Yellow flag on prognostic factors for non-specific chronic low back pain patients subjected to mini-invasive treatment: a cohort study.

OBJECTIVES: Research was conducted to study the efficacy of analgesic infiltration treatment in a well-selected population of patients with non-specific drug-resistant chronic low back pain. It studied the pain on a numeric rating scale and the physical and mental condition of patients using a short-form health survey-36, before and six months after invasive pain treatment. DESIGN: This is a prospective observational single center cohort study. SETTING: The study took place in the Multimodal Pain Therapy Unit of the IRCCS Institute of Neurological Sciences in Bologna, Italy. SUBJECTS: Four hundred and thirteen out of a total 538 patients admitted to the unit with non-specific drug-resistant chronic low back pain were enrolled in the study. METHOD: Patients were enrolled with written consent between April 2017 and November 2018. The study assessed NRS, BDI and SF-36 scores before and six months after mini-invasive treatment. RESULTS: There is an inverse correlation between Mental Component Scale (MCS) and Physical component scale as measured by SF-36. Older patients in a worse physical condition but with a more positive outlook on their quality of life were more likely to improve after invasive treatment (p < 0.001). The BDI scale is more effective in the diagnosis of depression than MCS. CONCLUSIONS: The prognostic value of MCS given to the patient before mini-invasive treatment could lead physicians to adopt a multimodal approach that includes consideration of the psychological features of pain and possibly antidepressant therapy.

Predictors of an appropriate admission to an ICU after a major pulmonary resection.

BACKGROUND: There are no recommendations about admission to an ICU after a major lung resection and there are considerable differences among institutions in this respect. OBJECTIVES: To audit the practice of admission to an ICU after a major lung resection and evaluate factors predicting the need for intensive care. METHODS: Clinicalrecords of all patients who underwent major pulmonary resections in a 14-month period were reviewed retrospectively. The criteria for postoperative admission to the ICU were: (1) standard pneumonectomy if comorbidity index (CI) >0 and/or ASA score >1, and/or abnormal spirometry or arterial gas analysis; (2) extended pneumonectomy; (3) lobectomy if CI >or=4 and/or ASA >or=3; (4) lobectomy if FEV(1) <60% of predicted; (5) lobectomy if FEV(1) is between 60 and 80% and hypercapnia. RESULTS: Among the 49 patients postoperatively admitted to the surgical ward, only 1 needed late intensive care. Among the 55 patients admitted to the ICU, 25 did not require specific intensive care and were discharged 24 h postoperatively, whereas the remaining 30 patients required specific intensive care. Multivariate analysis identified ASA score, predictive postoperative DL(CO), and predictive postoperative product (PPP) as independent predictors of a need for admission to an ICU. CONCLUSION: This empirical protocol was useful in identifying patients not likely to need admission to the ICU. ASA score, predictive postoperative DL(CO), and PPP are independent predictors of a need for admission to an ICU.