Perioperative Medicine最新文献

Background: We aimed to compare thromboembolic (TE) complications between intravenous and epidural analgesia after unilateral total knee arthroplasty (TKA) under neuraxial anesthesia.

Methods: In this retrospective study, patients who received spinal anesthesia (SA) and intravenous patient-controlled analgesia (IV-PCA) were allocated to the SA-IV group, and those who received combined spinal-epidural (CSE) anesthesia and epidural PCA were allocated to the CSE-E group. Primary outcome was composite incidence of in-hospital TE events defined as myocardial infarction, stroke, peripheral artery occlusion, pulmonary embolism, or deep vein thrombosis. Secondary outcomes were general complications and pain score. After propensity score matching, outcomes were compared using generalized estimating equation.

Results: Among 1,244 cases from 2016 to 2022 at a tertiary hospital, 321 patients in SA-IV and 214 patients in CSE-E were analyzed after matching. The incidence of TE complications was comparable between SA-IV and CSE-E groups [0.9% (n = 3) vs. 2.8% (n = 6); odds ratio (OR) 1.88, 95% confidence interval (CI) 0.89-10.57; p = 0.08]. There were no differences in general complications, delirium, falls, or bedsores. In the CSE-E group, transient motor weakness was more frequent (OR 2.70, 95% CI 9.27-451.78; p < 0.001), and the number of days to joint exercise initiation was higher. However, pain score after TKA was significantly lower in the CSE-E group [5(3-6) vs. 3(2-5); p < 0.001].

Conclusion: In this retrospective analysis, the incidence of TE complications after TKA under neuraxial anesthesia was not significantly different between intravenous and epidural analgesia. Epidural analgesia was associated with lower pain intensity, higher incidence of motor weakness, and late initiation of exercise.

Objective: To evaluate the association between red cell distribution width (RDW) on admission and preoperative deep venous thrombosis (DVT) in older adult patients with hip fractures.

Methods: Older adult patients with hip fractures were screened from January 2015 to September 2019. A multivariate logistic regression model was used to identify the association between RDW on admission and DVT in these patients. Sensitivity analysis was used to test the robustness of the results.

Results: A total of 1686 patients were included in this study. The multivariate logistic regression model showed that RDW was associated with DVT after adjusting for confounders (odds ratio (OR) = 1.03, 95% confidence interval (CI): 1.01-1.05; P < 0.001). An increase in one RDW was associated with a rise of 3% in DVT in older adults with hip fractures. In addition, we found that the linear association was stable in sensitivity analysis.

Conclusions: The RDW on admission was associated with preoperative DVT in hip fractures.

Trial registration: ChiCTR2200057323.

Background: Non-placement of nasogastric tube (NPGT) before operation for elective abdominal surgery and early removal of nasogastric tube (ERGT) are encouraged in clinical practice. However, it is not clear whether these two measures are applicable to all patients with HCC undergoing hepatectomy.

Methods: Demographic characteristics, surgical variables, comfort, and postoperative outcome of 412 patients were retrospectively analyzed.

Results: The NPGT group comprised 225 patients, while the ERGT group comprised 187 patients. There was no significant difference between the two groups in sex, age, operation time, body mass index, hepatic function, type of hepatectomy, first anal exhaust time, half-liquid eating time, length of postoperative hospital stays, and incidence of postoperative complications before and after propensity score matching (PSM). Compared with the ERGT group, the postoperative incidence of nasopharyngeal discomfort (23.0% vs. 3.11%), nausea and vomiting (14.44% vs. 8.0%), and sore throat (20.86% vs. 2.22%) was significantly lower in the NPGT group (all P < 0.05), even after PSM. A long operation time, and a history of abdominal surgery were independent risk factors for postoperative nasogastric tube placement in the NPGT group. Receiver operating characteristic curve showed an operation time of > 326 min with a maximum area under the curve of 0.744.

Conclusions: Patients with HCC undergoing hepatectomy without prophylactic nasogastric tube placement have a low but measurable risk of postoperative nasogastric tube re-insertion. Preoperative nasogastric tube insertion is recommended for patients with a history of abdominal surgery and/or estimated operation time of > 326 min.

Sound is ubiquitous, and it affects all aspects of life, such as relieving stress and causing harm. Moreover, sound has negative and positive effects on hospital patients or medical staff. With the global annual increase in surgical volumes, the effect of perioperative sound stimulation on patients receiving surgical care cannot be ignored. Therefore, this review aimed to summarise the positive and negative effects of perioperative sound on postoperative outcomes and offer recommendations for future management of intraoperative and postoperative procedures. The effect of auditory stimuli on patients receiving surgical care has been demonstrated, showing that perioperative music reduces preoperative anxiety in patients receiving perioperative care. Additionally, intraoperative noise impedes effective communication among medical personnel and negatively influences postoperative outcomes in patients, such as increased postoperative pain and increased susceptibility to sensorineural hearing loss. Postoperative noise can reduce patients' sleep quality and easily cause sleep disorders, which can lead to reduced postoperative pain sensitivity. Conversely, using perioperative music or other positive stimuli alleviates postoperative pain, anxiety, and delirium in patients. In the future, sound stimulation can be used as an effective dual-purpose tool to mitigate the detrimental effects of unnecessary noise pollution in hospitals through noise isolation techniques and other measures and as a non-pharmacological intervention to improve perioperative outcomes in patients, thereby offering additional advantages for medical services and perioperative rehabilitation.

Background: Preoperative educational interventions are often implicitly regarded as a useful and cost-effective means of improving arthroplasty care. However, previous research in this area is limited - both in terms of age and clinical heterogeneity. This review adds to the existing literature by investigating the relationship between educational interventions and clinically relevant outcome measures, whilst also incorporating a larger sample size, and more stringently defined eligibility criteria. The primary outcome was preoperative anxiety. Secondary outcomes were patient knowledge score, postoperative pain, time-to-discharge, quality-of-life, and surgical complication rate.

Methods: A systematic review and meta-analysis of 19 randomised controlled trials. Inclusion criteria specified an adult population receiving elective hip or knee arthroplasty, an intervention group participating in a structured educational intervention, and a control group receiving no education beyond routine preoperative consenting. Outcome data were independently extracted by the review team, before being pooled for statistical analysis using comparison of mean differences and a random effects model.

Results: Results showed small, but statistically significant, improvements for the outcomes of patient anxiety (SMD -0.37, 95% CI -0.63 to -0.11), knowledge (SMD +0.37, 95% CI +0.05 to +0.69), and pain (SMD -0.31, 95% CI -0.47 to -0.15). However, the results for other outcome measures were not statistically significant.

Conclusions: Findings show a trend in favour of education for reducing anxiety and postoperative pain, though effect sizes were small, and the amount of practical benefit remains questionable due to inter-trial clinical heterogeneity. It was also observed that multi-format interventions may be beneficial for patients with greater anxiety, learning needs, or pain. Further research is necessary due to a lack of trials with reproducibly described interventions.