scholarly journals Preoperative characteristics and intraoperative factors do not correlate with accomplishments of active straight-leg raising, standing up, and walking after primary total knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yoshinori Ishii ◽  
Hideo Noguchi ◽  
Junko Sato ◽  
Ikuko Takahashi ◽  
Hana Ishii ◽  
...  
Keyword(s):  
Postoperative Rehabilitation ◽  
Duration Of Surgery ◽  
Standing Up ◽  
Straight Leg Raising ◽  
Special Surgery ◽  
Total Knee ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Hospital For Special Surgery ◽  
Objective Functional

Abstract Background The correlations between patient characteristics and early postoperative functional performances after total knee arthroplasty have not been adequately studied. The purpose of this study was to clarify the effects of preoperative characteristics (sex, age, body mass index, American Society of Anesthesiologists grade, hospital for special surgery score) and intraoperative factors (duration of surgery and tourniquet use) on the time required to accomplish active straight-leg-raising, standing up, and walking as the objective performances for the initiation of early postoperative rehabilitation. Methods This cross-sectional retrospective study included 307 patients (384 primary total knee arthroplasties). Postoperative times required until each activity was accomplished were measured. Various preoperative characteristics and intraoperative factors that might affect three objective performances were evaluated. Results The postoperative times required before each activity was accomplished were 1.5 ± 0.5 days for active straight-leg-raising, 1.2 ± 0.5 days for standing up, and 1.4 ± 0.7 days for walking. There were no significant correlations between any factor (age, body mass index, hospital for special surgery score, duration of surgery, and tourniquet use) and the three objective performances using Spearman’s correlation coefficient. There were no differences in sex or American Society of Anesthesiologists grade for three objective functional assessments by Wilcoxon rank sum test. Conclusions Differences in patient preoperative characteristics and intraoperative factors are unlikely to affect three objective functional performances in the early postoperative period. Therefore, there is no need to consider differences between patients when initiating early postoperative rehabilitation.

Blood loss and knee function after unicompartment knee arthroplasty(UKA) without tourniquet

2020 ◽  
Author(s):  
Zhanfeng Zhang ◽  
Jianming Zhong ◽  
Jikang Min ◽  
Dan Wang ◽  
Lidong Wu
Keyword(s):  
Blood Loss ◽  
Knee Arthroplasty ◽  
Knee Function ◽  
Whole Process ◽  
Hidden Blood Loss ◽  
Total Knee ◽  
American Society ◽  
Without Tourniquet ◽  
And Function ◽  
American Society Of Anesthesiologists

Abstract BackgroundThe characteristics of blood loss and knee function after unicompartment knee arthroplasty(UKA) remains unclear. Utilization of tourniquet is considered to compromise the outcome of knee arthroplasty. This study aims to evaluate the hidden blood loss and function restoration of UKA without tourniquet by comparing with total knee arthroplasty(TKA).MethodsIn this retrospective study, a total of 112 patients were included from August 2017 to October 2018. Both the UKA group (n = 56) and the TKA group (n = 56) underwent procedure without utilization of tourniquet during the whole process. The gender, age, body mass index, American Society of Anesthesiologists score, Kellgren-Lawrence grade, preioperative Hb, and volume of hidden blood loss (HBL) were recorded and analysed. Knee function was assessed at 3 month and 12 month after procedure by using HSS score.ResultThe mean volume of HBL was significant lower in UKA group (324.23ml ± 147.05, 864.82ml ± 206.37, P = 0.001). The HSS score was higher in UKA group 3 month after procedure (88.16 ± 5.57, 83.04 ± 4.88, P = 0.033). No HBL difference was observed in either groups in terms of gender nor age. Hb level dropped to the bottom at the 4th day postoperatively. No correlation was observed between HBL and knee function.ConclusionWithout utilization of tourniquet, the HBL could not be ignored in UKA though it is much less than TKA, and the knee function was not compromised by it.Trial registrationCurrent trial ISRCTN85133278 (Retrospectively registered on 06 April 2020).

The Combitube in Elective Surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Luis A. Gaitini ◽  
Sonia J. Vaida ◽  
Somri Mostafa ◽  
Boris Yanovski ◽  
Milian Croitoru ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Airway Device ◽  
Spontaneous Ventilation ◽  
Mechanically Ventilated ◽  
Entire Duration ◽  
Duration Of Surgery ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Spontaneously Breathing

Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

Prospective Surveillance for Surgical Site Infection in St. Petersburg, Russian Federation

2007 ◽  
Vol 28 (3) ◽  
pp. 319-325 ◽  
Author(s):  
Samuel M. Brown ◽  
Sergey R. Eremin ◽  
Sergey A. Shlyapnikov ◽  
Elena A. Petrova ◽  
Ludmila V. Shirokova ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Russian Federation ◽  
Surgical Site Infections ◽  
The United States ◽  
Physical Status Classification ◽  
Local Practices ◽  
Duration Of Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Adjusted Incidence

Objective.To assess the risk-adjusted incidence and predictors of surgical site infections (SSIs).Design.Prospective, multicenter, observational cohort study.Setting.Seven surgical departments at 3 urban academic hospitals in St. Petersburg, Russian Federation.Patients.All patients had surgery performed between January 15 and May 12, 2000. A total of 1,453 surgical procedures were followed up. Medical records were unavailable for less than 3% of all patients; patients were not excluded for any other reason. The mean patient age was 49.3 years, 61% were female, and 34% had an American Society of Anesthesiologists physical status classification (hereafter, “ASA classification”) of at least 3. Surgery for 45% of the patients was emergent.Results.In all, 138 patients (9.5%) developed SSI, for a rate that was approximately 3.5 times the risk-stratified rates in the United States. Male sex (odds ratio [OR], 1.54), ASA classifications of 3 (OR, 3.7) or 4 (OR, 5.0), longer duration of surgery (OR, 2.2), and wound classes of 3 (OR, 5.5) or 4 (OR, 14.3) were associated with increased SSI risk in multivariate analysis. Endoscopic surgery was associated with a lower risk of SSI (OR, 0.23). Antibiotic prophylaxis was used in 0%-33% of operations, and 69% of uninfected patients received antibiotics after the operation.Conclusions.The SSI rates are significantly higher than previously reported. Although this finding may be attributable to inadequate antibiotic prophylaxis, local infection control and surgical practices may also be contributors. Use of antibiotic prophylaxis should be encouraged and the effect of local practices further investigated. Active SSI surveillance should be expanded to other parts of the Russian Federation.

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

2020 ◽  
Author(s):  
Shih-Hao Chen ◽  
Jen-Yuh Chen ◽  
Tze-Hong Wong ◽  
Frederick Buechel ◽  
Meng-Huang Wu
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Management ◽  
Major Complication ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Pain Visual Analog Scale ◽  
Total Knee ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSimultaneous bilateral total knee arthroplasty (SBTKA) increases the rates of procedure-related complications and mortality compared with unilateral TKA. There are no well-defined guidelines for selecting patients to avoid mortality and proposing an upgrade treatment to decrease complication rates. This study aimed to evaluate whether optimal perioperative management could improve the safety of SBTKA. From 2005 to 2017, 1,166 cases of SBTKA were identified from 14,209 TKA procedures. We retrospectively examined the SBTKA patients' demographics, comorbidity profiles, procedure-related complications, and perioperative management during two time periods. Optimal perioperative workup for managing SBTKA significantly decreased the incidences of major complication from 6.2 to 2.4% (p = 0.001) and minor complications from 28.9 to 21.5% (p = 0.004) during period I and period II, respectively. The efficiency of less tourniquet use along with intraarticular tranexamic acid injection was demonstrated by the decreases of hemoglobin (Hb) change in the first 2 days after surgery (p = 0.005) and blood transfusion requirement (p = 0.035) during the SBTKA. Furthermore, the less tourniquet use group had less thigh pain (visual analog scale decreased from 6.0 to 4.2, p = 0.003), shorter duration of hospital stay (decreased from 7.8 to 7.1, p < 0.001), and lower coagulation time (decrease from 3.5 to 2.9, p < 0.001) than the routine tourniquet use group. Patient's screening must be performed carefully for cardiopulmonary compromise in patients aged >80 years and with an American Society of Anesthesiologists score of 3. Additionally, hospitalists should consider developing methods for the eligibility, testing, and perioperative monitoring of patients who undergo SBTKA with the aim of avoiding complications and improving outcomes.

Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with either TURis or transurethral resection of the prostate method

2018 ◽  
Vol 86 (2) ◽  
pp. 69-73
Author(s):  
Eleftheria Chalari ◽  
George Intas ◽  
Sofia Zyga ◽  
Georgios Fildissis ◽  
Maria Tolia ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Transurethral Resection ◽  
Core Body Temperature ◽  
Lower Body ◽  
Lower Body Mass Index ◽  
Duration Of Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Core Body

Purpose: The purpose of the study was to investigate the incidence of perioperative hypothermia in urology patients undergoing transurethral resection with either TURis or transurethral resection of the prostate method and to recognize the risk factors that were responsible for the occurrence of hypothermia intraoperatively in these patients. Methods: It was a randomized prospective study. A total of 168 patients, according to American Society of Anesthesiologists physical status I–III, were scheduled for transurethral resection either with TURis or transurethral resection of the prostate method. We measured the core body temperature before (preoperative), during (perioperative) and after (postoperative) the surgery. Age, body mass index, American Society of Anesthesiologists score, duration of surgery, preoperative prostatic volume, and vital signs were also recorded. Results: The prevalence of inadvertent hypothermia was 64.1% for the TURis group and 60% for the transurethral resection of the prostate group. Hypothermic patients in TURis group were significantly older (87.7 ± 1.7 vs 68 ± 6.7 years, p < 0.05) and had lower body mass index (26.9 ± 3.6 vs 29.2 ± 2.7, p < 0.05), while hypothermic patients in the transurethral resection of the prostate group were significantly older (86 ± 1.1 vs 70 ± 7.4 years, p < 0.05) and had notably higher duration of surgery (140.6 ± 28.9 vs 120.3 ± 14.3 min, p < 0.05) than normothermic patients. Conclusion: Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with both TURis and transurethral resection of the prostate method is of high incidence. We recommend monitoring of the temperature of core body of all these patients, especially those with advanced age and lower body mass index.

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