scholarly journals Patient reporting of complications after surgery: what impact does documenting postoperative problems from the perspective of the patient using telephone interview and postal questionnaires have on the identification of complications after surgery?

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028561 ◽  
Author(s):  
John Woodfield ◽  
Priya Deo ◽  
Ann Davidson ◽  
Tina Yen-Ting Chen ◽  
Andre van Rij
Keyword(s):  
Patient Satisfaction ◽  
Telephone Interview ◽  
Short Form ◽  
Linear Regression Analysis ◽  
Satisfaction Score ◽  
Secondary Outcome ◽  
Patient Satisfaction Score ◽  
Sf 36 ◽  
American Society ◽  
Discharge From Hospital

ObjectivesTo identify the frequency of postoperative complications, including problems identified by patients and complications occurring after discharge from hospital. To identify how these impact on quality of life (QoL) and the patient’s perception of the success of their treatment.DesignData from three prospective sources: surgical audit, a telephone interview (2 weeks after discharge) and a patient-focused questionnaire (2 months after surgery) were retrospectively analysed.SettingDunedin Hospital, Dunedin, New Zealand.ParticipantsOf the 500 patients, 100 undergoing each of the following types of surgeries: anorectal, biliary, colorectal, hernia and skin.Primary and secondary outcome measuresThe primary outcomes were complications and the 36-item Short Form Health Survey (SF-36). Secondary outcomes included the patient’s ratings of their treatment and a questionnaire-derived patient satisfaction score.Results226 patients reported a complication; there were 344 separate complications and 411 reports of complications (16% of complications were reported on more than one occasion). The audit, telephone interview and questionnaire captured 12.6%, 36.3% and 51% of the 411 reports, respectively. Patients with complications had a lower SF-36 Physical Composite Summary (PCS) score (48.5 vs 43.9, p=0.021) and a lower Patient Satisfaction Score (85.6 vs 74.6, p<0.001). Rating of information received, care received, symptoms experienced, QoL and satisfaction with surgery were all significantly worse for patients with complications. On linear regression analysis, surgical complications, American Society of Anaesthesiologists score and age all made a similar contribution to the SF-36 PCS score, with standardised beta coefficients between 0.19 and 0.21.ConclusionsFollowing surgery, over 40% of patients experienced complications. The QoL and satisfaction score were significantly less than for those without complications. The majority of complications were diagnosed after discharge from hospital. Taking more notice of the patient perspective helps us to identify problems, to understand what is important to them and may suggest ways to improve perioperative care.

scholarly journals Evaluation of Epidural Analgesic Paste Components in Lumbar Decompressive Surgery

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 414-424 ◽  
Author(s):  
Roberto Jose Diaz ◽  
S. Terry Myles ◽  
R. John Hurlbert
Keyword(s):  
Postoperative Pain ◽  
Outcome Measures ◽  
Short Form ◽  
Decompressive Surgery ◽  
Secondary Outcome ◽  
Mcgill Pain Questionnaire ◽  
Analgesic Consumption ◽  
Sf 36 ◽  
Cord Injury ◽  
Discharge From Hospital

Abstract BACKGROUND: Adjuncts for pain management in lumbar decompressive surgery are needed to reduce narcotic consumption and promote early mobility. OBJECTIVE: To evaluate the efficacy and active components of a previously described epidural analgesic paste in controlling postoperative pain and facilitating early discharge from hospital after lumbar decompressive surgery. METHODS: A randomized double-blind controlled trial was conducted. Two-hundred and one patients were randomized to 1 of 4 analgesic epidural pastes at the time of lumbar spinal surgery: combination paste (morphine + methylprednisolone), steroid paste (methylprednisolone alone), morphine paste (morphine alone), or placebo. The primary outcome measures used were analgesic consumption and the McGill Pain Questionnaire (MPQ). Secondary outcome measures were: modified American Spinal Cord Injury Association (ASIA) score, Short Form 36 General Health Survey (SF-36), Aberdeen Pain Index (ABPI), time to ambulation and time to discharge from hospital. RESULTS: Administration of combination and steroid paste, but not morphine paste, resulted in a statistically significant reduction in mean pain rating index (PRI) and present pain intensity (PPI) components of the MPQ in the first 3 days after surgery. Likewise, postoperative in-patient narcotic analgesic consumption was reduced in the combination paste and steroid paste group, but not in the morphine paste group. No difference in time to ambulation or discharge, SF-36 scores, ABPI scores, or neurologic recovery was observed. CONCLUSION: An analgesic paste containing methylprednisolone acetate is effective at reducing postoperative pain after lumbar decompressive surgery. Mixing effective doses of morphine sulfate in the paste abrogates the expected analgesic effects of epidural morphine.

scholarly journals Patient Satisfaction versus Patient Reported Outcomes

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Chayanin Angthong
Keyword(s):  
Patient Satisfaction ◽  
Patient Reported Outcomes ◽  
Satisfaction Score ◽  
Successful Outcome ◽  
P Value ◽  
Treatment Level ◽  
Foot And Ankle ◽  
Patient Satisfaction Score ◽  
Sf 36 ◽  
Patient Reported

Category: Other Introduction/Purpose: Several researches focused on patient reported outcomes (PROs), however, little is known about the actual correlation between the patient satisfaction and PROs. The present study is to determine the correlation between patient satisfaction and PROs. Methods: A total of 35 patients with foot and ankle disability participated in this study to complete the data in terms of the patient satisfaction score and PROs. All of them were treated by a single foot and ankle surgeon. The Thai patient satisfaction score or Foot and Ankle Satisfaction Score [FASS] (0 [worst] -100 [best]) consisted of 4 items regarding patient’s perspectives as 1) symptoms, 2) function, 3) other complaints, and 4) recommendation of his/her treatment for other patients. PROs measures consisted of validated Thai visual analogue scale foot and ankle (VASFA) (0 [worst] -100 [best]) and Thai Short Form-36 (SF-36) (0 [worst] -100 [best]). Results: Mean total FASS was 92.0 ± 11.8, 87.7 ± 17.0, 98.6 ± 6.0, 98.6 ± 8.5 and for the items: symptoms, function, other complaints, and recommendation of his/her treatment for other patients, respectively. Mean total FASS was 94.2 ± 6.8. Mean VASFA was 67.7 ± 18.3. Mean SF-36 was 82.7 ± 10.7.There were no significant correlations between mean total FASS and PROs (VASFA [p-value < 0.05], SF-36 [p-value <0.05]). There were no significant correlations between mean FASS in all items and PROs (VASFA, SF-36) with all p-values < 0.05. The significant correlation was found between VASFA and SF-36 (Pearson correlation coefficient = 0.734; p-value<0.01). Conclusion: One of the successful treatment results is the improvement of patient satisfaction. Even if several researches focused on the assessment of PROs to achieve the successful outcome, this kind of measures was no significant correlation with patient satisfaction. PROs were not able to reflect the patient satisfaction following treatments. Patient satisfaction may be related to other parameters, in addition to the PROs, such as the patient expectation, the post-treatment level of physician-patient relationship, the patient’s confidence in his/her physician capability, etc. Further study is needed to clarify these factors.

scholarly journals Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

2017 ◽  
Vol 6 (7) ◽  
pp. 2836
Author(s):  
Ashima Taneja ◽  
Kamaldeep Arora ◽  
Isha Chopra ◽  
Anju Grewal ◽  
Sushree Samiksha Naik ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Epidural Analgesia ◽  
Comparative Study ◽  
Satisfaction Score ◽  
Epidural Group ◽  
Patient Satisfaction Score ◽  
Vaginal Deliveries ◽  
Group A ◽  
Group B

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group.

scholarly journals Predictive factors of quality of life in temporal and extratemporal lobe epilepsy: association with affective temperament profiles and psychiatric comorbidities

2021 ◽  
Vol 79 (9) ◽  
pp. 799-807
Author(s):  
Sehnaz Basaran ◽  
Halil İbrahim Tas
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Predictive Factors ◽  
Focal Epilepsy ◽  
Short Form ◽  
Linear Regression Analysis ◽  
Treatment Strategies ◽  
Affective Temperaments ◽  
Sf 36

ABSTRACT Background: Investigating predictive factors of reduced quality of life (QOL) of patients and their association with focal epilepsy can improve management and treatment strategies. Objective: This study aimed to investigate the relationship between affective temperaments, depression, anxiety, disease characteristics, and QOL and to explore the predictors of QOL in patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). Methods: A total of 50 patients with TLE, 51 patients with ETLE, and 70 controls were enrolled. Affective temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A). QOL was assessed by the Short-Form Health Survey (SF-36). Beck Depression Inventory and Beck Anxiety Inventory were used to explore depression and anxiety severity, respectively. Results: Compared with the controls, patients with TLE and ETLE had significantly higher scores on all TEMPS-A scales, except on hyperthymic temperament. All the SF-36 subscale scores were lower in the TLE and ETLE groups. Linear regression analysis revealed that depressive symptoms, anxiety, depressive and irritable temperament, and seizure frequency were significant predictors of QOL in TLE. Patients with ETLE with temperamental disturbances, depressive symptoms, and polytherapy had a poorer QOL. Conclusions: Affective temperaments, psychiatric disorders, and clinical factors may predict impaired QOL in patients with TLE and ETLE. Further studies are needed to identify predictors of QOL in various epilepsy subtypes.

scholarly journals Quality of Life From Canadian Cancer Trials Group MA.17R: A Randomized Trial of Extending Adjuvant Letrozole to 10 Years

2018 ◽  
Vol 36 (6) ◽  
pp. 563-571 ◽  
Author(s):  
Julie Lemieux ◽  
Michael D. Brundage ◽  
Wendy R. Parulekar ◽  
Paul E. Goss ◽  
James N. Ingle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aromatase Inhibitor ◽  
Short Form ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Change Scores ◽  
Sf 36 ◽  
Cancer Trials

Purpose MA.17R was a Canadian Cancer Trials Group–led phase III randomized controlled trial comparing letrozole to placebo after 5 years of aromatase inhibitor as adjuvant therapy for hormone receptor–positive breast cancer. Quality of life (QOL) was a secondary outcome measure of the study, and here, we report the results of these analyses. Methods QOL was measured using the Short Form-36 (SF-36; two summary scores and eight domains) and menopause-specific QOL (MENQOL; four symptom domains) at baseline and every 12 months up to 60 months. QOL assessment was mandatory for Canadian Cancer Trials Group centers but optional for centers in other groups. Mean change scores from baseline were calculated. Results One thousand nine hundred eighteen women were randomly assigned, and 1,428 women completed the baseline QOL assessment. Compliance with QOL measures was > 85%. Baseline summary scores for the SF-36 physical component summary (47.5 for letrozole and 47.9 for placebo) and mental component summary (55.5 for letrozole and 54.8 for placebo) were close to the population norms of 50. No differences were seen between groups in mean change scores for the SF-36 physical and mental component summaries and the other eight QOL domains except for the role-physical subscale. No difference was found in any of the four domains of the MENQOL Conclusion No clinically significant differences were seen in overall QOL measured by the SF-36 summary measures and MENQOL between the letrozole and placebo groups. The data indicate that continuation of aromatase inhibitor therapy after 5 years of prior treatment in the trial population was not associated with a deterioration of overall QOL.

scholarly journals COMPARING THE EFFECTS OF BUPIVACAINE AND ROPIVACAINE INSTILLATION FOR POST OPERATIVE ANALGESIA IN PATIENTS UNDERGOING LUMBER SPINE SURGERY: A PROSPECTIVE RANDOMISED DOUBLE BLIND STUDY

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Shashikant Sharma ◽  
T. Prabhakar ◽  
Usha Shukla ◽  
Shagufta Naaz
Keyword(s):  
Heart Rate ◽  
Patient Satisfaction ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Respiratory Rate ◽  
Visual Analogue Score ◽  
Study Groups ◽  
Satisfaction Score ◽  
Patient Satisfaction Score ◽  
Surgeon Satisfaction

As it is a comparative study of Bupivacaine and Ropivacaine therefore Ropivacaine is a long-acting amide local anaesthetic with a potentially improved safety profile when compared to bupivacaine . Ropivacaine is less lipophilic than bupivacaine and is less likely to penetrate large myelinated motor fibres, resulting in a relatively reduced motor blockade. Subject and Methods:  90 patients, who belongs to American society of Anesthesiologist grade I & II of age 18-65 years randomized into three groups (n=30). All three groups received propofol bolus 0.75mg/kg IV followed by IV infusion at 0.025 mg/kg/min. group A received Nalbuphine 50 μg/kg IV bolus, group B fentanyl 1.5 μg/kg IV bolus and group C received Dexmedetomidine infusion 1 μg/kg given over 10 min as bolus followed by 0.1 mg/kg/hr IV infusion for maintenance. Ramsay sedation score and Visual analogue scale measured for sedation and analgesia respectively at 10 minute interval for 1st hour of surgery then every 30 minutes upto the end of surgery. Desired RSS was defined 3-5. Intraoperative hemodynamic variables viz. Heart Rate (HR), Respiratory Rate (RR), Mean Arterial Pressure (MAP) and SPO2 were recorded every 10 min till the end of surgery. Recovery was assessed using Modified Aldrete Score in the recovery room. Time to achieve Aldrete recovery score of 10 was recorded. Patient satisfaction score and Surgeon satisfaction score were noted using a 7-point Likert verbal rating scale. Results: The groups were comparable with respect to demographic parameters. Ramsay sedation was significantly higher in Dexmedetomidine group (P<0.05) than Nalbuphine and fentalyl group, while Visual analogue score was comparable in all three study groups (p>0.05). Heart rate and Mean arterial pressure both significantly decreased in Dexmedetomidine group from the baseline during study period (p<0.05). Respiratory rate and SPO2 were comparable in all three groups. In this study MAP was never <60 mmhg, SPO2 was never <94% and Respiratory rate was never <12 bpm. Time to achieve modified alderate score in Dexmedetomidine (0.93±2.33 min) was significantly least as compare to Nalbuphine (1.80±2.65) & Fentanyl group (3.50±4.76) (p=0.016). Patient satisfaction score in Dexmedetomidine was significantly higher (6.53±0.44) (p=0.005). Surgeon satisfaction score in Dexmedetomidine was also significantly higher (6.73±0.52) (p=0.000). Two patients in Dexmedetomidine group had episode of bradycardia which was managed with injection Atropine 0.6 mg effectively Conclusion: From these observations and analyses of the present study, it can be inferred that: ❖ Sedation in Dexmedetomidine was acceptable when used for MAC for middle ear surgeries. ❖ Visual analogue score was similar in all three study groups. ❖ Heart rate & Mean arterial pressure in Dexmedetomidine was lower than baseline value. ❖ Changes in Respiratory rate and SPO2 were similar in all three study groups. ❖ Time to achieve Modified alderate score of 10 in group Dexmedetomidine was least, suggesting quicker recovery from anesthesia. ❖ Patient and surgeon satisfaction score in Dexmedetomidine was significantly higher. Keywords: Dexmedetomidine, Nalbuphine, Bupivacaine, Ropivacaine

scholarly journals Lumbar canal stenosis: analyzing the role of stabilization and the futility of decompression as treatment

2019 ◽  
Vol 46 (5) ◽  
pp. E7 ◽  
Author(s):  
Atul Goel ◽  
Shashi Ranjan ◽  
Abhidha Shah ◽  
Abhinandan Patil ◽  
Ravikiran Vutha
Keyword(s):  
Patient Satisfaction ◽  
Nodal Point ◽  
Satisfaction Score ◽  
Spinal Instability ◽  
Fixation Technique ◽  
Patient Satisfaction Score ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Spinal Segments

OBJECTIVEThe authors report their current experience with their previously published novel form of treatment in 70 cases of lumbar canal stenosis. The treatment consisted of only fixation of the spinal segments by the transarticular screw fixation technique. No bone, ligament, osteophyte, or disc resection was done for spinal canal and neural foraminal decompression. The proposed treatment is based on the concept that vertical instability that results in telescoping of the facets on physical activity forms the nodal point of pathogenesis of lumbar canal stenosis.METHODSDuring the period June 2014 to May 2018, 70 patients presenting with the classically described symptoms of lumbar canal stenosis were treated surgically by only fixation of involved spinal segments. Apart from clinical and radiological guides, instability was diagnosed on the basis of physical observation of the status of articulation by direct manipulation of bones of the region. The operation involved transarticular insertion of 2 or 3 screws for each articulation. The Oswestry Disability Index and visual analog scale were used to assess the patients before and after surgery and at follow-up. Additionally, a personalized patient satisfaction score was used to assess the outcome of surgery.RESULTSClinical symptomatic recovery was observed in all patients in the immediate postoperative period. During the average follow-up period, 100% of patients had varying degrees of symptomatic relief. The patient satisfaction score suggested that all patients were very satisfied with the surgical procedure. The transarticular fixation technique provided strong spinal segment fixation and a reliable ground for bone arthrodesis. No patient needed any additional modality of treatment or reoperation for recurrence of symptoms.CONCLUSIONSSpinal instability is the nodal point of pathogenesis of spinal degeneration–related lumbar canal stenosis. Only fixation of the involved spinal segments is necessary—decompression by bone or soft-tissue resection is not necessary.

Factors Influencing Patient Satisfaction after Microvascular Decompression for Hemifacial Spasm: A Focus on Residual Spasms

2021 ◽  
pp. 1-9
Author(s):  
Jeong-A Lee ◽  
Doo-Sik Kong ◽  
Soo Jung Kim ◽  
Seunghoon Lee ◽  
Sang-Ku Park ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Surgical Outcomes ◽  
Social Life ◽  
Interpersonal Relationship ◽  
Psychological Problem ◽  
Satisfaction Score ◽  
Patient Satisfaction Score ◽  
Significant Difference

<b><i>Introduction:</i></b> Patients with hemifacial spasm (HFS) experience improvement in symptoms after microvascular decompression (MVD); however, patient satisfaction is sometimes low. This study aimed to analyze the relationship between residual spasms and patient satisfaction, identify factors affecting satisfaction, and investigate the degree of improvement in spasms which result in patient satisfaction after surgery. <b><i>Methods:</i></b> 297 patients who completed a questionnaire after MVD for HFS between March 2020 and June 2020 were included. Information on surgical outcomes and patient satisfaction was collected using the questionnaire, and their relationships were analyzed. <b><i>Results:</i></b> Among the 297 patients, the mean residual spasm percentage and patient satisfaction score were negatively correlated with 14.0% and 8.8 points, respectively. In addition to residual spasms, discomfort caused by persistent spasms, psychological problem-solving, better social life, and interpersonal relationship improvement were associated with satisfaction. There was no significant association between the presence of complications and satisfaction. There was no significant difference in the satisfaction score at up to 30% residual spasm, and the patients with 0–30% residual spasm had a satisfaction score of 7 points or higher. <b><i>Conclusion:</i></b> Residual spasms and discomfort from residual spasms decreased patient satisfaction after MVD for HFS. It is then necessary to perform accurate surgical resolution to improve surgical outcomes and provide adequate management to reduce postoperative discomfort and anxiety, and ultimately to enhance satisfaction. Residual spasms of up to 30% compared with the preoperative severity can be considered a good outcome when evaluating surgical outcomes.

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