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Obesity Surgery Apr 2024Increasing evidence suggests that bariatric surgery (BS) patients are at risk for substance abuse disorders (SUD). The purpose of this systematic review and... (Meta-Analysis)
Meta-Analysis Review
Increasing evidence suggests that bariatric surgery (BS) patients are at risk for substance abuse disorders (SUD). The purpose of this systematic review and meta-analysis was to determine the relationship between BS and the development of new-onset substance abuse disorder (SUDNO) in bariatric patients. On October 31, 2023, we reviewed the scientific literature following PRISMA guidelines. A total of 3242 studies were analyzed, 7 met the inclusion criteria. The pooled incidence of SUDNO was 4.28%. Patients' characteristics associated with SUDNO included preoperative mental disorders, high pre-BS BMI, and public health insurance. Surgical factors associated with new SUDNOs included severe complications in the peri- or postoperative period. The occurrence of SUDNOs is a non-negligeable complication after BS. Predisposing factors may be identified and preventive actions undertaken.
Topics: Humans; Obesity, Morbid; Bariatric Surgery; Substance-Related Disorders; Postoperative Period; Preoperative Period
PubMed: 38430321
DOI: 10.1007/s11695-024-07130-7 -
Revista Brasileira de Enfermagem 2024to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation. (Review)
Review
OBJECTIVES
to map the factors associated with increased lactate levels in the postoperative period of cardiac surgery using extracorporeal circulation.
METHODS
this is a scoping review carried out in December 2022, across ten data sources. It was prepared in accordance with the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews checklist.
RESULTS
the most recurrent findings in studies regarding the factors responsible for the increase in lactate were: tissue hypoperfusion, cardiopulmonary bypass time and use of vasoactive drugs. In 95% of studies, increased lactate was related to increased patient mortality.
CONCLUSIONS
discussing the causes of possible complications in cardiac surgery patients is important for preparing the team and preventing complications, in addition to ensuring quality recovery.
Topics: Humans; Cardiac Surgical Procedures; Checklist; Lactic Acid; Postoperative Period; Research Design
PubMed: 38511788
DOI: 10.1590/0034-7167-2023-0117 -
Explore (New York, N.Y.) 2024To study whether perioperative electroacupuncture (EA) can improve postoperative gastrointestinal recovery in patients receiving thoracoscopic lung surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To study whether perioperative electroacupuncture (EA) can improve postoperative gastrointestinal recovery in patients receiving thoracoscopic lung surgery.
METHODS
This study was a single-center, prospective, randomized open-label trial. 180 patients who underwent video-assisted thoracoscopic segmentectomy or lobectomy were randomized to EA group (three sessions, 24 h prior to surgery, postoperative 4 h and 24 h) or usual care group (UC group). The primary outcomes were time to first flatus and defecation. Secondary outcomes included incidence and degree of abdominal distention, postoperative nausea and vomiting (PONV) and pain scores within 72 h after surgery, postoperative morphine use, time to ambulation, and length of hospital stay.
RESULTS
Time to first flatus (15.4 ± 3.2 h vs. 17.0 ± 3.7 h, P = 0.004) and time to first defecation (75.9 ± 7.9 vs. 79.7 ± 8.1 h, P = 0.002) in the EA group were significantly shorter than the UC group. The incidences of abdominal distension and PONV postoperative 24 h were significantly reduced in the EA group (P < 0.05). There was no difference in postoperative pain intensity, morphine use, time to ambulation, and length of hospital stay between the two groups (P>0.05).
CONCLUSION
Electroacupuncture is a simple intervention for accelerating postoperative gastrointestinal recovery and may be considered as an adjunct strategy in enhanced recovery protocols in thoracoscopic lung surgery.
Topics: Humans; Electroacupuncture; Male; Female; Middle Aged; Thoracic Surgery, Video-Assisted; Prospective Studies; Aged; Pain, Postoperative; Postoperative Nausea and Vomiting; Length of Stay; Postoperative Period; Defecation; Pneumonectomy
PubMed: 38007308
DOI: 10.1016/j.explore.2023.11.004 -
Cirugia Pediatrica : Organo Oficial de... Apr 2024Literature comparing different alternatives for pain control in the immediate postoperative period of pediatric acute appendicitis (PAA) is scarce.
Prospective evaluation of the emetogenic profile and analgesic efficacy of intravenous ibuprofen and metamizole in the immediate postoperative period of pediatric acute appendicitis.
BACKGROUND
Literature comparing different alternatives for pain control in the immediate postoperative period of pediatric acute appendicitis (PAA) is scarce.
MATERIALS AND METHODS
We prospectively compared the analgesic and emetogenic profile of intravenous ibuprofen and metamizole in the immediate postoperative period of PAA. For this purpose, we used a sample of patients operated on in 2021 in our center. Participants were recruited on arrival at the Emergency Department and histopathological confirmation of the diagnosis was obtained in all of them. Pain was evaluated every 8 hours after the surgery with validated visual analog scales ranging from 0 to 10 points. Repeated measures ANOVA was used to compare the evolution of pain in the 48 hours after surgery between the two groups.
RESULTS
The sample included 95 patients (65% males) with a mean age of 9.7 years (sd: 3.14). 41 patients were treated with Ibuprofen (group 1) and 54 with metamizole (group 2). No significant differences were found in the level of pain either in the comparisons of point measurements or in its evolution in the 48 hours after surgery (p= 0.58). After adjusting for the received fluid therapy, children in the metamizole group had significantly more emetic episodes and needed significantly more doses of ondansetron.
CONCLUSIONS
In our cohort, ibuprofen had a similar analgesic efficacy and a better emetogenic profile than metamizole in the immediate postoperative period of PAA. Future prospective, adequately controlled studies with larger sample sizes are needed to validate these findings.
Topics: Male; Humans; Child; Female; Ibuprofen; Dipyrone; Appendicitis; Pain, Postoperative; Analgesics; Postoperative Period
PubMed: 38623799
DOI: 10.54847/cp.2024.02.15 -
JBJS Reviews Aug 2023Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total hip arthroplasty (THA). This study aimed to determine rates,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total hip arthroplasty (THA). This study aimed to determine rates, timelines, and prognostic factors associated with RTW and RTS outcomes after primary THA.
METHODS
A systematic review was conducted on MEDLINE, EMBASE, and CENTRAL databases with 57 studies meeting inclusion/exclusion criteria. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions and risk of bias in randomized trials (RoB2) tools. Meta-analysis and pooled analysis were conducted, with forest plots to summarize odds ratios and 95% confidence interval (CI).
RESULTS
The pooled RTW rate across all studies was 70% (95% CI, 68%-80%), with rates varying significantly from 11% to 100%. The mean time to RTW was 11.2 weeks (range 1-27). A time point analysis showed increasing RTW rates with a maximum rate at 2 years of 90%. Increased age (p < 0.001) and preoperative heavy labor (p = 0.005) were associated with lower RTW rates. The RTS rate ranged from 42% to 100%, with a pooled rate of 85% (95% CI, 74%-92%). The mean time to RTS was 16.1 weeks (range 8-26). The RTS ranged from 20% to 80% with a pooled proportion of 56% (95% CI, 42%-70%, I2 = 90%) for high-intensity sports and from 75% to 100% for low-intensity sports with a pooled proportion of 97% (95% CI, 83-99, I2 = 93%).
CONCLUSION
Most patients RTW and RTS after THA in an increasing manner as time passes with rates more than 85% after 1 year. These rates may be greatly affected by various factors, most notably age, the intensity of the sport, and the type of work performed. In general, young patients, low-demand work or sports can be resumed as soon as 4 to 6 weeks after surgery, but with increased restrictions as the intensity increases. This information should be used by practitioners to manage postoperative expectations and provide appropriate recommendations to patients.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Arthroplasty, Replacement, Hip; Return to Sport; Return to Work; Sports; Postoperative Period
PubMed: 37549241
DOI: 10.2106/JBJS.RVW.22.00249 -
Transplantation Proceedings May 2024End-stage heart failure patients were at increased risk for acquiring COVID-19 infection and progression to severe disease, given multiple health care contacts and...
BACKGROUND
End-stage heart failure patients were at increased risk for acquiring COVID-19 infection and progression to severe disease, given multiple health care contacts and underlying health conditions. Understanding the outcomes of such patients will help risk-stratify and guide optimization before heart transplant surgery. The aim of this study was to evaluate the impact of the COVID-19 pandemic on heart transplantation activity and outcomes in the early postoperative period.
METHODS
Retrospective data analysis of patients undergoing orthotopic heart transplantation in our institution from March 2020 to July 2023. The patient population (N = 208) included 176 (84.6%) men and 32 (15.4%) women. The perioperative data of the pandemic group, March 2020 to February 2022 (N = 151), and the post-pandemic group, March 2022 to July 2023 (N = 57), were compared.
RESULTS
The number of patients requiring inotropic support increased during the post-COVID-19 era (N = 48 [84.2%], vs N = 72 [47.7%], P < .001). There were no differences in renal complications. Duration of mechanical ventilation was longer in the post-pandemic group (19 hours [14-24] vs 14 hours [9-28], P < .05).
CONCLUSIONS
The extended duration of mechanical ventilation in the post-pandemic group may be related to the patient's preoperative condition. The number of heart transplant recipients with end-stage heart failure requiring inotropic support increased in the post-COVID-19 era. Although some efforts have been made to reduce the impact of the pandemic, more research is required.
Topics: Humans; Heart Transplantation; COVID-19; Female; Male; Retrospective Studies; Middle Aged; Heart Failure; Postoperative Complications; Adult; Respiration, Artificial; Postoperative Period; Aged; SARS-CoV-2; Cardiotonic Agents
PubMed: 38777713
DOI: 10.1016/j.transproceed.2024.03.018 -
JPMA. the Journal of the Pakistan... Apr 2024To evaluate the occurrence and potential risk factors of residual curarisation after surgery and the subsequent acute respiratory events in elderly patients. (Observational Study)
Observational Study
OBJECTIVE
To evaluate the occurrence and potential risk factors of residual curarisation after surgery and the subsequent acute respiratory events in elderly patients.
METHODS
The prospective, cohort study was conducted at Ankara City Hospital from July to December 2021, and comprised data of geriatric patients undergoing elective surgery under general anaesthesia using moderate-acting nondepolarising muscle relaxants. Postoperative acute respiratory events in the post-anaesthesia care unit were subsequently noted. Data was analysed using SPSS 25.
RESULTS
Of the 185 patients aged >65 years evaluated, 174(94%) were included; 88(50.6%) females and 86(49.4%) males. The incidence of residual curarisation was in 6(3.4%) patients. Postoperative residual curarisation was significantly associated with smooth recovery process (p<0.05). The recovery was associated with intraoperative bleeding, total dose of neuromuscular blocker, and the length of time from the last dose of neuromuscular blocker to antagonist administration (p<0.05). Postoperative critical respiratory events were more common in patients with postoperative residual curarisation (p< 0.001). The length of stay in post-anaesthesia care unit was 1.57 times longer in such patients (p=0.001).
CONCLUSION
Postoperative residual curarisation increased length of hospital stay and respiratory complications.
Topics: Humans; Female; Male; Aged; Prospective Studies; Postoperative Complications; Aged, 80 and over; Risk Factors; Anesthesia Recovery Period; Length of Stay; Anesthesia, General; Elective Surgical Procedures; Neuromuscular Blockade
PubMed: 38751263
DOI: 10.47391/JPMA.9525 -
Acta Orthopaedica Belgica Sep 2023Arthroscopic anterior cruciate ligament reconstruction (ACLR) is often performed with the use of a thigh tourniquet. Surgeons believe this helps improve visualisation... (Review)
Review
Arthroscopic anterior cruciate ligament reconstruction (ACLR) is often performed with the use of a thigh tourniquet. Surgeons believe this helps improve visualisation and reduce operative time. However, tourniquet use has been associated with many complications including increased pain, neurovascular injury, venous thromboembolism, haematoma formation, and others. In this article, we describe a method allowing comparable arthroscopic visualisation to be achieved without the aid of a tourniquet for ACLR procedures. The literature evidence relating to this technique as well as tourniquet use for ACLR is also reviewed. Tourniquet-less ACLR can be achieved through the combined application of hypotensive anaesthesia, intravenous tranexamic acid, and use of adrenaline-supplemented irrigation fluid and local anaesthetic. Performing ACLR without a tourniquet avoids the risks associated with its use and reduces the severity of post-operative haemarthrosis which may contribute to the patient's pain and limit their ability to perform their rehabilitation exercises.
Topics: Humans; Tourniquets; Venous Thromboembolism; Anterior Cruciate Ligament Reconstruction; Pain; Postoperative Period; Anterior Cruciate Ligament Injuries
PubMed: 37935228
DOI: 10.52628/89.3.11747 -
Journal of Neurological Surgery. Part... Jul 2024Resection of infiltrative neuroepithelial primary brain tumors, such as low-grade gliomas (LGGs) remains a neurosurgical challenge. Usual lack of clinical deficit...
BACKGROUND
Resection of infiltrative neuroepithelial primary brain tumors, such as low-grade gliomas (LGGs) remains a neurosurgical challenge. Usual lack of clinical deficit despite LGGs growing in eloquent brain areas may be explained by reshaping and reorganization of functional networks. The development of modern diagnostic imaging techniques could disclose better understanding of the rearrangement of the brain cortex; however, mechanisms underlying such compensation and how it occurs in the motor cortex remain unclear. This systematic review aims to analyze the neuroplasticity of motor cortex in patients with LGGs, as determined by neuroimaging and functional techniques.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, medical subject headings (MeSH) and the following terms related to neuroimaging, LGGs and neuroplasticity were used with the Boolean operators AND and OR to synonymous terms in the PubMed database. Among the 118 results, 19 studies were included in the systematic review.
RESULTS
Motor function in patients with LGG was characterized by a compensation in the contralateral and supplementary motor areas and premotor functional networks. Furthermore, ipsilateral activation in these types of gliomas was rarely described. Moreover, some studies did not reveal statistical significance in association between functional reorganization and the postoperative period, which can be explained by the low number of patients.
CONCLUSION
Our findings suggest a high pattern of reorganization per different eloquent motor areas and gliomas diagnosis. Understanding this process is useful to guide safe surgical resection and to develop protocols that assess the plasticity, even though functional network rearrangement needs to be better characterized by more studies.
Topics: Humans; Glioma; Neuronal Plasticity; Brain Neoplasms; Motor Cortex; Brain Mapping; Postoperative Period; Neuroimaging; Preoperative Period
PubMed: 36808404
DOI: 10.1055/a-2037-5993 -
Scientific Reports Jun 2024There are no targeted rehabilitation training modalities and assessment tools for patients after transoral endoscopic thyroidectomy vestibular approach (TOETVA). Herein,...
There are no targeted rehabilitation training modalities and assessment tools for patients after transoral endoscopic thyroidectomy vestibular approach (TOETVA). Herein, we develop a new assessment questionnaire and rehabilitation training modality and evaluate its safety and effectiveness. The THYCA-QoL-TOETVA questionnaire was compiled, and reliability and validity analyses were performed. Patients were divided into the new rehabilitation training group (N) or the conventional rehabilitation training group (C), and 1:1 propensity score matching (PSM) was performed after administering questionnaires to patients in both groups. Cervical range of motion (CROM) data were also measured and collected for statistical analysis. The questionnaire used in this study showed good expert authority, coordination, internal consistency, and questionnaire reliability. A total of 476 patients were included after PSM, and the questionnaire results showed that recovery and quality of life were better in the N group than in the C group (124.55 ± 8.171 vs. 122.94 ± 8.366, p = 0.026). Analysis of cervical spine mobility showed that rehabilitation was better in the N group compared to the C group at postoperative one month (flexion: 1.762°, extension: 4.720°, left lateral bending: 3.912°, right lateral bending: 4.061°, left axial rotation: 5.180°, right axial rotation: 5.199°, p value all of these < 0.001), and at postoperative three months (flexion: 2.866°, extension: 2.904°, left lateral bending: 3.927°, right lateral bending: 3.330°, left axial rotation: 4.395°, right axial rotation: 3.992°, p value all of these < 0.001). The THYCA-QoL-TOETVA provides an appropriate and effective tool for measuring the postoperative quality of life of TOETVA patients. This new rehabilitation training can effectively alleviate the problem of limited neck movement and improve the quality of life of patients after TOETVA surgery.Trial registration: ChiCTR2300069097.
Topics: Humans; Quality of Life; Thyroidectomy; Female; Male; Adult; Middle Aged; Surveys and Questionnaires; Range of Motion, Articular; Postoperative Period; Natural Orifice Endoscopic Surgery
PubMed: 38926508
DOI: 10.1038/s41598-024-65589-x