Post-operative care and complications

Abstract Introduction Operative notes play a valuable role in ensuring that surgical patients receive consistent and adequate care. There are many inherent difficulties affecting their quality. We performed a QI project to improve surgical operative notes at our centre. Method A questionnaire assessing subjective quality of operative notes was sent to all foundation doctors delivering post-operative care. Compliance to each inclusion recommendation in the RCS guidelines was analysed. A standardised template for operative notes was incorporated into the hospital’s electronic records system, compliance was then reassessed. Results Questionnaire responses (16) were better for typed vs hand-written notes in all domains: ease of accessing notes, following intra-operative steps, following post-operative plans and frequency of asking for additional information regarding plans. After implementation of the template, mean compliance across 19 RCS parameters improved from 69% (55 operations) to 89% (46 operations). Number of parameters with 100% compliance improved from 2/19 to 8/19. Compliance increased in 14/19 parameters, there was no change in 2/19 (already 100%) and a reduction was seen in 3/19. Conclusions Results from our analysis and questionnaire showed that typed notes were favourable when compared to hand-written. The introduction of a standardised electronic template, without investment in new software, improved compliance to RCS guidelines.

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Use radiography rarely, not routinely, for hip hemiarthroplasty

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01605-3 ◽

2021 ◽

Author(s):

Lucy Clare Maling ◽

John Martin Lynch ◽

Robert William Walker ◽

Mark Ross Norton ◽

Rory George Middleton

Keyword(s):

Patient Safety ◽

Cognitive Impairment ◽

Limited Resources ◽

Cognitively Impaired ◽

Clinical Change ◽

Index Procedure ◽

Hip Hemiarthroplasty ◽

Operative Care ◽

Fluoroscopic Imaging ◽

Retrospective Database

Abstract Purpose Hip hemiarthroplasty (HA) is a commonly performed operation. A post-operative radiograph forms part of the routine hip fracture pathway, although patients are often mobilised prior to this investigation. This study seeks to provide evidence for a pragmatic clinical change to optimise patient safety and allocate limited resources within the National Health Service (NHS). Methods We undertook a retrospective database review of 1563 HA procedures to assess whether the routine ordering of check radiographs played an important role in a patient’s post-operative care. Results 18 (1.2%) mechanical complications led to a return to theatre within 6 weeks of the index procedure. All were dislocations. Ten had a normal post-operative radiograph and five had documented suspicion of dislocation prior to radiography. The post-operative check radiograph was the sole identifier of dislocation in only three patients (0.2%). All three of these patients were pre-morbidly bed bound and non-communicative due to cognitive impairment (AMTS 0/10). Conclusion Unless a patient is pre-morbidly bed bound and cognitively impaired, routine post-operative radiography following HA surgery is of little clinical benefit, yet may carry considerable risk to the patient and cost to the NHS. A pragmatic compromise is to perform intra-operative fluoroscopic imaging.

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An Empirical Study on the Operative Treatment of Symptomatic Urolithiasis in Germany

Urologia Internationalis ◽

10.1159/000510589 ◽

2021 ◽

pp. 1-7

Author(s):

Alina Reicherz ◽

Rüveyde Sahin ◽

Lorine Häuser ◽

Joachim Noldus ◽

Peter Bach

Keyword(s):

Response Rate ◽

Intraoperative Complications ◽

Nationwide Survey ◽

Treatment Modalities ◽

European Guidelines ◽

Operative Care ◽

Double J Stent ◽

Before And After ◽

Related Group ◽

Ureteral Stenting

Purpose: The guidelines of the German, European, and American Urological Associations on urolithiasis advise against general ureteral stenting before and after an uncomplicated ureterorenoscopy (URS). However, German and European guidelines state that stenting prior to URS facilitates stone extraction and reduces intraoperative complications. According to the published literature, German practice seems to deviate from recommendations. This nationwide survey aimed to evaluate the treatment modalities of urolithiasis. Methods: In November 2018 and March 2019, a total of 199 urological hospital departments in Germany were anonymously surveyed about operative care of symptomatic urolithiasis. The response rate was 72.9%. The survey consisted of 25 questions about diagnostics, surgical technique, and aftercare of the URS. This questionnaire is available in the appendix. Results: A primary URS is performed in ≤10% in 49.6% of the hospitals. In every second urological department (49.7%), the German Diagnosis Related Group (G-DRG) system influences the period of pre-stenting before a secondary URS. After a secondary URS, which is performed in 53.8% of the departments in over 80% of the patients, 14% of the departments omit stenting. The standard for stenting seems to be a 28-cm-long 7 Charrière double-J stent in Germany. Conclusion: In Germany, the percentage of primary URS is low, and a ureter stenting is performed in most of the urological departments after URS. Delaying therapy due to economic aspects is the standard in almost half of all urological departments.

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Extended endoscopic frontal nasal sinus surgery in management of chronic and recurrent frontal sinus diseases

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00104-x ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Ahmed Sobhi Abdelaal ◽

Mohamed Kamel Al Awady ◽

Tawfik Abdelaty Elkholy

Keyword(s):

Frontal Sinus ◽

Anatomical Variation ◽

Sinus Surgery ◽

Frontal Sinusitis ◽

Office Visits ◽

Nasal Sinus ◽

Frontal Sinus Surgery ◽

Operative Care ◽

Intimate Relation

Abstract Background The anatomical variation of the frontal sinus and its intimate relation to the skull base and orbit makes its surgery demanding. The extended endoscopic frontal sinus surgery allows wide better drainage and preventing the recurrence of the disease. Fourteen patients underwent EEFSS from May 2017 to May 2019. These patients are nine patients presented by chronic recurrent frontal sinusitis, three patients presented by chronic recurrent fronto ethmoidal mucocele and two patients with chronic recurrent external frontal fistula. Draff III done for ten patients of them and Draff IIB done for four patients of them. This study is designed for evaluating the efficacy of the extended endoscopic frontal sinus surgery (E E F S S) in management of chronic and recurrent frontal sinus diseases. Results The neo opening of the restored frontal sinus was remained opened with Draff III with high success rate; two patients from four patients with Draff IIb were with closed nasofrontal duct. The main follow-up was 12 months; the patients were followed up post-operatively for many office visits without any other manifestations. Conclusion The chronic recurrent frontal sinus diseases can be treated successfully with extended endoscopic frontal sinus surgery (E E F S S). The extended endoscopic frontal sinus surgery (Draff III) provides good results with low morbidity and less post-operative care.

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Obesity and Spine Surgery: A Qualitative Review About Outcomes and Complications. Is It Time for New Perspectives on Future Researches?

Global Spine Journal ◽

10.1177/21925682211022313 ◽

2021 ◽

pp. 219256822110223

Author(s):

Fabio Cofano ◽

Giuseppe Di Perna ◽

Daria Bongiovanni ◽

Vittoria Roscigno ◽

Bianca Maria Baldassarre ◽

...

Keyword(s):

Spine Surgery ◽

Clinical Results ◽

Grading System ◽

Obese Patients ◽

Lumbar Surgery ◽

Operative Care ◽

Operative Complications ◽

Proper Weight ◽

Level 2

Study Design: Literature review. Objectives: An increasing number of obese patients requires operative care for degenerative spinal disorders. The aim of this review is to analyze the available evidence regarding the role of obesity on outcomes after spine surgery. Peri-operative complications and clinical results are evaluated for both cervical and lumbar surgery. Furthermore, the contribution of MIS techniques for lumbar surgery to play a role in reducing risks has been analyzed. Methods: Only articles published in English in the last 10 years were reviewed. Inclusion criteria of the references were based on the scope of this review, according to PRISMA guidelines. Moreover, only paper analyzing obesity-related complications in spine surgery have been selected and thoroughly reviewed. Each article was classified according to its rating of evidence using the Sacket Grading System. Results: A total number of 1636 articles were found, but only 130 of them were considered to be relevant after thorough evaluation and according to PRISMA checklist. The majority of the included papers were classified according to the Sacket Grading System as Level 2 (Retrospective Studies). Conclusion: Evidence suggest that obese patients could benefit from spine surgery and outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior approaches. The use of MIS techniques plays a key role in order to reduce surgical risks. Further studies should evaluate the role of multidisciplinary counseling between spine surgeons, nutritionists and bariatric surgeons, in order to plan proper weight loss before elective spine surgery.

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A Guide to the Generation of a 6-Hydroxydopamine Mouse Model of Parkinson’s Disease for the Study of Non-Motor Symptoms

Biomedicines ◽

10.3390/biomedicines9060598 ◽

2021 ◽

Vol 9 (6) ◽

pp. 598

Author(s):

Débora Masini ◽

Carina Plewnia ◽

Maëlle Bertho ◽

Nicolas Scalbert ◽

Vittorio Caggiano ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Mouse Model ◽

Survival Rates ◽

Dorsal Striatum ◽

Brain Regions ◽

Motor Symptoms ◽

Operative Care ◽

6 Hydroxydopamine ◽

Non Motor Symptoms

In Parkinson’s disease (PD), a large number of symptoms affecting the peripheral and central nervous system precede, develop in parallel to, the cardinal motor symptoms of the disease. The study of these conditions, which are often refractory to and may even be exacerbated by standard dopamine replacement therapies, relies on the availability of appropriate animal models. Previous work in rodents showed that injection of the neurotoxin 6-hydroxydopamine (6-OHDA) in discrete brain regions reproduces several non-motor comorbidities commonly associated with PD, including cognitive deficits, depression, anxiety, as well as disruption of olfactory discrimination and circadian rhythm. However, the use of 6-OHDA is frequently associated with significant post-surgical mortality. Here, we describe the generation of a mouse model of PD based on bilateral injection of 6-OHDA in the dorsal striatum. We show that the survival rates of males and females subjected to this lesion differ significantly, with a much higher mortality among males, and provide a protocol of enhanced pre- and post-operative care, which nearly eliminates animal loss. We also briefly discuss the utility of this model for the study of non-motor comorbidities of PD.

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