pós-Operatórios/normas , Período Pós-Operatório , Resultado do TratamentoRESUMO
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurologic syndrome that affects the elderly population in a context of concomitant medical conditions. The aim of this study was to understand the significance of comorbidities using 4 validated and specific clinical scores: Cumulative Illness Rating Scale (CIRS), American Society of Anesthesiologists (ASA) score, Comorbidity Index (CMI), and Charlson Comorbidity Index (CCI). METHODS: From 2015 until 2019, the Bologna PRO-Hydro multidisciplinary team selected 63 patients for shunt surgery. All comorbidity scores were collected during preoperative anesthesia evaluation. Positive shunt response was defined as an improvement in overall disability (assessed with modified Rankin Scale [mRS]), in risk of fall (assessed with Tinetti Permormance Orientated Mobility Assessment, Tinetti) and in INPH specific symptoms (assessed with INPH Grading Scale, INPHGS). RESULTS: Patients with elevated values of CIRS had worse performance in gait and balance at Tinetti scale, both before (P = 0.039) and after surgery (P = 0.005); patients with high values of CMI had inferior values of Tinetti at baseline (P = 0.027) and higher mRS after surgery (P = 0.009); ASA 2 patients had better postoperative Tinetti scores than ASA 3 patients (P = 0.027). A positive or negative shunt response was not significantly correlated with patients' preoperative comorbidity scores. CONCLUSIONS: Patients with multiple comorbidities have a worse preoperative condition compared to patients with less concomitant diseases, and the proposed comorbidity scores, CIRS in particular, are useful clinical tools for the anesthesiologist. Comorbidities, though, do not impact overall postoperative outcome.
Assuntos
Derivações do Líquido Cefalorraquidiano/tendências , Hidrocefalia de Pressão Normal/epidemiologia , Hidrocefalia de Pressão Normal/cirurgia , Cuidados Pós-Operatórios/tendências , Acidentes por Quedas/prevenção & controle , Idoso , Comorbidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/cirurgia , Feminino , Seguimentos , Marcha/fisiologia , Humanos , Masculino , Equilíbrio Postural/fisiologia , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/cirurgiaRESUMO
BACKGROUND: Stereotactic needle brain biopsy is a commonly used neurosurgical procedure. However, up to 15% of biopsies result in undiagnostic pathology reports. Repeat biopsy or continued management without a diagnosis are often considered after undiagnostic biopsies. There have been no reports about the role of postoperative imaging in predicting the diagnostic yield of stereotactic biopsies. METHODS: We retrospectively assessed all stereotactic biopsies performed over an 11-year period. We performed fusion of immediate postoperative computed tomography (CT) with preoperative MRI, to document whether the air bubble in the postoperative CT was located within the targeted lesion. We then evaluated the association of this fusion-based accuracy assessment with the diagnostic yield of the biopsy. RESULTS: Fewer than 5% of biopsies did not have an air bubble on postoperative CT. A total of 226 biopsies were performed for 219 patients. In our sample, 213 of 226 biopsies were accurate (94.2% accuracy rate), and 203 of 226 biopsies gave a definitive diagnosis (89.8% diagnostic rate). In those cases where the fusion was accurate, the diagnostic rate was 93.9%. When the fusion was inaccurate, the diagnostic rate was only 23.1% (odds ratio 51.5, 95% confidence interval 12.6-210.44, P < 0.001). Of all patient, imaging, surgical, and admission parameters, the only parameter that correlated with diagnostic outcome of the biopsy was the fusion construct accuracy. CONCLUSIONS: Fusion of immediate postoperative CT with preoperative imaging is predictive of the diagnostic rate. In cases where the pathology report following a biopsy is not diagnostic, this fusion may be useful in making decisions regarding repeat biopsy or considering other diagnostic options.
Assuntos
Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética/tendências , Cuidados Pós-Operatórios/tendências , Cuidados Pré-Operatórios/tendências , Técnicas Estereotáxicas , Tomografia Computadorizada por Raios X/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/métodos , Biópsia por Agulha/tendências , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Técnicas Estereotáxicas/tendências , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
BACKGROUND: Since the start of the COVID-19 pandemic and consequent lockdowns, the use of telehealth interventions has rapidly increased both in the general population and among transplant recipients. Among pediatric transplant recipients, this most frequently takes the form of interventions on mobile devices, or mHealth, such as remote visits via video chat or phone, phone-based monitoring, and mobile apps. Telehealth interventions may offer the opportunity to provide care that minimizes many of the barriers of in-person care. METHODS: The present review followed the PRISMA guidelines. Sources up until October 2020 were initially identified through searches of PsycInfo® and PubMed® . RESULTS: We identified ten papers that reported findings from adult interventions and five studies based in pediatrics. Eight of the adult publications stemmed from the same two trials; within the pediatric subset, this was the case for two papers. Studies that have looked at mHealth interventions have found high acceptability rates over the short run, but there is a general lack of data on long-term use. CONCLUSIONS: The literature surrounding pediatric trials specifically is sparse with all findings referencing interventions that are in early stages of development, ranging from field tests to small feasibility trials. The lack of research highlights the need for a multi-center RCT that utilizes robust measures of medication adherence and other outcome variables, with longer-term follow-up before telehealth interventions should be fully embraced.
Assuntos
COVID-19/prevenção & controle , Acessibilidade aos Serviços de Saúde , Transplante de Órgãos , Pediatria/métodos , Cuidados Pós-Operatórios/métodos , Telemedicina/métodos , Adulto , Atitude Frente a Saúde , Canadá , Criança , Europa (Continente) , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Pediatria/economia , Pediatria/tendências , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/tendências , Telemedicina/economia , Telemedicina/tendências , Estados UnidosRESUMO
BACKGROUND: The delivery of healthcare services by telemedicine decreases costs of traveling for patients, is less time-consuming, and most importantly permits the connection between highly skilled specialists and patients. However, whether the use of telemedicine (text messaging) for LT patients was affected by the COVID-19 pandemic is unknown. METHODS: We collected data (following consent from patients and parents) from 57 patients (33 male/24 female) with a median age of 47 (IQR: 9-91) months, whom we followed up with text messaging between September 2019 and September 2020, spanning the 6 months prior to COVID-19 and during this period. RESULTS: In total, 723 text message mediated consultations occurred during this period, henceforth simply referred to as "messages." Three hundred and twenty-eight (45%) messages occurred during the 6 months up to the start of the pandemic. Following the COVID-19 outbreak, the number of messages increased to 395 (55%). The three most common reasons of messaging were post-liver-LT follow-up messages (n = 215/723, 29.7%), consultations for drug use (n = 157/723, 21.7%), and medication prescriptions (n = 113/723, 15.6%). Protocol biopsy discussions (n = 33/723, 4.6%) and fever (n = 27/723, 3.7%) were among others (vaccination, rash, diarrhea, cough, fatigue, acne). During the COVID-19 outbreak, only post-LT follow-up messages increased significantly to 132/395 (33%) from 83/328 (25%) (p-value: .02). CONCLUSIONS: We found that the pandemic resulted in an increase in the total number of text message mediated consultations and specifically for the use of post-LT follow-up. Messaging was effective for post-LT follow-ups and all patients were at least satisfied.
Assuntos
COVID-19/prevenção & controle , Transplante de Fígado , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidados Pós-Operatórios/tendências , Padrões de Prática Médica/tendências , Telemedicina/tendências , Envio de Mensagens de Texto/tendências , Criança , Pré-Escolar , Feminino , Seguimentos , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Masculino , Satisfação do Paciente , Cuidados Pós-Operatórios/métodos , Estudos RetrospectivosRESUMO
OBJECTIVE: Wound drain used to be a routine procedure after craniotomy for aneurysm clipping, although this was not based on clinical evidence. The purpose of our study was to determine the necessity of wound drain placement after anterior circulation aneurysm surgery. METHODS: Retrospective analysis of patients with anterior circulation aneurysms treated by clipping in the Department of Neurosurgery, Wuhan University Zhongnan hospital from January 2019 to December 2019 was carried out. Demographic and clinical data, including age, sex, body mass index, disease history, results of the laboratory and imaging examinations, and surgical logs, were reviewed. RESULTS: A total of 236 patients (90 male and 146 female) were included in the analysis and were divided into a Drain group and a No Drain group according to whether postoperative wound drainage was applied. There was no statistical difference in the incidence of a postoperative extradural hematoma between patients in the 2 groups. However, the incidence of postoperative meningitis was higher in the Drain group than in the No Drain group (9.09% vs. 1.59%, P = 0.009), and the total length of stay and postoperative length of stay in the Drain group were also more extended than in the No Drain group (17.32 ± 6.45 vs. 14.43 ± 5.75, P = 0.005; 12.83 ± 5.07 vs. 9.82 ± 4.50, P = 0.007, respectively). CONCLUSIONS: Postoperative wound drain did not significantly reduce the incidence of an extradural hematoma after anterior circulation aneurysm surgery. On the contrary, it may be associated with an increased incidence of postoperative meningitis and length of stay. Given these findings, the postoperative drain should be maintained cautiously and meet more rigorous application criteria.
Assuntos
Drenagem/tendências , Aneurisma Intracraniano/cirurgia , Tempo de Internação/tendências , Cuidados Pós-Operatórios/tendências , Instrumentos Cirúrgicos/tendências , Ferida Cirúrgica/terapia , Adulto , Idoso , Craniotomia/efeitos adversos , Craniotomia/tendências , Drenagem/efeitos adversos , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Instrumentos Cirúrgicos/efeitos adversos , Ferida Cirúrgica/diagnóstico por imagemRESUMO
BACKGROUND: Patient satisfaction has become an important variable in assessing outcomes after spine surgery. Although minimally invasive surgery (MIS) techniques have become popular owing to reduced perioperative complications compared with open deformity surgery, whether patient-reported postoperative satisfaction differ between the 2 surgical approaches is unclear. The aim of this study was to characterize postoperative patient-reported outcomes (PRO) in patients who underwent open surgery or MIS for adult spinal deformity (ASD). METHODS: PRO scores were prospectively collected for patients undergoing deformity correction surgery between 2016 and 2018. Inclusion criteria were age >18 years, ASD, and completed PRO surveys. Patient demographic, clinical, and radiographic data and PRO survey responses were analyzed. A post hoc analysis comparing patients who were satisfied with their outcome and those who were unsatisfied was performed. RESULTS: Forty patients who underwent operative management of ASD (19 in the open surgery group and 21 in the MIS group) met the criteria for inclusion in this study. Patients in the MIS group reported higher mental health and self-image scores at 6 months; however, at the 12-month follow-up, both the open surgery and MIS groups reported minimal clinically important differences in back pain, leg pain, and functional status. Patient satisfaction scores did not differ based on surgical approach or intraoperative complications. CONCLUSIONS: PRO after open surgery and after MIS for ASD reflected successful outcomes with significant improvements in PRO survey scores but with subtle differences in the postoperative recovery process. The MIS group reported faster recovery with earlier improvement in self-image and mental health scores, which may stem from correction of smaller deformities. At the 12-month follow-up, postoperative satisfaction was high for the majority of patients in both groups.
Assuntos
Saúde Mental/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Qualidade de Vida , Doenças da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Procedimentos Cirúrgicos Minimamente Invasivos/psicologia , Medição da Dor/psicologia , Medição da Dor/tendências , Cuidados Pós-Operatórios/psicologia , Cuidados Pós-Operatórios/tendências , Estudos Prospectivos , Qualidade de Vida/psicologia , Doenças da Coluna Vertebral/psicologiaRESUMO
BACKGROUND: With hospital leaders and policy makers increasingly seeking ways to improve resource use, there has been heightened interest in reducing hospital length of stay (LOS) and performing spine procedures on an outpatient basis. We aimed to determine which risk factors correlated with prolonged LOS after anterior lumbar interbody fusion (ALIF). METHODS: Medical records for patients who underwent ALIF were retrospectively reviewed. Patients were divided into those who had extended (≥3 days) versus nonextended (<3 days) LOS, and patient demographics, medical comorbidities, and preoperative medications were analyzed. Univariate and multivariate regression were then used to determine preoperative risk factors for extended LOS. RESULTS: A total of 166 patients were included (mean age, 48.7 years). Medical comorbidities included hypertension (31.9%), diabetes (8.4%), and obesity (body mass index >30 kg/m2) (48.8%). LOS was not extended in 121 patients and extended in 45. Mean LOS was 2.2 days (95% confidence interval, 1.9-2.5). On multivariate logistic analysis, age ≥65 years (P = 0.001), preoperative benzodiazepine use (P = 0.014), 12-item Short Form mental component score (P = 0.008), estimated blood loss (P = 0.015), time to mobilization (P < 0.001), and total operative time (P = 0.020) were independent predictors for extended LOS. CONCLUSIONS: As attempts are made to perform more spine procedure in ambulatory surgical centers, strict patient selection criteria are all critical in making this possible. Our results suggest that age, preoperative benzodiazepine use, higher intraoperative blood loss, delayed mobilization, and lower 12-item Short Form mental component score were correlated with increased LOS. Therefore, inpatient ALIF may be more suitable for patients with these risk factors.
Assuntos
Tempo de Internação/tendências , Vértebras Lombares/cirurgia , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/diagnóstico , Fusão Vertebral/tendências , Adulto , Idoso , Escalas de Graduação Psiquiátrica Breve , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Cuidados Pré-Operatórios/tendências , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/métodos , Adulto JovemRESUMO
PURPOSE: The Controlling Nutritional Status (CONUT) Score, a new parameter that reflects the immuno-nutritional status, has been closely associated with prognosis in many cancer types. However, the prognostic significance of the CONUT score in Glioblastoma Multiforme (GBM) is not known. In this study, we aimed to show the prognostic significance of the CONUT score in the postoperative period in patients with GBM. METHODS: 120 patients followed up with GBM were included in the study, retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cut-off values were determined for the CONUT score, and the patients were divided into low (<2.5) and high (≥2.5) CONUT groups. Systemic immune inflammation index (SII), prognostic nutritional index (PNI), and neutrophil-lymphocyte ratio (NLR) were grouped according to the cut-off point of 1111, 46.5, and 4.48, respectively. Cox regression analyzes were used to assess their prognostic significance for progression-free survival (PFS) and overall survival (OS). RESULTS: The high CONUT score group was found to have worse PFS and OS than the low CONUT score group (pâ¯<â¯0.001, pâ¯<â¯0.001). In univariate analysis, age, gender, comorbidity, CONUT score, SII, PNI, NLR were found to be significant for both PFS and OS. In multivariate analysis, only age and CONUT score were found as independent prognostic factors for both PFS (p: 0.040, pâ¯<â¯0,001) and OS (p: 0,041, pâ¯<â¯0,001). CONCLUSION: The CONUT score in the postoperative period in patients with GBM is an independent prognostic parameter that predicts progression and survival.
Assuntos
Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Avaliação Nutricional , Estado Nutricional/fisiologia , Cuidados Pós-Operatórios/tendências , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Glioblastoma/sangue , Glioblastoma/diagnóstico por imagem , Humanos , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Cuidados Pós-Operatórios/métodos , Curva ROC , Estudos RetrospectivosRESUMO
The risk of aerosol transmission has been a key factor for the rapid dissemination of the coronavirus pandemic. Transportation of coronavirus disease 2019 (COVID-19)-infected patients with active air leaks could expose unprotected health care personnel and other patients to aerosolized viral particles. We devised a way to avoid aerosolization while the chest tube drain is on water seal. It involves placing an Ultipor100 viral filter on the suction port of the drain system as well as sealing off the safety valve. This mechanism allows positive pressure from an air leak to escape while on water seal while trapping viral particles.
Assuntos
COVID-19/terapia , Portador Sadio/prevenção & controle , Tubos Torácicos/efeitos adversos , Gerenciamento Clínico , Invenções/tendências , Cuidados Pós-Operatórios/tendências , COVID-19/epidemiologia , Portador Sadio/epidemiologia , Humanos , Cuidados Pós-Operatórios/métodosAssuntos
Tempo de Internação/tendências , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica/fisiologia , Anestesia/efeitos adversos , Anestesia/tendências , Humanos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologiaRESUMO
BACKGROUND: In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. Historically, subjective patient-reported outcome (PRO) surveys have been used to determine the relative benefit of surgical treatments. Using smartphone-based accelerometers, surgeons now have the ability to arrive at objective outcome metrics. OBJECTIVE: To use Apple Health (Apple Inc, Cupertino, California) data to approximate physical activity levels before and after spinal fusion as an objective outcome measurement. METHODS: Personal activity data were acquired retrospectively from the cellphones of consenting patients. These data were used to measure changes in activity level (daily steps, flights climbed, and distance traveled) before and after patients underwent spine surgery at a single institution by a single surgeon. After data collection, we investigated the demographic information and daily physical activity pre- and postoperatively of participating patients. RESULTS: Twenty-three patients were included in the study. On average, patients first exceeded their daily 1-yr average distance walked, flights climbed, and steps taken at 10.3 ± 14, 7.6 ± 21.1, and 8 ± 9.9 wk, respectively. Mean flights climbed, distance traveled, and steps taken decreased significantly from 6 mo prior to surgery to 2 wk postoperatively. Distance traveled and steps taken significantly increased from 6 mo prior to surgery to 7 to 12 mo postoperatively. CONCLUSION: We demonstrated a valuable supplement to traditional PROs by using smartphone-based activity data. This methodology yields a rich data set that has the potential to augment our understanding of patient recovery.
Assuntos
Acelerometria/tendências , Exercício Físico/fisiologia , Cuidados Pós-Operatórios/tendências , Smartphone/tendências , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/tendências , Acelerometria/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/métodos , Inquéritos e Questionários , Resultado do Tratamento , Caminhada/fisiologiaRESUMO
STUDY DESIGN: Retrospective review. OBJECTIVE: The aim of this study was to examine the association between preoperative depression and patient satisfaction in the outpatient spine clinic after lumbar surgery. SUMMARY OF BACKGROUND DATA: The Clinician and Group Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is used to measure patient experience in the outpatient setting. CG-CAHPS scores may be used by health systems in physician incentive programs and quality improvement initiatives or by prospective patients when selecting spine surgeons. Although preoperative depression has been shown to predict poor patient-reported outcomes and less satisfaction with the inpatient experience following lumbar surgery, its impact on patient experience with spine surgeons in the outpatient setting remains unclear. METHODS: Patients who underwent lumbar surgery and completed the CG-CAHPS survey at postoperative follow-up with their spine surgeon between 2009 and 2017 were included. Data were collected on patient demographics, Patient Health Questionnaire 9 (PHQ-9) scores, and Patient-Reported Outcome Measurement Information System Global Health Physical Health (PROMIS-GPH) subscores. Patients with preoperative PHQ-9 scores ≥10 (moderate-to-severe depression) were included in the depressed cohort. The association between preoperative depression and top-box satisfaction ratings on several dimensions of the CG-CAHPS survey was examined. RESULTS: Of the 419 patients included in this study, 72 met criteria for preoperative depression. Depressed patients were less likely to provide top-box satisfaction ratings on CG-CAHPS metrics pertaining to physician communication and overall provider rating (OPR). Even after controlling for patient-level covariates, our multivariate analysis revealed that depressed patients had lower odds of reporting top-box OPR (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.06-0.63, Pâ=â0.007), feeling that their spine surgeon provided understandable explanations (OR: 0.32, 95% CI: 0.11-0.91, Pâ=â0.032), and feeling that their spine surgeon provided understandable responses to their questions or concerns (OR: 0.19, 95% CI: 0.06-0.63, Pâ=â0.007). CONCLUSION: Preoperative depression is independently associated with lower OPR and satisfaction with spine surgeon communication in the outpatient setting after lumbar surgery.Level of Evidence: 3.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/psicologia , Depressão/psicologia , Vértebras Lombares/cirurgia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Cuidados Pré-Operatórios/psicologia , Idoso , Procedimentos Cirúrgicos Ambulatórios/tendências , Depressão/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/psicologia , Cuidados Pós-Operatórios/tendências , Cuidados Pré-Operatórios/tendências , Estudos Prospectivos , Estudos Retrospectivos , Cirurgiões/psicologia , Cirurgiões/tendências , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment. METHODS: Patients with an American Society of Anesthesiologists (ASA) score >1 and who were scheduled for major surgery of >2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models. RESULTS: Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 [7-18] vs 8 [4-12]; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2-11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57-0.71). CONCLUSIONS: When lung ultrasound is performed precociously <2 hours after extubation, detection of immediate postoperative alveolar consolidation and pleural effusion by lung ultrasound is associated with postoperative pulmonary complications and morbi-mortality. Further study is needed to determine the effect of ultrasound-guided intervention for patients at high risk of postoperative pulmonary complications.
Assuntos
Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Estudos de Coortes , Feminino , Humanos , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/tendências , Resultado do TratamentoRESUMO
The optimal adjuvant treatment of high-risk low-grade glioma (LGG) is controversial. We performed this retrospective cohort study to compare three treatments including observation, radiotherapy (RT) alone, and radiotherapy combined with concomitant and adjuvant temozolomide (TMZ) chemotherapy (STUPP regimen) in patients with high-risk LGG. Patients with high-risk (age > 40 or undergoing subtotal resection or biopsy) LGG treated with observation or radiotherapy alone or STUPP regimen after operation were retrospectively analyzed. Survival rates were evaluated by the Kaplan-Meier method; the log-rank test was applied to compare differences between groups. A total of 250 patients met the inclusion criteria. Median follow-up for living people was 70 months. Overall, patients who received radiotherapy with or without temozolomide had better progression-free survival (PFS) and overall survival (OS) when compared with observation (median PFS: observation, 59 months; RT, 82 months; STUPP, not reached; median OS: observation, 96 months; RT, not reached; STUPP, not reached), whereas STUPP regimen did not further prolong PFS or OS than RT alone (PFS, P = 0.203; OS, P = 0.146). In oligodendroglioma (IDH mutant and 1p/19q codeleted) subtype, only STUPP regimen brought longer PFS when compared with observation (P = 0.008). The incidence of grade 3 or 4 neutropenia (P < 0.001) and nausea or vomiting (P = 0.004) was higher in the STUPP group than the figure for the RT alone group. PFS and OS were similarly improved in patients with high-risk LGG receiving RT alone or STUPP regimen. However, only STUPP regimen was able to bring better PFS for oligodendroglioma (IDH mutant and 1p/19q codeleted) subgroup. Longer follow-up time is needed to determine an association with treatment effect in different histological and molecular subgroups.
Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/radioterapia , Glioma/tratamento farmacológico , Glioma/radioterapia , Temozolomida/uso terapêutico , Conduta Expectante/tendências , Adulto , Idoso , Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Glioma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Cuidados Pós-Operatórios/tendências , Intervalo Livre de Progressão , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Organização Mundial da SaúdeRESUMO
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To elucidate the postoperative time course of improvements in physical and mental well-being in patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Spinal surgeons should understand the postoperative course in detail. However, data are still needed regarding the time course of improvements in well-being, a fundamental aspect of human life, after cervical surgery for CSM. METHODS: One hundred consecutive patients who underwent laminoplasty for CSM, with complete clinical data preoperatively and 3 months and 2 years postoperatively, were enrolled. The Short Form-36 physical component summary (PCS) and mental component summary (MCS) scores were used as parameters of physical and mental well-being, respectively, and 4.0 was defined as the minimal clinically important difference (MCID) for both parameters. RESULTS: On average, PCS and MCS scores were significantly improved after surgery (Pâ<â0.001, P=0.004, respectively). Moreover, 64 and 48 patients achieved meaningful improvement (>MCID) in PCS and MCS scores at 3 months postoperatively, with maintained improvement (to 2 yr) in 46/64 (71.9%) and 34/48 patients (70.8%), respectively (PCS vs. MCS: Pâ=â0.912). Additionally, 15 of 36 patients (41.7%) and 8 of 52 patients (15.4%) achieved late improvement (meaningful improvement at 2 yr but not at 3 months) in PCS and MCS scores, respectively (PCS vs. MCS: Pâ=â0.007). In multivariate regression analysis, improvement in cJOA score was significantly associated with PCS improvement, but not MCS improvement, at both 3 months and 2 years (Pâ=â0.001, Pâ>â0.001, respectively). CONCLUSION: The overall outcome of physical well-being improvement is decided within 3 months postoperatively, in proportion to the recovery in myelopathy, with a relatively high chance of meaningful improvement over the next 21 months. The outcome of improvement in mental well-being is decided within 3 months postoperatively, independently from the recovery in myelopathy, with a low chance of meaningful improvement over the next 21 months.Level of Evidence: 3.
Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/tendências , Saúde Mental/tendências , Cuidados Pós-Operatórios/tendências , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Laminoplastia/psicologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Cuidados Pós-Operatórios/psicologia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/psicologia , Espondilose/diagnóstico , Espondilose/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
STUDY DESIGN: Retrospective case-control radiographic study. OBJECTIVE: The aim of this study was to explore whether directionality of lumbosacral fractional curve relative to C7 plumb line (PL) affected postoperative coronal imbalance in patients with degenerative lumbar scoliosis (DLS). SUMMARY OF BACKGROUND DATA: The spatial relationship between lumbar main curve and C7 PL was reported to have impact on postoperative coronal imbalance in DLS. Although fractional curve played more important role than lumbar main curve in DLS, the spatial relationship between fractional curve and C7 PL and their impact on the postoperative coronal balance are still unknown. METHODS: One hundred one DLS patients treated with posterior instrumented fusion were reviewed. Coronal measurements included C7 migration, fractional curve, L4/L5 coronal tilt, major Cobb angle. Based on directionality of fractional curve (orientation of L4 coronal tilt was used to represent it) relative to C7 PL preoperatively, coronal patterns was separated into: consistency pattern, L4 coronally tilts toward C7 PL; opposition pattern, L4 coronally tilts opposite C7 PL; the distributions of these two patterns and Type A, B,C were analyzed. According to postoperative C7 migration, patients were divided into imbalanced group and balanced group. RESULTS: Compared to balanced group, the imbalanced group had higher percentage of preoperative consistency pattern (80.6% vs. 33.8%, Pâ<â0.001) and Type C (36.1% vs. 7.7%, Pâ<â0.001); larger fractional curve or L4 coronal tilt pre- and postoperatively, larger L5 coronal tilt postoperatively. Logistic regression analysis showed predictors for postoperative coronal imbalance were consistency pattern (odds ratio [OR] 5.103, 95% confidence interval [CI]: 1.660-15.687, Pâ=â0.004) and type C (OR 4.061; 95% CI: 1.056-15.618; Pâ=â0.041). CONCLUSION: Directionality of fractional curve relative to C7 PL was associated with postoperative coronal imbalance in DLS patients. In addition to type C, consistency pattern might be an independent risk factor for postoperative coronal imbalance.Level of Evidence: 3.
Assuntos
Vértebras Cervicais/cirurgia , Vértebras Lombares/cirurgia , Cuidados Pós-Operatórios/tendências , Equilíbrio Postural/fisiologia , Escoliose/cirurgia , Fusão Vertebral/tendências , Idoso , Estudos de Casos e Controles , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Escoliose/diagnóstico por imagemRESUMO
STUDY DESIGN: Prospective follow-up study. OBJECTIVE: The aim of this study was to assess whether depressive symptoms change the outcome of lumbar spine fusion (LSF) surgery at a 5-year follow-up. SUMMARY OF BACKGROUND DATA: Previous reports of the influence of depressive symptoms on the results of spine surgery are controversial, but the patient characteristics and indications for surgery varied widely between the studies. The influence of depressive symptoms on the 5-year outcome of LSF has not been studied. METHODS: The study was based on data from a local LSF database from two hospitals comprising 392 consecutive patients (mean age 61 years, 277 women) who underwent an instrumented LSF and fulfilled the 5-year follow-up. At the 5-year follow-up, the patients were compared with a control group from the general population (nâ=â477, age-, sex-, and residential area-matched) extracted from Official Statistics of Finland. The prevalence of depressive symptoms was evaluated using the Depression Scale (DEPS; 0-30) and disability was evaluated by the Oswestry Disability Index (ODI; 0-100%). A DEPS score ≥12 was considered to indicate depressive symptoms. RESULTS: Before surgery, 35% of the patients had depressive symptoms. The proportion diminished to 13% at 3 months postoperatively and increased to 24% at 5 years. In the population, the prevalence was 11% at baseline and 10% at the 5-year follow-up. The preoperative ODI was 54 in the patients with depressive symptoms, and it was 41 in the patients with no depressive symptoms. The changes at 5-year follow-up were -20 and -18, correspondingly. The same congruence was preserved when analyzing short and long fusions separately. These changes were statistically and clinically significant. In the control population, the ODI remained around 24 in depressive people and 10 in nondepressive people. CONCLUSION: Our data suggest that patients with and without depressive symptoms may benefit equally well from LSF. LEVEL OF EVIDENCE: 3.