The Scar Cosmesis Assessment and Rating Scale To Evaluate The Cosmetic Outcomes of The Totally Thoracoscopic Cardiac Surgery

Abstract Background Conventional median sternotomy is widely used in cardiac surgery, while the totally thoracoscopic cardiac surgery which is considered to have aesthetic advantages now is increasingly used in China because patients' requirements for minimally invasive and aesthetically pleasing are significantly increased. Fewer studies have been conducted on the assessment of surgical scars after cardiac surgery. Compared to a median sternotomy approach, multiple-incision totally thoracoscopic cardiac surgery offers smaller but numerous and scattered incisions. In addition to two working ports on the upper and lower margins of the right breast, we also need an inguinal incision and an axillary incision. So, does totally thoracoscopic cardiac surgery really have aesthetic advantages? This study has the following objectives: (a) to compare the long term cosmetic effect of post-operative scars between median sternotomy cardiac surgery and totally thoracoscopic cardiac surgery; (b) to evaluate the effectiveness of the Scar Cosmesis Assessment and Rating(SCAR) scale, in combination with the Numeric Rating Scale(NRS) in the assessment of surgical scars after cardiac surgery. Methods Collection of consecutive patients who came to our institution from January 2019 to May 2019 for cardiac surgery via median sternotomy or totally thoracoscopic approach for at least one year of follow-up. Inter-rater reliability, internal consistency and convergent validity were evaluated for the SCAR scale and the NRS. Clinic characteristics and the scores of the SCAR scale and the NRS were analyzed using the Student's t test or Mann-Whitney U-test between the two groups. Results Thirty-one patients underwent cardiac surgery via a totally thoracoscopic approach (TA n = 31), and forty-two patients via a median sternotomy approach (SA n = 42). No significant differences were found in demographic and clinical data between the two groups. Validity and reliability of the SCAR scale and the NRS were satisfactory. The results of the SCAR scale showed that SA group scored significantly higher than TA group on “overall impression” and “patient questions” subscales with statistical significance (P < 0.05). The overall SCAR scale scores and the NRS scores were statistically significant (P < 0.05). Conclusions The SCAR scale in combination with the NRS is an effective tool for assessment of scar aesthetics after cardiac surgery. Surgical scars of totally thoracoscopic cardiac surgery can achieve desirable cosmetic effects in Chinese population. Especially in susceptible individuals with high risk of keloid and hypertrophic scars. Patients with appropriate indications can undergo cardiac surgery through the totally thoracoscopic approach and obtain a satisfactory scar appearance.

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The Scar Cosmesis Assessment and Rating scale to Evaluate the Cosmetic Outcomes of the Totally Thoracoscopic Cardiac Surgery

10.21203/rs.3.rs-31841/v1 ◽

2020 ◽

Author(s):

Ling-chen Huang ◽

Dao-zhong Chen ◽

Liang-wan Chen ◽

Qi-chen Xu ◽

Zi-he Zheng ◽

...

Keyword(s):

Cardiac Surgery ◽

Convergent Validity ◽

Rating Scale ◽

Statistical Significance ◽

Median Sternotomy ◽

Numeric Rating Scale ◽

Validity And Reliability ◽

Thoracoscopic Approach ◽

Axillary Incision ◽

Scar Assessment

Abstract Background: Conventional median sternotomy is widespread used in cardiac surgery, while the multiple-incision totally thoracoscopic cardiac surgery which is considered to have aesthetic advantages now is increasingly used in china because patients' requirements for minimally invasive and aesthetically pleasing are significantly increased. Fewer studies have been conducted on the assessment of surgical scars after cardiac surgery. Compared to a median sternotomy approach, totally thoracoscopic cardiac surgery offers smaller but numerous and scattered incisions, requiring two surgical incisions on the upper and lower margins of the right breast, as well as an inguinal incision and an axillary incision. So, does totally thoracoscopic cardiac surgery really have aesthetic advantages? This study has the following objectives: (a) to compare the long term cosmetic effect of post-operative scars between median sternotomy cardiac surgery and totally thoracoscopic cardiac surgery; (b) to evaluate the effectiveness of the Scar Cosmesis Assessment and Rating(SCAR) scale, in combination with the Numeric Rating Scale(NRS) in the assessment of surgical scars after cardiac surgery.Methods: Collection of consecutive patients who came to our institution from January 2019 to May 2019 for cardiac surgery via median sternotomy or totally thoracoscopic approach for at least one year of follow-up. Inter-rater reliability, internal consistency and convergent validity were evaluated for the SCAR scale and the NRS. Clinic characteristics and the score of the SCAR scale and the NRS were analyzed using the Student's t test or Mann-Whitney U-test between the two groups.Results: 31 patients underwent cardiac surgery via the totally thoracoscopic approach (TA n = 31), and 42 patients via the median sternotomy approach (SA n = 42). No significant differences were found in demographic and clinical data between the two groups. Validity and reliability of the SCAR scale and the NRS were satisfactory. The scores of “overall impression” and “patient questions” were obviously higher in the sternotomy group with statistical significance (P < 0.05). The overall SCAR scale scores and the NRS scores were statistically significant (P < 0.05).Conclusions: The SCAR scale in combination with the NRS is an effective tool for scar assessment after cardiac surgery. Surgical scars of totally thoracoscopic cardiac surgery can achieve desirable cosmetic effects in Chinese population. Especially in susceptible individuals with high risk of keloid and hypertrophic scars. Patients with appropriate indications can undergo cardiac surgery through the totally thoracoscopic approach and obtain a satisfactory scar appearance.

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The use of the Scar Cosmesis Assessment and rating scale to evaluate the cosmetic outcomes of totally thoracoscopic cardiac surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01294-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ling-chen Huang ◽

Dao-zhong Chen ◽

Liang-wan Chen ◽

Qi-chen Xu ◽

Zi-he Zheng ◽

...

Keyword(s):

Cardiac Surgery ◽

Convergent Validity ◽

Rating Scale ◽

Median Sternotomy ◽

Numeric Rating Scale ◽

Validity And Reliability ◽

Thoracoscopic Approach ◽

Axillary Incision ◽

Cosmetic Outcomes ◽

Numeric Rating

Abstract Background Conventional median sternotomy is widely used in cardiac surgery, while thoracoscopic cardiac surgery, which is considered to have aesthetic advantages, is being performed increasingly more often in China because patients’ requests for minimally invasive procedures yielding aesthetically pleasing results have significantly increased. Few studies have been conducted to assess surgical scars after cardiac surgery. Compared to the median sternotomy approach, multiple-incision totally thoracoscopic cardiac surgery requires smaller but numerous and scattered incisions. In addition to two working ports on the upper and lower margins of the right breast, an inguinal incision and an axillary incision are made. Therefore, does totally thoracoscopic cardiac surgery truly have aesthetic advantages? This study has the following objectives: (a) to compare median sternotomy cardiac surgery and total thoracoscopic cardiac surgery in terms of the long-term cosmetic outcomes of post-operative scars and (b) to evaluate the effectiveness of the Scar Cosmesis Assessment and Rating scale in combination with the numeric rating scale in the assessment of surgical scars after cardiac surgery. Methods Consecutive patients who visited our institution from January 2019 to May 2019 for cardiac surgery via median sternotomy or the totally thoracoscopic approach and followed up for at least one year were included. Inter-rater reliability, internal consistency and convergent validity were evaluated for the Scar Cosmesis Assessment and Rating scale and the numeric rating scale. Clinical characteristics and the scores of the two scales were compared between the two groups using Student’s t test or the Mann-Whitney U test. Results Thirty-one patients underwent cardiac surgery via the totally thoracoscopic approach, and 42 patients underwent cardiac surgery via the median sternotomy approach. No significant differences were found in the demographic or clinical data between the two groups. The validity and reliability of the two scales were satisfactory. For the Scar Cosmesis Assessment and Rating scale, the median sternotomy group scored statistically significantly higher than did the totally thoracoscopic group on the “overall impression” and “patient question” subscales (P < 0.05). The overall scores of the Scar Cosmesis Assessment and Rating scale and numeric rating scale were statistically significantly different (P < 0.05). Conclusions The Scar Cosmesis Assessment and Rating scale in combination with the numeric rating scale is an effective tool for the assessment of scar aesthetics after cardiac surgery. Surgical scars of totally thoracoscopic cardiac surgery can yield desirable cosmetic outcomes in Chinese individuals, especially in susceptible individuals with a high risk of keloid and hypertrophic scars. Patients with appropriate indications can undergo cardiac surgery with the totally thoracoscopic approach and exhibit a satisfactory scar appearance.

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Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis

Open Heart ◽

10.1136/openhrt-2020-001474 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001474

Author(s):

Ellaha Kakar ◽

Ryan J Billar ◽

Joost van Rosmalen ◽

Markus Klimek ◽

Johanna J M Takkenberg ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Rating Scale ◽

Meta Analysis ◽

Numeric Rating Scale ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Music Intervention ◽

Opioid Use ◽

Beneficial Effects

ObjectivesPrevious studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery.MethodsFive electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated.ResultsTwenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01).ConclusionsOffering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.

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The Neuropsychiatric Inventory-Diary Rating Scale (NPI-Diary): A Method for Improving Stability in Assessing Neuropsychiatric Symptoms in Dementia

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000490380 ◽

2018 ◽

Vol 8 (3) ◽

pp. 306-320 ◽

Cited By ~ 5

Author(s):

Francesca Morganti ◽

Alex Soli ◽

Paola Savoldelli ◽

Gloria Belotti

Keyword(s):

Health Care ◽

Internal Consistency ◽

Convergent Validity ◽

Care Setting ◽

Rating Scale ◽

Neuropsychiatric Symptoms ◽

Validity And Reliability ◽

Neuropsychiatric Inventory ◽

Test Retest Reliability ◽

Adequate Internal Consistency

Background: In health-care settings, the use of the Neuropsychiatric Inventory-Nursing Home (NPI-NH) may not always be consistent with the authors’ guidelines, which affects its reliability. To avoid this bias, a diary version of the NPI (NPI-Diary) was developed. Aims: This study aimed to evaluate the psychometric properties (internal consistency and reliability) of the NPI-Diary, and examined its convergence with the NPI-NH. Methods: Two raters administered the NPI-NH and NPI-Diary to 40 participants with Alzheimer’s disease, selected randomly from a hospital’s weekly turnover. Results: The NPI-Diary exhibited adequate internal consistency (total: α = 0.581) and test-retest reliability (total: ρ = 0.711; p < 0.01). The interrater reliability values (ICC) for the NPI-NH and NPI-Diary differed significantly (Total: NPI-NH ICC = 0.506, NPI-Diary ICC = 0.879; Frequency: NPI-NH ICC = 0.51, NPI-Diary ICC = 0.798; Severity: NPI-NH ICC = 0.491, NPI-Diary ICC = 0.809). The convergent validity between the two inventories was also significant (total: ρ = 0.48; p < 0.01). Conclusions: The NPI-Diary showed more appropriate validity and reliability compared to the NPI-NH, when administered in a highly variable sample, as is generally the case in the current health-care setting.

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Construct Validity of the Modified Numeric Rating Scale of Patient Global Assessment in Psoriatic Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.110919 ◽

2012 ◽

Vol 39 (4) ◽

pp. 844-848 ◽

Cited By ~ 11

Author(s):

YING-YING LEUNG ◽

KWOK-WAH HO ◽

TRACY-YANNER ZHU ◽

LAI-SHAN TAM ◽

EMILY WAILIN KUN ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Construct Validity ◽

Disease Activity ◽

Severity Score ◽

Convergent Validity ◽

Global Assessment ◽

Rating Scale ◽

Health Assessment ◽

Numeric Rating Scale ◽

Numeric Rating

Objective.The construct validity of the patient global health assessment (PGA) in psoriatic arthritis (PsA) has not been analyzed, despite its common use. We evaluated the construct validity of a numeric rating scale (NRS) of the PGA in PsA.Methods.Patients with PsA who fulfilled the ClASsification for Psoriatic ARthritis (CASPAR) criteria were recruited at a tertiary referral center. Demographic data were collected and PGA data were determined from administration of an 11-point NRS (0 to 10 points representing best to worst status). Convergent and discriminant validity were evaluated by correlation between PGA and clinical variables. Patients were grouped as having severe disease based on Disease Activity Score 28-joint count (DAS28) > 5.1, Health Assessment Questionnaire (HAQ) > 1.0, walking with aids, and social welfare-dependent. Patients were grouped as being in remission by DAS28 < 2.6 and the Minimal Disease Activity Criteria. Known-group validity of PGA was evaluated.Results.A total of 125 patients (52% men) were studied. Convergent validity revealed strong correlations of PGA with pain score, HAQ, and DAS28; and weak correlations with skin severity score, physician’s global assessment and morning stiffness. In multivariate analysis, PGA was associated with pain, physical function, mental function, and skin severity score. PGA distinguished different levels of severity well, as determined by comparison with different known groups with large effect sizes.Conclusion.Judged on an NRS, the PGA had good construct validity and satisfactorily distinguished all levels of severity in PsA.

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Chronic pain in children after cardiac surgery via sternotomy

Cardiology in the Young ◽

10.1017/s104795111300139x ◽

2013 ◽

Vol 24 (5) ◽

pp. 893-899 ◽

Cited By ~ 15

Author(s):

Mette H. Lauridsen ◽

Anders D. Kristensen ◽

Vibeke E. Hjortdal ◽

Troels S. Jensen ◽

Lone Nikolajsen

Keyword(s):

Chronic Pain ◽

Cardiac Surgery ◽

Quantitative Sensory Testing ◽

Rating Scale ◽

Numeric Rating Scale ◽

Sensory Testing ◽

Sensory Abnormalities ◽

Scar Area ◽

Post Operative Pain

AbstractIntroductionChronic pain is common after sternotomy in adults with reported prevalence rates of 20–50%. So far, no studies have examined whether children develop chronic pain after sternotomy.Material and methodsPostal questionnaires were sent to 171 children 10–60 months after undergoing cardiac surgery via sternotomy at the age of 0–12 years. The children were asked to recall the intensity and duration of their post-operative pain, if necessary with the help from their parents, and to describe the intensity and character of any present pain. Another group of 13 children underwent quantitative sensory testing of the scar area 3 months after sternotomy.ResultsA total of 121 children, median (range) age 7.7 (4.2–16.9) years, answered the questionnaire. Their age at the time of surgery was median (range) 3.8 (0–12.9) years, and the follow-up period was median (range) 4 (0.8–5.1) years. In all, 26 children (21%) reported present pain and/or pain within the last week located in the scar area; in 12 (46%) out of the 26 children, the intensity was ≥4 on a numeric rating scale (0–10). Quantitative sensory testing of the scar area revealed sensory abnormalities – pinprick hyperalgesia and brush and cold allodynia – in 10 out of 13 children.ConclusionChronic pain after cardiac surgery via sternotomy in children is a problem that should not be neglected. The pain is likely to have a neuropathic component as suggested by the sensory abnormalities demonstrated by quantitative sensory testing.

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Pain after Cardiac Surgery

Anesthesiology ◽

10.1097/00000542-200610000-00026 ◽

2006 ◽

Vol 105 (4) ◽

pp. 794-800 ◽

Cited By ~ 135

Author(s):

Pasi Lahtinen ◽

Hannu Kokki ◽

Markku Hynynen

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Scale Score ◽

Severe Pain ◽

Rating Scale ◽

Artery Bypass ◽

Numeric Rating Scale ◽

Persistent Pain ◽

Numeric Rating Scale Score ◽

Numeric Rating

Background Persistent chest pain may originate from cardiac surgery. Conflicting results have been reported on the incidence of persistent poststernotomy pain with considerable discrepancies between the retrospective reports and the one prospective study conducted to assess this pain. Therefore, the authors conducted a follow-up survey for the first 12 months after cardiac surgery in 213 patients who had a sternotomy. Methods The authors performed a prospective inquiry of acute and chronic poststernotomy pain both before and after cardiac surgery. Two hundred thirteen coronary artery bypass patients received a questionnaire preoperatively, 4 days postoperatively, and 1, 3, 6, and 12 months postoperatively. All patients were asked about their expectations, their preferences, and the location and intensity of postoperative pain. Results The return rates for the postal questionnaires were 203 (95%) and 186 (87%) after 1 and 12 months, respectively. Patients experienced more pain postoperatively at rest than they had expected to preoperatively. At rest, the worst actual postoperative pain was 6 (0-10), and the worst expected pain as assessed preoperatively was 5 (0-10) (P = 0.013). The worst reported postoperative pain was severe (numeric rating scale score 7-10) in 49% at rest, in 78% during coughing, and in 62% of patients on movement. One year after the operation, 26 patients (14%) reported mild chronic poststernotomy pain at rest, 1 patient (1%) had moderate pain, and 3 patients (2%) had severe pain. Upon movement, persistent pain was even more common: 45 patients (24%) had mild, 5 patients (3%) had moderate, and 7 patients (4%) had severe pain. Patients who experienced moderate to severe acute postoperative pain also reported any chronic poststernotomy pain (numeric rating scale score 1-10) more frequently. Conclusions Although common, the incidence of persistent pain after sternotomy was lower than previously reported. Also, reassuringly, 1 year after surgery this pain was mostly mild in nature both at rest and on movement.

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Randomized Trial of Sternal Closure for Low Risk Patients: Rigid Fixation versus Wire Closure

The Heart Surgery Forum ◽

10.1532/hsf.1860 ◽

2017 ◽

Vol 20 (4) ◽

pp. 164 ◽

Cited By ~ 3

Author(s):

Graham Graham ◽

Jeevan Kumar ◽

Shinya Unai ◽

Diehl T James ◽

Hitoshi Hirose, MD

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Hospital Stay ◽

Rating Scale ◽

Randomized Study ◽

Length Of Hospital Stay ◽

Numeric Rating Scale ◽

Female Group ◽

Rigid Fixation ◽

Intubation Time

Background: A previous retrospective analysis of our cardiac surgery patients showed shortened ventilation time and hospital stay among patients receiving rigid sternal fixation compared to sternal wire fixation. We performed a prospective randomized study to further investigate these outcomes and determine if rigid closure can provide reduced pain after cardiac surgery.Methods: Patients undergoing cardiac surgery between July 2011 and May 2014 were prospectively randomized into wire closure (Group C) or rigid fixation using sternal plates (Group R) groups. Age above 80, emergency surgery, redo sternotomy, and immunosuppression were among major exclusion criteria precluding randomization. Intubation time was recorded for all patients. Pain scores were determined daily from postoperative day 1 until day 5 at 6 a.m. using a numeric rating scale. Narcotic pain medication requirements from day 1 to 5 were collected and converted into intravenous morphine equivalents.Results: Of 80 patients, 39 patients were in Group R (average age 65 ± 8; 31 male and 8 female) and 41 patients were in Group C (average age 66 ± 9; 34 male and 7 female). Group R patients had a higher body mass index than patients in Group C (Group R: 31 ± 5; Group C: 29 ± 5; P = .04). No significant differences in the end points of intubation time and postoperative pain were observed. Conclusion: This randomized study of cardiac surgery patients showed no significant benefits of rigid fixation over conventional sternal wire closure with regard to intubation time, postoperative pain, or length of hospital stay.

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Health-Related Quality of Life following Minimally Invasive Totally Thoracoscopic Mitral Valve Surgery

10.21203/rs.3.rs-29664/v1 ◽

2020 ◽

Author(s):

Ling-chen Huang ◽

Dao-zhong Chen ◽

Liang-wan Chen ◽

Qi-chen Xu ◽

Zi-he Zheng ◽

...

Keyword(s):

Mitral Valve ◽

Pain Intensity ◽

Rating Scale ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Thoracoscopic Approach ◽

Aesthetic Appearance ◽

Related Quality ◽

Health Related

Abstract Background In order to compare the impact of two different approaches to mitral valve surgery on health-related quality of life, we conducted a retrospective study comparing minimally invasive totally thoracoscopic mitral valve surgery with median sternotomy mitral valve surgery. Methods A total of 163 patients who underwent mitral valve surgery at our institution between January 1, 2019 and December 31, 2019 were enrolled. In 163 patients, mitral valve surgery was performed using either totally thoracoscopic approach (TA n = 78) or median sternotomy approach (SA n = 85). We used the Scar Cosmesis Assessment and Rating Scale and the Numerical Rating Scale to measure the pain intensity and the aesthetic appearance of surgical incision and used the MOS SF-36 to assess the HRQoL. Results The two groups of patients were similar in terms of demographic, echocardiography data and postoperative complications. The pain intensity and aesthetic appearance of the totally thoracoscopic approach were significantly better than that of the median sternotomy approach. Significant differences in the subscale of the SF-36 were found between the two groups. Conclusions When compared to the median sternotomy mitral valve surgery, totally thoracoscopic mitral valve surgery has an equally good outcome, while improving aesthetic appearance and reducing pain intensity. Our study suggested that totally thoracoscopic approach is superior to median sternotomy approach in terms of pain intensity, aesthetic appearance and HRQoL.

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