Factors Influencing Early Postoperative Recovery After Laparoscopic Cholecystectomy.

PURPOSE: To study the factors influencing early postoperative recovery after laparoscopic cholecystectomy. DESIGN: A nonexperimental retrospective study. METHODS: The study was performed using records from all patients who had undergone laparoscopic cholecystectomy at a hospital in Northern Sweden in 2017 (219 patients in total). Nonparametric data were analyzed using Spearman's rho, Mann-Whitney U test, and logistic regression. Parametric data were analyzed using Pearson's correlation, an independent t test, and analysis of variance. FINDINGS: The length of stay in the postanesthesia care unit was not predicted by factors such as age, gender, body mass index, American Society of Anesthesiologists classification, postoperative nausea and vomiting, premedication, or type of surgery. Younger age and high classification level were significant predictors of pain during rest and pain when in motion. No significant predictors of postoperative nausea were found. The majority of study participants experienced little or no pain or nausea. The documentation of pain, nausea, and premedication was inadequate in many cases. CONCLUSIONS: Nurses in postanesthesia care units should work to preventively identify and address patients' medical and emotional needs so that optimal conditions for postoperative recovery can be provided.

The Effect of Exaggerated Lithotomy Position on Shoulder Pain after Laparoscopic Cholecystectomy.

BACKGROUND: The exaggerated lithotomy position with the expertise of nurses can be successful solution for the patients who have the postoperative shoulder pain after laparoscopic cholecystectomy. AIMS: This study aimed to determine the effect of applying an exaggerated lithotomy positions to patients who had laparoscopic cholecystectomy to relieve shoulder pain. The study was conducted on nonrandomized groups and made as a semiexperimental study with a pretest/post-test control group design. Design, Settings, and Subjects/Participants: The study was conducted on 102 patients who had elective laparoscopic cholecystectomy and agreed to participate in this study after they met the inclusion-exclusion criteria in the general surgery clinic of a training and research hospital in Istanbul between December 12, 2012, and June 30, 2013. METHODS: The pain levels (10 minutes before and after positioning) and peripheral oxygen saturation (SPO2) levels (1 minute, 5 minutes, and 10 minutes before and after positioning-total 6 times) of the patients were measured using a visual analog scale and pulse oximetry, respectively. The pain levels and the analgesic (pethidine hydrochloride and diclofenac sodium) usage of the patients in both the experimental and the control group were compared. RESULTS: The exaggerated lithotomy position appreciably lowered the shoulder pain of the patients in the experimental group (t = 12.663; p = .000 < .001). It also increased peripheral saturation levels of the patients more rapidly compared with those in the control group receiving analgesics (t = 17.693; p = .000 < .005). In addition, it decreased the need to use additional analgesics and opioids (t = 2.14; p = .037). CONCLUSIONS: In this study the exaggerated lithotomy position was found to be fast and effective for relieving shoulder pain after laparoscopic cholecystectomy, decreased the need to use additional analgesics and opioids, and, in conjunction with pain control, also contributed to improvements in respiratory functions.

Real-time instrument detection in minimally invasive surgery using radiofrequency identification technology.

BACKGROUND: A key part of surgical workflow recording is recognition of the instrument in use. We present a radiofrequency identification (RFID)-based approach for real-time tracking of laparoscopic instruments. METHODS: The system consists of RFID-tagged instruments and an antenna unit positioned on the Mayo stand. For reliability analysis, RFID tracking data were compared with the assessment of the perioperative video data of instrument changes (the reference standard for instrument application detection) in 10 laparoscopic cholecystectomies. When the tagged instrument was on the Mayo stand, it was referred to as "not in use." Once it was handed to the surgeon, it was considered to be "in use." Temporal miscounts (incorrect number of instruments "in use") were analyzed. The surgeons and scrub nurses completed a questionnaire after each operation for individual system evaluation. RESULTS: A total of 110 distinct instrument applications ("in use" versus "not in use") were eligible for analysis. No RFID tag failure occurred. The RFID detection rates were consistent with the period of effective instrument application. The delay in instrument detection was 4.2 ± 1.7 s. The highest percentage of temporal miscounts occurred during phases with continuous application of coagulation current. Surgeons generally rated the system better than the scrub nurses (P = 0.54). CONCLUSIONS: The feasibility of RFID-based real-time instrument detection was successfully proved in our study, with reliable detection results during laparoscopic cholecystectomy. Thus, RFID technology has the potential to be a valuable additional tool for surgical workflow recognition that could enable a situation dependent assistance of the surgeon in the future.

Impact of acceptance-based nursing intervention on postsurgical recovery: preliminary findings.

Research has shown that teaching individuals to experience pain and anxiety as inevitable products of the actions they freely and responsibly undertake yields healthier reactions to suffering. This preliminary study assesses whether a brief acceptance-based psychological intervention along with the usual presurgical protocol for a laparoscopic cholecystectomy will produce healthier reactions to postsurgical pain, and will reduce anxiety, duration of postsurgical hospitalization, and demand of analgesics. After admission, screening, and consent procedures, we assessed pain and anxiety. Patients in the experimental condition (n = 6) then received a brief acceptance-based nursing intervention addressing the individual meaning of surgery, and including a metaphor and defusion practice, along with routine care. Patients in the control condition (n = 7) received routine care only. Twenty-four hr following the intervention, surgery took place. Pain, anxiety, and patients' demand for analgesics were assessed 24 hr or 48 hr after surgery. All six experimental patients, as compared to three of seven control patients, demanded fewer analgesics and left the hospital within 24 hr or 48 hr from surgery even in the presence of frequent and/or intense pain. Anxiety slightly decreased in the experimental patients. The brief acceptance-based intervention was effective in improving postsurgical recovery. These preliminary findings support the potential of this type of intervention as a cost-effective strategy to be implemented in the sanitary context.

Effects of Individualized Nursing Based on Zero-Defect Theory on Perioperative Patients Undergoing Laparoscopic Cholecystectomy.

Objective: This study is aimed at analyzing the effects of individualized nursing based on the zero-defect theory on perioperative patients undergoing laparoscopic cholecystectomy. Methods: 174 patients who underwent laparoscopic cholecystectomy from 1st November 2019 to 30th November 2020 were enrolled as the research subjects and randomly divided into control and observation groups. The patients in the control group received conventional perioperative nursing care, and the patients in the observation group were treated with individualized nursing based on the zero-defect theory. Results: The heart rate, diastolic blood pressure, and systolic blood pressure level of patients in two groups after nursing decreased significantly, and the reduction in the observation group was more significant than that in the control group. The depression and anxiety scores of the two groups after nursing were decreased, and the decrease in the observation group was significantly greater than that in the control group. The time to first postoperative exhaust, return to normal intake, out-of-bed activity, and hospital stay in the observation group was less than that in the control group. The incidence of postoperative complications in the observation group was substantially lower than that in the control group. The satisfaction degree of nursing care in the observation group was significantly higher than that in the control group. Conclusion: Individualized nursing care based on zero-defect theory can effectively reduce the perioperative psychological stress response of patients with laparoscopic cholecystectomy. It helps to improve the negative emotions of depression and anxiety, promotes the recovery of disease, reduces postoperative complications, and improves nursing satisfaction, which is worthy of clinical promotion.

Developing critical thinking in the perioperative environment.

Critical thinking is considered an essential skill for nurses by many, including major accrediting agencies, health care administrators, and AORN. This is in part because of the environment in which nurses function. Health care, medicine, technology, and nursing are dynamic and constantly changing. The perioperative environment is complex, fast paced, unique, and oftentimes unpredictable. Critical thinking skills enable perioperative nurses to function effectively and evolve in this ever-changing environment. Nursing education programs are mandated to teach critical thinking skills. It is the practice arena, however, that refines, hones, and grows these skills. This article provides an overview of critical thinking in the context of nursing, as well as strategies and interventions designed to teach critical thinking skills.

Impact of clinical pathways in surgery.

BACKGROUND: One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities. METHOD: Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65). RESULTS: Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p < 0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from euro 6,390 to euro 4,800 (p < 0.001). Costs for diagnostic tests were reduced by 33% (p < 0.001). Nursing hours decreased, reducing nursing costs by 24% from euro 1,810 to euro 1,374 (p < 0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07). CONCLUSIONS: This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.

Prevention and management of postoperative nausea and vomiting in adults.

In early 2007, patients at our small community hospital's outpatient surgery center experienced postoperative nausea and postoperative nausea and vomiting (PONV) at a rate of 27% to 35%. Many record reviews and a written survey of nurses in the postanesthesia care unit and same day surgery center revealed that little or no risk assessment and no consistent prophylaxis or treatment were in use by nurses, physicians, or anesthesia care providers. After a review of the literature and discussions with anesthesia care providers, we developed and put into practice a risk assessment tool and perioperative care path. A formal evaluation to assess the effectiveness of the plan was performed one year after implementation. We found that the rates of PONV had decreased to 16%. AORN J 90 (September 2009) 391-413. (c) AORN, Inc, 2009.

Care of patients undergoing laparoscopic cholecystectomy.

This article discusses laparoscopic cholecystectomy, or surgical removal of the gall bladder through a process also known as keyhole surgery. It explains the pre- and post-operative nursing care of patients undergoing this surgery. The anaesthetic considerations and operative technique are also described.

[Nursing in a Day Surgery regime: experience in laparoscopic colecistectomy]. / Gestione del paziente sottoposto a colecistectomia laparoscopica in One Day Surgery.

The introduction of new surgical techniques, that allow rapid functional recovery, and short-lasting anesthetics has made it possible to include a wider range of procedures in day surgery regimes. Videolaparoscopic colecistectomy (VLC) , a video-assisted surgical model, is one of these. The University Hospital of Pisa has responded to the growing needs of clients by creating an autonomous unit for this purpose, the Day Surgery Service for general surgery, in order to identify an efficient model in terms of organization, management and quality. This model is described paying particular attention to the role of nurses. In our experience, day surgery for colecistic pathologies proved to be safe and reliable and creation of separate channels for day surgery patients increases the level of client satisfaction.

Outpatient recovery after laparoscopic cholecystectomy.

Economic incentives and technologic advances have encouraged health care providers to shift an increasing portion of postoperative care out of the hospital. Selected patients undergo complex outpatient surgical procedures and are discharged within 24 hours of surgery. Because this trend is relatively new, published accounts of patients' experiences with at-home recovery are rare. Consequently, the authors conducted a qualitative study of 19 patients who underwent laparoscopic cholecystectomy procedures on an outpatient basis. Using semistructured postoperative telephone interviews, the authors monitored the patients' recovery processes. One theme (ie, toward a usual self) with two patterns (ie, progressive activity, self-management) emerged. The results reveal patients' definitions of recovery, understanding of postoperative instructions, willingness to ask questions, and advice for patients undergoing similar procedures. Nursing implications for discharge instructions and follow-up care also are discussed.

The RN first assistant's role in a laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is one of the most frequently performed laparoscopic procedures today and involves the same surgical principles as an open cholecystectomy, except that access to the abdomen is gained transabdominally using video laparoscopic techniques and instrumentation. Registered nurse first assistants (RNFAs) provide retraction and tissue exposure for the surgeon during this procedure and should be aware of safe laparoscopic surgical techniques and potential injuries that can occur from manipulation of surrounding structures. The experience and expertise of the RNFA when assisting in a laparoscopic cholecystectomy are key to the successful completion of the surgery.

Effect of continuously warmed i.v. fluids on intraoperative hypothermia.

The investigators examined the effect of infusing continuously warmed (ie, 37.0 degrees C [98.6 degrees F]) i.v. fluids in two groups of middle-aged female patients undergoing laparoscopic cholecystectomy procedures. They hypothesized that increasing i.v. fluid temperature during surgery would decrease patients' risk for hypothermia. One group of patients received prewarmed i.v. fluids that cooled to room temperature during surgery. The second group received i.v. fluids that were warmed continuously by a fluid warmer during the surgical procedures. Analyses of covariance, with the first intraoperative temperature measurement treated as the covariate, revealed nonsignificant results at the P < .05 level. The results suggest that administering continuously warmed i.v. fluids intraoperatively has no significant effect on maintaining patients' body temperatures during short laparoscopic surgical procedures.

Self-efficacy enhanced preoperative instruction.

Perioperative nurses traditionally have helped patients cope with the adversities of surgery through preoperative instruction. The authors conducted a study to determine whether an efficacy-enhancing preoperative teaching protocol was effective in increasing preoperative self-efficacy in patients scheduled to undergo laparoscopic cholecystectomy procedures with general anesthesia. The subjects were 60 surgical patients in a 156-bed community hospital located in the midwestern United States. Analysis of covariance indicated there were no significant differences between groups after controlling for preoperative self-efficacy. Further research is needed to determine whether an efficacy-enhancing teaching protocol can improve selected short- and long-term outcomes in surgical patients.

Treatment of cholelithiasis in children with sickle cell disease.

Medical and surgical advances have improved the treatment of cholelithiasis (ie, gallstones) in children with sickle cell disease (SCD). Children with SCD have an increased risk of developing pigment gallstones that initially may be asymptomatic but that can lead to acute symptoms of cholelithiasis. An elective laparoscopic cholecystectomy procedure is recommended for pediatric patients with SCD to prevent the risk of requiring an emergency cholecystectomy procedure. The primary benefits of this approach include a shorter hospital stay after surgery, decreased postoperative discomfort, decreased risk of complications, and a quicker return to normal activities.

Recovery from laparoscopic cholecystectomy procedures.

The authors studied the postoperative experiences of 53 patients who had uncomplicated laparoscopic cholecystectomy procedures. Patients rated their pain, nausea, vomiting, and fatigue before surgery, before discharge, and on postoperative days one, two, three, four, and seven. The majority of patients reported more difficult and painful and slower recoveries than they expected or that they believed were indicated in the education materials provided to prepare them for surgery. The experiences of the patients in this study clearly indicate a need to modify preoperative preparatory education materials.

Evaluation of nurse-led discharge following laparoscopic surgery.

INTRODUCTION: The United Kingdom's Department of Health has identified reducing delays in patient discharge as a key aim for Health Service development. Laparoscopic cholecystectomy and laparoscopic inguinal hernia repair may be safely performed on a short stay basis, but day case rates remain low, with delays in discharge identified as a major contributing factor. Nurse-led discharge has been widely advocated to speed patient discharge across varied specialities, but objective evidence to support its use is lacking. This study aimed to assess the effectiveness of nurse-led discharge following laparoscopic surgery. METHODS: A retrospective comparison of doctor-led and nurse-led discharge following laparoscopic surgery was performed by analysis of two consecutive 4-month periods, prior to and following the introduction of nurse-led discharge by a laparoscopic nurse specialist. Outcomes assessed included time to discharge, reasons for delayed discharge, hospital readmissions and primary care episodes following discharge. RESULTS: A total of 128 patients were included in the study, with each discharge group containing 64 patients. Patients in the nurse-led discharge group were significantly more likely to be discharged on the day of surgery than patients in the doctor-led discharge group (17.2% vs. 4.7%; P = 0.023), with a highly significant difference in same day discharge rates noted among patients operated on during morning theatre lists (44.0% vs. 10.7%; P = 0.006). There was no significant difference between the discharge groups in readmission rates or in the number of patients seeking primary care attention following discharge. CONCLUSIONS: Nurse-led discharge may speed discharge following laparoscopic surgery with no apparent detriment to patient care.

One-stop cholecystectomy clinic: an application of lean thinking--can it improve the outcomes?

Lean thinking principles were utilised to set up 'One-stop cholecystectomy clinics' at which patients underwent the surgical and the preoperative assessment during the same visit. The main aims were to reduce the number of patient hospital visits, preoperative admissions and the waiting time to surgery. The results showed a significant reduction in the number of patient visits as well as the waiting time to surgery thus highlighting that patientcare can be improved by good team working and lean management.

Health-related quality of life in patients undergoing cholecystectomy.

This large-scale prospective cohort study of a Taiwan population applied generalized estimating equations to evaluate predictors of health-related quality of life (HRQOL) after open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) procedures performed between February 2007 and November 2008. The Gastrointestinal Quality of Life Index and Short Form-36 were used in a preoperative assessment and in 3(rd) month and 6(th) month postoperative assessments of 38 OC and 259 LC patients. The HRQOL of the cholecystectomy patients were significantly improved at 3 months and 6 months postsurgery (p<0.05). At 3 months postsurgery, HRQOL improvement was significantly larger in LC patients than in OC patients. Patient characteristics, clinical characteristics, and health care quality were also significantly related to HRQOL improvement (p<0.05). Additionally, after controlling for related variables, preoperative health status was significantly and positively associated with each subscale of the Gastrointestinal Quality of Life Index and Short Form-36 throughout the 6 months (p<0.05). Patients should be advised that their postoperative HRQOL may depend not only on their postoperative health care but also on their preoperative functional status.