Guided imagery is a relaxation technique that uses mental visualization to help individuals relax and focus their minds. This systematic review examines the effect of guided imagery on perioperative anxiety in hospitalized adult patients. The aim is to provide a comprehensive analysis of the existing evidence on the efficacy of guided imagery as an intervention for reducing perioperative anxiety.
Methods
A systematic search was conducted on databases including Web of Science, PubMed, Scopus, and PsycINFO. After screening titles and abstracts, full-text articles were assessed for eligibility. The selected studies were analyzed for their findings related to the effect of guided imagery on perioperative anxiety in adult patients.
Results
Nine studies met the inclusion criteria and provided sufficient data for analysis. The majority of the included studies reported a statistically significant reduction in perioperative anxiety following guided imagery interventions. The variations in intervention protocols, such as the content, duration, and frequency of guided imagery, were observed across the studies. Patient satisfaction and acceptance of guided imagery interventions were generally high.
Conclusion
The findings of this systematic review suggest that guided imagery is an effective intervention for reducing perioperative anxiety in hospitalized adult patients. Despite the limitations of small sample sizes and variability in measurement tools, the consistent positive results and high patient satisfaction indicate the potential benefits of incorporating guided imagery into perioperative care protocols. More comprehensive research with bigger samples and standardized tools is essential for guiding imagery integration in clinical practice.
目的引导想象是一种放松技巧，它利用心理可视化来帮助人们放松和集中注意力。本系统综述研究了引导想象对住院成年患者围手术期焦虑的影响。方法在 Web of Science、PubMed、Scopus 和 PsycINFO 等数据库中进行了系统检索。在筛选了标题和摘要后，对全文进行了资格评估。结果9项研究符合纳入标准，并提供了足够的数据用于分析。所纳入的大多数研究报告称，在引导想象干预后，围手术期焦虑症在统计学上有明显减轻。各项研究的干预方案存在差异，如引导想象的内容、持续时间和频率。患者对引导式意象干预的满意度和接受度普遍较高。 结论：本系统综述的研究结果表明，引导式意象是减少住院成年患者围手术期焦虑的有效干预方法。尽管存在样本量小和测量工具不同的局限性，但一致的积极结果和较高的患者满意度表明，将引导式意象疗法纳入围手术期护理方案具有潜在的益处。使用更大样本和标准化工具进行更全面的研究对于指导将意象疗法纳入临床实践至关重要。
{"title":"The effect of Guided imagery on perioperative anxiety in hospitalized adult patients: A systematic review of randomized controlled trials","authors":"Mahdiyeh Arjmandy Anamagh , Mohammad Shafiei Kouhpayeh , Shahab Khezri , Rasoul Goli , Navid Faraji , Babak Choobi Anzali , Himan Maroofi , Nima Eskandari , Fereshteh Ghahremanzad","doi":"10.1016/j.sipas.2024.100255","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100255","url":null,"abstract":"<div><h3>Objective</h3><p>Guided imagery is a relaxation technique that uses mental visualization to help individuals relax and focus their minds. This systematic review examines the effect of guided imagery on perioperative anxiety in hospitalized adult patients. The aim is to provide a comprehensive analysis of the existing evidence on the efficacy of guided imagery as an intervention for reducing perioperative anxiety.</p></div><div><h3>Methods</h3><p>A systematic search was conducted on databases including Web of Science, PubMed, Scopus, and PsycINFO. After screening titles and abstracts, full-text articles were assessed for eligibility. The selected studies were analyzed for their findings related to the effect of guided imagery on perioperative anxiety in adult patients.</p></div><div><h3>Results</h3><p>Nine studies met the inclusion criteria and provided sufficient data for analysis. The majority of the included studies reported a statistically significant reduction in perioperative anxiety following guided imagery interventions. The variations in intervention protocols, such as the content, duration, and frequency of guided imagery, were observed across the studies. Patient satisfaction and acceptance of guided imagery interventions were generally high.</p></div><div><h3>Conclusion</h3><p>The findings of this systematic review suggest that guided imagery is an effective intervention for reducing perioperative anxiety in hospitalized adult patients. Despite the limitations of small sample sizes and variability in measurement tools, the consistent positive results and high patient satisfaction indicate the potential benefits of incorporating guided imagery into perioperative care protocols. More comprehensive research with bigger samples and standardized tools is essential for guiding imagery integration in clinical practice.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"18 ","pages":"Article 100255"},"PeriodicalIF":0.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000226/pdfft?md5=307c420023f63dd7a02598159252d172&pid=1-s2.0-S2666262024000226-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141542732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-13DOI: 10.1016/j.sipas.2024.100252
Philip KW Hong , Aman Pathak , Aditya S Shirali
Introduction
Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications, making it challenging to identify predictors of complications to improve shared decision making. Recent advancements in clinical bioinformatics and surgical decision-making tools have the potential to improve patient outcomes. This systematic review aimed to assess the current understanding of factors predicting such complications following thyroidectomy.
Methods
We searched PubMed/MEDLINE, Web of Science, and EMBASE for studies published between 2010 and October 2023, investigating predictors of postoperative complications after thyroidectomy. Studies were included if they investigated predictors of hypocalcemia, hypoparathyroidism, vocal cord paresis (VCP), hematoma, or other postoperative complications. Studies solely reliant on univariate and ROC analyses were excluded. Independent predictors of each postoperative complication were evaluated and categorized as biochemical, surgical, and patient/disease specific.
Results
Forty-five studies were included. Biochemical hypocalcemia and transient hypoparathyroidism were the most investigated complications, with reported rates ranging from 15.7 % to 76.7 % and 12.9 % to 53.8 %, respectively. The majority of studies (n = 35, 77 %) focused on these complications. Biochemical markers (e.g., serum calcium, parathyroid hormone) were the most frequent predictors identified for these complications. Surgical factors (inadvertent parathyroidectomy) were frequently studied for all complications. Age, gender, and thyroid pathology were common patient/disease-specific predictors.
Conclusion
This review highlights the disparity in research on complication predictors. Most studies focused on hypocalcemia and hypoparathyroidism, with fewer examining VCP, hematoma, and mortality. Notably, a lack of high-quality evidence exists due to the scarcity of prospective and randomized controlled trials. Future research should explore incorporating a wider range of independent predictors, especially surgical factors, into comprehensive predictive models. This review can serve as a foundation for developing such models to improve risk prediction for a broader spectrum of thyroidectomy complications.
{"title":"Predictors of postoperative complications following thyroidectomy: A systematic review","authors":"Philip KW Hong , Aman Pathak , Aditya S Shirali","doi":"10.1016/j.sipas.2024.100252","DOIUrl":"10.1016/j.sipas.2024.100252","url":null,"abstract":"<div><h3>Introduction</h3><p>Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications, making it challenging to identify predictors of complications to improve shared decision making. Recent advancements in clinical bioinformatics and surgical decision-making tools have the potential to improve patient outcomes. This systematic review aimed to assess the current understanding of factors predicting such complications following thyroidectomy.</p></div><div><h3>Methods</h3><p>We searched PubMed/MEDLINE, Web of Science, and EMBASE for studies published between 2010 and October 2023, investigating predictors of postoperative complications after thyroidectomy. Studies were included if they investigated predictors of hypocalcemia, hypoparathyroidism, vocal cord paresis (VCP), hematoma, or other postoperative complications. Studies solely reliant on univariate and ROC analyses were excluded. Independent predictors of each postoperative complication were evaluated and categorized as biochemical, surgical, and patient/disease specific.</p></div><div><h3>Results</h3><p>Forty-five studies were included. Biochemical hypocalcemia and transient hypoparathyroidism were the most investigated complications, with reported rates ranging from 15.7 % to 76.7 % and 12.9 % to 53.8 %, respectively. The majority of studies (<em>n</em> = 35, 77 %) focused on these complications. Biochemical markers (e.g., serum calcium, parathyroid hormone) were the most frequent predictors identified for these complications. Surgical factors (inadvertent parathyroidectomy) were frequently studied for all complications. Age, gender, and thyroid pathology were common patient/disease-specific predictors.</p></div><div><h3>Conclusion</h3><p>This review highlights the disparity in research on complication predictors. Most studies focused on hypocalcemia and hypoparathyroidism, with fewer examining VCP, hematoma, and mortality. Notably, a lack of high-quality evidence exists due to the scarcity of prospective and randomized controlled trials. Future research should explore incorporating a wider range of independent predictors, especially surgical factors, into comprehensive predictive models. This review can serve as a foundation for developing such models to improve risk prediction for a broader spectrum of thyroidectomy complications.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"18 ","pages":"Article 100252"},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000196/pdfft?md5=0197fe99a28f7610c52ea5a77d650aba&pid=1-s2.0-S2666262024000196-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.sipas.2024.100251
Nada Lelovic , Rebecca Reif , Hanna Jensen , Adria Abella Villafranca , Mary Katherine Kimbrough , Kevin Sexton
Background
While previous literature has shown that resident involvement increases operative time, the influence of resident involvement on operative time is generally not considered in current methods of case time predictions or operating room planning. Furthermore, evidence of prolonged case times based on the level of the assisting resident is yet scarce. We hypothesized that operative time would increase with the post-graduate year of assisting residents as they gain more autonomy in the operating room.
Study design
This was an observational cohort study in which we retrospectively analyzed 802 laparoscopic cholecystectomy cases performed in a single academic institution between May 2014 and December 2020. Only cases in which a Post Graduate Year 1 to 5 (PGY) resident was assisting were included.
Results
PGY1–4 residents had statistically significant positive time coefficient results in all linear regression models, except PGY2s in urgent cases. PGY-2 residents had the longest overall average case time of 98 min. Emergent cases were more likely to have prolonged case times.
Conclusions
The increased average case time associated with PGY-2 residents is likely due to a new level of increased autonomy in the operating room (OR) during this year of training. The linear regression results indicated PGY1–4 residents were more likely to have longer laparoscopic cholecystectomy operative times than the PGY5 residents, except PGY2s in urgent cases. This may reflect the accumulation of surgical skills at the PGY5 level. Resident involvement should be considered in the prediction of operative time in an academic setting.
{"title":"Resident level is associated with operative time in laparoscopic cholecystectomy","authors":"Nada Lelovic , Rebecca Reif , Hanna Jensen , Adria Abella Villafranca , Mary Katherine Kimbrough , Kevin Sexton","doi":"10.1016/j.sipas.2024.100251","DOIUrl":"10.1016/j.sipas.2024.100251","url":null,"abstract":"<div><h3>Background</h3><p>While previous literature has shown that resident involvement increases operative time, the influence of resident involvement on operative time is generally not considered in current methods of case time predictions or operating room planning. Furthermore, evidence of prolonged case times based on the level of the assisting resident is yet scarce. We hypothesized that operative time would increase with the post-graduate year of assisting residents as they gain more autonomy in the operating room.</p></div><div><h3>Study design</h3><p>This was an observational cohort study in which we retrospectively analyzed 802 laparoscopic cholecystectomy cases performed in a single academic institution between May 2014 and December 2020. Only cases in which a Post Graduate Year 1 to 5 (PGY) resident was assisting were included.</p></div><div><h3>Results</h3><p>PGY1–4 residents had statistically significant positive time coefficient results in all linear regression models, except PGY2s in urgent cases. PGY-2 residents had the longest overall average case time of 98 min. Emergent cases were more likely to have prolonged case times.</p></div><div><h3>Conclusions</h3><p>The increased average case time associated with PGY-2 residents is likely due to a new level of increased autonomy in the operating room (OR) during this year of training. The linear regression results indicated PGY1–4 residents were more likely to have longer laparoscopic cholecystectomy operative times than the PGY5 residents, except PGY2s in urgent cases. This may reflect the accumulation of surgical skills at the PGY5 level. Resident involvement should be considered in the prediction of operative time in an academic setting.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100251"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000184/pdfft?md5=0dd64703d3d1e4780a5478a78c6a46ec&pid=1-s2.0-S2666262024000184-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.1016/j.sipas.2024.100250
Jenna C. Marek , Allison O. Dumitriu Carcoana , William J. West III , Emily E. Weeden , Ajay Varadhan , Jessica Cobb , Sarah Cool , Gregory Fishberger , Collin B. Chase , Maykel Dolorit , Harrison E. Strang , Carla C. Moodie , Joseph R. Garrett , Jenna R. Tew , Jobelle Joyce-Anne R. Baldonado , Jacques P. Fontaine , Eric M. Toloza
Background
Marital status has been shown to have protective effects for married patients with various cancers. We sought to determine effects of marital status on perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL).
Methods
We retrospectively analyzed 709 consecutive patients who underwent RAPL between 2010 and 2022 by one surgeon. Patients were stratified by marital status at time of surgery. The Married group included married, domestically partnered, and co-habitating patients (N = 473). The Unmarried group included never married, divorced, and widowed individuals (N = 236). Demographics, preoperative comorbidities, intraoperative and postoperative complications, estimated blood loss (EBL), chest tube duration, hospital length of stay (LOS), tumor characteristics, and survival data were analyzed utilizing Student's t-test, Wilcoxon rank-sum test, Chi-square, or Fisher's exact test as appropriate, with significance at p
Results
Unmarried patients were more likely to be female, while married patients were more likely to experience robotic-associated intraoperative complications and greater intraoperative estimated blood loss. Kaplan-Meier survival analysis revealed no difference in 5-year overall survival based on marital status. Other perioperative outcomes, intraoperative complications (except robotic-associated), postoperative complications, demographic history (except gender), and preoperative comorbidities did not significantly differ between the two groups.
Conclusion
This study challenges the existing reports in the literature that marriage confers cancer treatment outcomes advantage and prolonged survival among cancer patients. Social support, in terms of a spouse or domestic partner, may be less protective in early-stage lung cancer and after minimally invasive pulmonary lobectomy compared to other cancer populations.
{"title":"Marital status shows no protective effect on perioperative outcomes after robotic-assisted pulmonary lobectomy","authors":"Jenna C. Marek , Allison O. Dumitriu Carcoana , William J. West III , Emily E. Weeden , Ajay Varadhan , Jessica Cobb , Sarah Cool , Gregory Fishberger , Collin B. Chase , Maykel Dolorit , Harrison E. Strang , Carla C. Moodie , Joseph R. Garrett , Jenna R. Tew , Jobelle Joyce-Anne R. Baldonado , Jacques P. Fontaine , Eric M. Toloza","doi":"10.1016/j.sipas.2024.100250","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100250","url":null,"abstract":"<div><h3>Background</h3><p>Marital status has been shown to have protective effects for married patients with various cancers. We sought to determine effects of marital status on perioperative outcomes after robotic-assisted pulmonary lobectomy (RAPL).</p></div><div><h3>Methods</h3><p>We retrospectively analyzed 709 consecutive patients who underwent RAPL between 2010 and 2022 by one surgeon. Patients were stratified by marital status at time of surgery. The Married group included married, domestically partnered, and co-habitating patients (<em>N</em> = 473). The Unmarried group included never married, divorced, and widowed individuals (<em>N</em> = 236). Demographics, preoperative comorbidities, intraoperative and postoperative complications, estimated blood loss (EBL), chest tube duration, hospital length of stay (LOS), tumor characteristics, and survival data were analyzed utilizing Student's <em>t</em>-test, Wilcoxon rank-sum test, Chi-square, or Fisher's exact test as appropriate, with significance at <em>p</em><span><math><mrow><mo>≤</mo><mn>0.05</mn><mo>.</mo></mrow></math></span></p></div><div><h3>Results</h3><p>Unmarried patients were more likely to be female, while married patients were more likely to experience robotic-associated intraoperative complications and greater intraoperative estimated blood loss. Kaplan-Meier survival analysis revealed no difference in 5-year overall survival based on marital status. Other perioperative outcomes, intraoperative complications (except robotic-associated), postoperative complications, demographic history (except gender), and preoperative comorbidities did not significantly differ between the two groups.</p></div><div><h3>Conclusion</h3><p>This study challenges the existing reports in the literature that marriage confers cancer treatment outcomes advantage and prolonged survival among cancer patients. Social support, in terms of a spouse or domestic partner, may be less protective in early-stage lung cancer and after minimally invasive pulmonary lobectomy compared to other cancer populations.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"18 ","pages":"Article 100250"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000172/pdfft?md5=265d3cb74253b6c9ac59a9cbb58661ec&pid=1-s2.0-S2666262024000172-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141308068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.1016/j.sipas.2024.100248
Carolina Vigna, Ana Sofia Ore, Anne Fabrizio, Evangelos Messaris
Background
Disparities exist the management of rectal cancer. We sought to evaluate short-term surgical outcomes among different racial/ethnic groups following rectal cancer resection.
Materials and Methods
National Surgical Quality Improvement Program (NSQIP) database (2016–2019) was queried. Patients undergoing rectal cancer resection were categorized by race/ethnicity. Circumferential resection margin positivity rate and postoperative outcomes were evaluated. 1:1 Propensity score matching (PSM) was used.
Results
Of 1,753 patients, 80.2 % were White, 7.6 % Black, 8.5 % Asian and 3.7 % Hispanic. On unadjusted analysis, Hispanic patients presented longer operative time(p = 0.029), and Black patients higher postoperative ileus(p = 0.003) and readmission(p = 0.023) rates. After PSM, Hispanics had a significantly higher circumferential resection margin positivity rate(p = 0.032), Black patients higher postoperative ileus rate(p = 0.014) and longer LOS(p = 0.0118) when compared to White counterparts.
Conclusion
Racial disparities were found in short-term postoperative outcomes. Hispanic patients presented higher margin positivity rate and Black patients worst 30-day postoperative outcomes. Comparative studies evaluating trends and a higher number of minority patients included in databases are warranted.
{"title":"Evaluation of racial/ethnic disparities in surgical outcomes after rectal cancer resection: An ACS-NSQIP analysis","authors":"Carolina Vigna, Ana Sofia Ore, Anne Fabrizio, Evangelos Messaris","doi":"10.1016/j.sipas.2024.100248","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100248","url":null,"abstract":"<div><h3>Background</h3><p>Disparities exist the management of rectal cancer. We sought to evaluate short-term surgical outcomes among different racial/ethnic groups following rectal cancer resection.</p></div><div><h3>Materials and Methods</h3><p>National Surgical Quality Improvement Program (NSQIP) database (2016–2019) was queried. Patients undergoing rectal cancer resection were categorized by race/ethnicity. Circumferential resection margin positivity rate and postoperative outcomes were evaluated. 1:1 Propensity score matching (PSM) was used.</p></div><div><h3>Results</h3><p>Of 1,753 patients, 80.2 % were White, 7.6 % Black, 8.5 % Asian and 3.7 % Hispanic. On unadjusted analysis, Hispanic patients presented longer operative time(<em>p</em> = 0.029), and Black patients higher postoperative ileus(<em>p</em> = 0.003) and readmission(<em>p</em> = 0.023) rates. After PSM, Hispanics had a significantly higher circumferential resection margin positivity rate(<em>p</em> = 0.032), Black patients higher postoperative ileus rate(<em>p</em> = 0.014) and longer LOS(<em>p</em> = 0.0118) when compared to White counterparts.</p></div><div><h3>Conclusion</h3><p>Racial disparities were found in short-term postoperative outcomes. Hispanic patients presented higher margin positivity rate and Black patients worst 30-day postoperative outcomes. Comparative studies evaluating trends and a higher number of minority patients included in databases are warranted.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100248"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000159/pdfft?md5=b8c6b9dcb291130b1c29412c364bcf2f&pid=1-s2.0-S2666262024000159-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.sipas.2024.100247
Lisa J. Toelle , Allison G. McNickle , Declan Feery , Salman Mohammed , Paul J. Chestovich , Kavita Batra , Douglas R. Fraser
Background
Pulmonary contusions (PC) are common after blunt chest trauma and can be identified with computed tomography (CT). Complex scoring systems for grading PC exist, however recent scoring systems rely on computer-generated algorithms that are not readily available at all hospitals. We developed a scoring system for grading PC to predict the need for prolonged mechanical ventilation and initial hospital admission location.
Methods
A retrospective review was performed of adult blunt trauma patients with PC identified on initial chest CT during 2020. Data elements related to demographics, injury characteristics, disposition and healthcare utilization were extracted. The primary outcome was the need for mechanical ventilation for greater than 48 h. A novel scoring system, the Pulmonary Contusion Score (PCS) was developed. The maximum score was 10, with each lobe contributing up to 2 points. A score of 0 was given for no contusion present in the lobe, 1 for less than 50 % contusion, and 2 for greater than 50 % contusion. A PCS of 4 was hypothesized to correlate with need for mechanical ventilation for over 48 h. A confusion matrix of the scoring algorithm was created, and inter-rater concordance was calculated from a randomly selected 125 patients.
Results
A total of 217 patients were identified. 118 patients (54 %) were admitted to the ICU, but only 23 patients (19 %) were intubated, and only 17 patients (8 %) required mechanical ventilation > 48 h. Sensitivity of the scoring system was 20 %, while specificity was 93 %. Negative predictive value was 93 %. Inter-rater agreement was 77 %.
Conclusion
The PCS is a scoring system with high specificity and negative predictive value that can be used to evaluate the need for mechanical ventilation after sustaining blunt PC and can help properly allocate hospital resources.
{"title":"The pulmonary contusion score: Development of a simple scoring system for blunt lung injury","authors":"Lisa J. Toelle , Allison G. McNickle , Declan Feery , Salman Mohammed , Paul J. Chestovich , Kavita Batra , Douglas R. Fraser","doi":"10.1016/j.sipas.2024.100247","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100247","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary contusions (PC) are common after blunt chest trauma and can be identified with computed tomography (CT). Complex scoring systems for grading PC exist, however recent scoring systems rely on computer-generated algorithms that are not readily available at all hospitals. We developed a scoring system for grading PC to predict the need for prolonged mechanical ventilation and initial hospital admission location.</p></div><div><h3>Methods</h3><p>A retrospective review was performed of adult blunt trauma patients with PC identified on initial chest CT during 2020. Data elements related to demographics, injury characteristics, disposition and healthcare utilization were extracted. The primary outcome was the need for mechanical ventilation for greater than 48 h. A novel scoring system, the Pulmonary Contusion Score (PCS) was developed. The maximum score was 10, with each lobe contributing up to 2 points. A score of 0 was given for no contusion present in the lobe, 1 for less than 50 % contusion, and 2 for greater than 50 % contusion. A PCS of 4 was hypothesized to correlate with need for mechanical ventilation for over 48 h. A confusion matrix of the scoring algorithm was created, and inter-rater concordance was calculated from a randomly selected 125 patients.</p></div><div><h3>Results</h3><p>A total of 217 patients were identified. 118 patients (54 %) were admitted to the ICU, but only 23 patients (19 %) were intubated, and only 17 patients (8 %) required mechanical ventilation > 48 h. Sensitivity of the scoring system was 20 %, while specificity was 93 %. Negative predictive value was 93 %. Inter-rater agreement was 77 %.</p></div><div><h3>Conclusion</h3><p>The PCS is a scoring system with high specificity and negative predictive value that can be used to evaluate the need for mechanical ventilation after sustaining blunt PC and can help properly allocate hospital resources.</p></div><div><h3>Level of evidence</h3><p>IV - diagnostic criteria</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100247"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000147/pdfft?md5=50257186706e56b5fde8be903d780796&pid=1-s2.0-S2666262024000147-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140621752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.sipas.2024.100246
Renxi Li , Stephen Huddleston
Background
Coronary Artery Bypass Grafting (CABG) is a high-risk surgery. Cardiovascular diseases are strongly associated with comorbidities. This study aimed to assess the prediction of in-hospital mortality by comorbidities in patients who underwent CABG.
Methods
The National Inpatient Sample database was used to extract patients who received 1, 2, 3, and 4+ CABG between Q4 2015 and 2020. Best-fit model by logistic regressions was used to predict in-hospital mortality by Elixhauser Comorbidity Index (ECI). Moreover, age was adjusted in ECI prediction.
Results
There were 190,524, 83,725, 48,147, and 13,540 patients who underwent 1, 2, 3, and 4+ CABG, respectively. In-hospital mortality was best predicted by ECI in 3 CABG (c-statistic = 0.63, 95 % CI = 0.62–0.65), followed by 4+ CABG (c-statistic = 0.63, 95 % CI = 0.60–0.66), 1 CABG (c-statistic = 0.62, 95 % CI = 0.61–0.63), and 2 CABG (c-statistic = 0.62, 95 % CI = 0.61–0.63). After adjusting for age, ECI adequately predicted in-hospital mortality in 4+ CABG (c-statistic = 0.72, 95 % CI = 0.69–0.75) and 3 CABG (c-statistic = 0.69, 95 % CI = 0.68–0.71). Predictive powers for age-adjusted ECI were comparable in 1 CABG (c-statistic=0.67, 95 % CI = 0.66–0.68) and 2 CABG (c-statistic = 0.67, 95 % CI = 0.65–0.68).
Conclusions
ECI was a moderate (c-statistic 0.6–0.7) predictor of in-hospital mortality in all CABG. Age-adjusted ECI could effectively predict in-hospital mortality, especially in patients who underwent 3 and 4+ CABG.
{"title":"Predicting in-hospital mortality using Elixhauser comorbidity in patients underwent single and multiple coronary artery bypass surgery","authors":"Renxi Li , Stephen Huddleston","doi":"10.1016/j.sipas.2024.100246","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100246","url":null,"abstract":"<div><h3>Background</h3><p>Coronary Artery Bypass Grafting (CABG) is a high-risk surgery. Cardiovascular diseases are strongly associated with comorbidities. This study aimed to assess the prediction of in-hospital mortality by comorbidities in patients who underwent CABG.</p></div><div><h3>Methods</h3><p>The National Inpatient Sample database was used to extract patients who received 1, 2, 3, and 4+ CABG between Q4 2015 and 2020. Best-fit model by logistic regressions was used to predict in-hospital mortality by Elixhauser Comorbidity Index (ECI). Moreover, age was adjusted in ECI prediction.</p></div><div><h3>Results</h3><p>There were 190,524, 83,725, 48,147, and 13,540 patients who underwent 1, 2, 3, and 4+ CABG, respectively. In-hospital mortality was best predicted by ECI in 3 CABG (<em>c</em>-statistic = 0.63, 95 % CI = 0.62–0.65), followed by 4+ CABG (<em>c</em>-statistic = 0.63, 95 % CI = 0.60–0.66), 1 CABG (<em>c</em>-statistic = 0.62, 95 % CI = 0.61–0.63), and 2 CABG (<em>c</em>-statistic = 0.62, 95 % CI = 0.61–0.63). After adjusting for age, ECI adequately predicted in-hospital mortality in 4+ CABG (<em>c</em>-statistic = 0.72, 95 % CI = 0.69–0.75) and 3 CABG (<em>c</em>-statistic = 0.69, 95 % CI = 0.68–0.71). Predictive powers for age-adjusted ECI were comparable in 1 CABG (<em>c</em>-statistic=0.67, 95 % CI = 0.66–0.68) and 2 CABG (<em>c</em>-statistic = 0.67, 95 % CI = 0.65–0.68).</p></div><div><h3>Conclusions</h3><p>ECI was a moderate (<em>c</em>-statistic 0.6–0.7) predictor of in-hospital mortality in all CABG. Age-adjusted ECI could effectively predict in-hospital mortality, especially in patients who underwent 3 and 4+ CABG.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100246"},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000135/pdfft?md5=b5189c977c86c425a945bd1d04e9c41a&pid=1-s2.0-S2666262024000135-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140557791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While hepatocellular carcinoma (HCC) remains the leading cause of liver transplant (LT) for liver tumors, indications have broadened over the years. Data regarding patient characteristics and outcomes of LT for liver tumors are limited.
Methods
From Jan-2002 to March-2022, 14,406 LT recipients for various liver tumors were identified in United Network for Organ Sharing database. Overall post-transplant survival analysis was performed with Kaplan-Meier method and multivariable Cox proportional-hazards model.
Results
During the study period, indications for LT for various hepatic tumors were HCC (88.5 %), benign tumors (5.1 %), cholangiocarcinoma (3.9 %), angiosarcoma (0.7 %), bile duct cancer (0.7 %), secondary tumors (0.5 %) and others (0.7 %). Compared to non-HCC, LT recipients for HCC were older (median age 61 vs 54 years, P < 0.001), more often male (77% vs 48 %, P < 0.001), more often Hispanic (16% vs 8.0 %), had higher BMI (28.2 vs 25.3, P < 0.001) and higher prevalence of Hepatitis C (53% vs 3.9 %, P < 0.001). Donor characteristics across various groups were similar. One-year survival in LT recipients of HCC was higher (HCC: 91.7% vs. non-HCC: 90.3 %) with adjusted Hazard Ratio (aHR) of 0.87; 95 % CI 0.77–0.99, P = 0.033 in a multivariable Cox regression analysis. Compared to HCC, survival outcomes were worse in cholangiocarcinoma (aHR 1.70; 95 %CI 1.43–2.01, P < 0.001), bile duct cancer (aHR 3.03; 95 %CI 2.12–4.33, P < 0.001), secondary tumors including colon cancer and neuroendocrine tumors (aHR 1.88; 95 % CI 1.24–2.85, P = 0.003), with best survival in patients with benign tumors (aHR 0.57; 95 %CI 0.46–0.70, P < 0.001).
Conclusions
LT is performed for various liver tumors with variable outcomes among these primary indications.
{"title":"Indications and outcomes of liver transplantation for liver tumors in the United States","authors":"Kenji Okumura, Abhay Dhand, Kamil Hanna, Ryosuke Misawa, Hiroshi Sogawa, Gregory Veillette, Seigo Nishida","doi":"10.1016/j.sipas.2024.100245","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100245","url":null,"abstract":"<div><h3>Background</h3><p>While hepatocellular carcinoma (HCC) remains the leading cause of liver transplant (LT) for liver tumors, indications have broadened over the years. Data regarding patient characteristics and outcomes of LT for liver tumors are limited.</p></div><div><h3>Methods</h3><p>From Jan-2002 to March-2022, 14,406 LT recipients for various liver tumors were identified in United Network for Organ Sharing database. Overall post-transplant survival analysis was performed with Kaplan-Meier method and multivariable Cox proportional-hazards model.</p></div><div><h3>Results</h3><p>During the study period, indications for LT for various hepatic tumors were HCC (88.5 %), benign tumors (5.1 %), cholangiocarcinoma (3.9 %), angiosarcoma (0.7 %), bile duct cancer (0.7 %), secondary tumors (0.5 %) and others (0.7 %). Compared to non-HCC, LT recipients for HCC were older (median age 61 vs 54 years, <em>P</em> < 0.001), more often male (77% vs 48 %, <em>P</em> < 0.001), more often Hispanic (16% vs 8.0 %), had higher BMI (28.2 vs 25.3, <em>P</em> < 0.001) and higher prevalence of Hepatitis C (53% vs 3.9 %, <em>P</em> < 0.001). Donor characteristics across various groups were similar. One-year survival in LT recipients of HCC was higher (HCC: 91.7% vs. non-HCC: 90.3 %) with adjusted Hazard Ratio (aHR) of 0.87; 95 % CI 0.77–0.99, <em>P</em> = 0.033 in a multivariable Cox regression analysis. Compared to HCC, survival outcomes were worse in cholangiocarcinoma (aHR 1.70; 95 %CI 1.43–2.01, <em>P</em> < 0.001), bile duct cancer (aHR 3.03; 95 %CI 2.12–4.33, <em>P</em> < 0.001), secondary tumors including colon cancer and neuroendocrine tumors (aHR 1.88; 95 % CI 1.24–2.85, <em>P</em> = 0.003), with best survival in patients with benign tumors (aHR 0.57; 95 %CI 0.46–0.70, <em>P</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>LT is performed for various liver tumors with variable outcomes among these primary indications.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100245"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000123/pdfft?md5=6edd88d1fb293f935ce91927c2c3c344&pid=1-s2.0-S2666262024000123-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140894413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-02DOI: 10.1016/j.sipas.2024.100244
Shivangi Parmar , Emily Eachus , Orly Morgan , Boris Yang , Violet Victoria , Suhas Seshadri , Armen Henderson , Stefan Kenel-Pierre , Joshua Laban
Background
The effects of housing insecurity on surgical care are under researched and largely unknown. Thus far, studies on surgery outcomes of people experiencing homelessness either focus on shelter-based patients or do not differentiate whether patients are sheltered or unsheltered, despite significant differences in care needs and health risks. Herein we provide the first report on surgical care trends of people experiencing unsheltered homelessness.
Methods
Clinical history, medication list, and blood pressure records of 300 people experiencing unsheltered homelessness receiving care at a free mobile clinic were deidentified, downloaded and analyzed in R studio 4.3.0. Participants were asked whether they had undergone surgery and included surgical history for those who had.
Results
Of 300 participants, 18 % (N = 55) had a history of surgery, most common being 1) orthopedics (N = 20), 2) vascular (N = 18), 3) general (N = 6), 4) acute trauma response (N = 5), 5) ophthalmology (N = 4), 6) surgical oncology (N = 2). Post-discharge, 13 % returned with wound site infections and 9 % were readmitted for treatment. Chi Square test showed Hypertension [X2 (1, n = 300)=10.9, p < 0.001] and Type II Diabetes [X2 (1, n = 300)=10.5, p = 0.0012] significantly increased likelihood of needing vascular surgery, particularly lower extremity wound debridement or amputation.
Conclusion
Little research has been done assessing surgical care trends for people experiencing unsheltered homelessness. Results indicate possible presence of barriers accessing cancer care and increased risk for vascular disease needing surgical intervention. Future research is needed to understand, address, and overcome current surgical care barriers to help this at-risk and underserved community.
背景住房不安全对外科护理的影响研究不足，而且在很大程度上不为人所知。迄今为止，有关无家可归者手术效果的研究要么集中在以庇护所为基础的病人身上，要么不区分病人是有庇护所的还是无庇护所的，尽管在护理需求和健康风险方面存在显著差异。方法对在免费流动诊所接受治疗的 300 名无家可归者的临床病史、药物清单和血压记录进行去身份化处理，并在 R studio 4.3.0 中下载和分析。结果 在 300 名参与者中，18%（N = 55）有手术史，最常见的手术有：1）骨科（N = 20）；2）血管科（N = 18）；3）普外科（N = 6）；4）急性创伤反应科（N = 5）；5）眼科（N = 4）；6）肿瘤外科（N = 2）。出院后，13% 的患者因伤口感染返回医院，9% 的患者再次入院接受治疗。Chi Square检验显示，高血压[X2 (1, n = 300)=10.9, p < 0.001]和II型糖尿病[X2 (1, n = 300)=10.5, p = 0.0012]显著增加了需要血管手术的可能性，尤其是下肢伤口清创或截肢。研究结果表明，无家可归者在获得癌症治疗方面可能存在障碍，而且需要外科手术治疗的血管疾病风险增加。未来的研究需要了解、解决和克服当前的外科护理障碍，以帮助这个高危和服务不足的群体。
{"title":"Surgical risks and care trends: A cross sectional study of people experiencing homelessness presenting at a free clinic care in Miami-Dade County","authors":"Shivangi Parmar , Emily Eachus , Orly Morgan , Boris Yang , Violet Victoria , Suhas Seshadri , Armen Henderson , Stefan Kenel-Pierre , Joshua Laban","doi":"10.1016/j.sipas.2024.100244","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100244","url":null,"abstract":"<div><h3>Background</h3><p>The effects of housing insecurity on surgical care are under researched and largely unknown. Thus far, studies on surgery outcomes of people experiencing homelessness either focus on shelter-based patients or do not differentiate whether patients are sheltered or unsheltered, despite significant differences in care needs and health risks. Herein we provide the first report on surgical care trends of people experiencing unsheltered homelessness.</p></div><div><h3>Methods</h3><p>Clinical history, medication list, and blood pressure records of 300 people experiencing unsheltered homelessness receiving care at a free mobile clinic were deidentified, downloaded and analyzed in R studio 4.3.0. Participants were asked whether they had undergone surgery and included surgical history for those who had.</p></div><div><h3>Results</h3><p>Of 300 participants, 18 % (<em>N</em> = 55) had a history of surgery, most common being 1) orthopedics (<em>N</em> = 20), 2) vascular (<em>N</em> = 18), 3) general (<em>N</em> = 6), 4) acute trauma response (<em>N</em> = 5), 5) ophthalmology (<em>N</em> = 4), 6) surgical oncology (<em>N</em> = 2). Post-discharge, 13 % returned with wound site infections and 9 % were readmitted for treatment. Chi Square test showed Hypertension [X2 (1, <em>n</em> = 300)=10.9, <em>p</em> < 0.001] and Type II Diabetes [X2 (1, <em>n</em> = 300)=10.5, <em>p</em> = 0.0012] significantly increased likelihood of needing vascular surgery, particularly lower extremity wound debridement or amputation.</p></div><div><h3>Conclusion</h3><p>Little research has been done assessing surgical care trends for people experiencing unsheltered homelessness. Results indicate possible presence of barriers accessing cancer care and increased risk for vascular disease needing surgical intervention. Future research is needed to understand, address, and overcome current surgical care barriers to help this at-risk and underserved community.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000111/pdfft?md5=e7a3e5f9196b9324a5ff46681f19cc7f&pid=1-s2.0-S2666262024000111-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140548558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of <0.001 due to our large size of analyzed cases.
Results
We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, p = <0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, p = <0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, p = <0.004).
Conclusions
Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.
{"title":"Impact of nursing home admission on in-hospital mortality and morbidity and length of stay: A case-control analysis","authors":"Claudio Canal , Anne-Sophie Mittlmeier , Valentin Neuhaus , Hans-Christoph Pape , Mathias Schlögl","doi":"10.1016/j.sipas.2024.100243","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100243","url":null,"abstract":"<div><h3>Methods</h3><p>We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of <0.001 due to our large size of analyzed cases.</p></div><div><h3>Results</h3><p>We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, <em>p</em> = <0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, <em>p</em> = <0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, <em>p</em> = <0.004).</p></div><div><h3>Conclusions</h3><p>Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100243"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266626202400010X/pdfft?md5=dd3de3c847b126c1e6b6d000e3f9c42f&pid=1-s2.0-S266626202400010X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140344591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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