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Background: There is wide variation in stress test utilization before major vascular surgery and adherence to practice guidelines is unclear. We defined rates of stress test compliance at our institution and led a quality improvement initiative to improve compliance with American Heart Association (ACC/AHA) guidelines. Methods: We implemented a stress testing order set in the electronic medical record at one tertiary hospital. We reviewed all patients who underwent elective, major vascular surgery in the 6 months before (Jan 1, 2022 – Jul 1, 2022) and 6 months after (Aug 1, 2022 – Jan 31, 2023) implementation. We studied stress test guideline compliance, changes in medical or surgical management, and major adverse cardiac events (MACE). Results: Before order set implementation, 37/122 patients (30%) underwent stress testing within the past year (29 specifically ordered preoperatively) with 66% (19/29) guideline compliance. After order set implementation, 50/173 patients (29%) underwent stress testing within the past year (41 specifically ordered preoperatively) with 80% (33/41) guideline compliance. In the pre- and postimplementation cohorts, stress testing led to a cardiovascular medication change or preoperative coronary revascularization in 24% (7/29) and 27% (11/41) of patients, and a staged surgery or less invasive anesthetic strategy in 14% (4/29) and 4.9% (2/41) of patients, respectively. All unindicated stress tests were surgeon-ordered and none led to a change in management. There was no change in MACE after order set implementation. Conclusions: Electronic medical record-based guidance of perioperative stress testing led to a slight decrease in overall stress testing and an increase in guideline-compliant testing. Our study highlights a need for improved preoperative cardiovascular risk assessment prior to major vascular surgery, which may eliminate unnecessary testing and more effectively guide perioperative decision-making. [ABSTRACT FROM AUTHOR]

Background: Many studies have reported the use of preoperative oral carbohydrates (CHO) in children, but the results are inconsistent. The aim of this meta-analysis is to assess the effectiveness and safety of oral CHO administration in children prior to surgery, with the goal of offering a dependable reference for clinical nursing practices and surgical interventions. Methods: Two authors searched PubMed, Clinical trials, Web of Science, Embase, Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang and Weipu databases for randomized controlled trial (RCT) on the effects of preoperative oral CHO in children up to April 12, 2024. We used RevMan 5.4 software for data analysis. Results: Nine RCTs involving a total of 1279 children were included. The meta-analysis showed that there was statistical difference in the pH of gastric juice (MD = 1.54, 95%CI: 1.40–1.67, p <.001), intraoperative sedation score (MD = 0.62, 95%CI: 0.27–0.97, p <.001), and the incidence of postoperative nausea and vomiting (OR = 0.40, 95%CI: 0.20–0.80, p =.009) between the CHO and control groups. There was no statistical difference in the RGV (MD = −0.23, 95%CI: −0.47–0.01, p =.06) and the postoperative blood glucose level (MD = −0.91, 95%CI: −5.03–3.21, p =.67) between the CHO and control groups. Egger regression analysis showed that there were no publication biases amongst the synthesized outcomes (all p >.05). Conclusion: The administration of oral CHO to children before surgery is safe and practicable. There is a need for additional, well-conducted studies with more participants to further elucidate the role of preoperative CHO administration. [ABSTRACT FROM AUTHOR]

Background: Anxiety before surgery is one of the most challenging aspects of preoperative care. Preoperative anxiety has a number of postoperative complications. There are only a few studies that report on preoperative anxiety in surgical patients in Ethiopia, and their prevalence differs from one study to the next. Objective: The aim of this study was to assess the level of preoperative anxiety and associated factors among surgical patients admitted at public hospitals in southern Ethiopia. Methods: From July to August 2022, a facility-based cross-sectional study was conducted among patients admitted to surgical wards at public hospitals. Data collection was conducted using a pretested, structured questionnaire administered by an interviewer. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory scale. The data were coded and entered in Epi Data Version 4.6, then exported to Statistical Package for Social Sciences version 25 for analysis. To describe the study variables, descriptive statistics were used. The associated factors were then identified using bivariate and multivariate logistic regression analyses. Results were declared at a p-value of less than 0.05 based on an adjusted odds ratio with a 95% confidence interval. Result: A total of 220 patients were enrolled, with a 99.5% response rate. The observed preoperative anxiety level was 57.5% (95%CI: 54.63–62.35). High preoperative anxiety was associated with no formal educational status (AOR: 3.75; 95%CI = 1.36, 10.39), fear of death (AOR =2.01; 95%CI = 1.09, 3.73), fear of waking up in middle of surgery (AOR =3.42; 95%CI =1.19, 9.77), fear of postoperative pain (AOR = 2.56; 95%CI = 1.15, 5.74). Conclusion: This study found that five out of ten patients scheduled for surgery in public hospitals had high levels of preoperative anxiety. Anxiety levels were associated with factors such as the educational status of respondents, fear of death, fear of waking up in the middle of surgery, and fear of postoperative pain. Preoperative anxiety assessments should be conducted regularly in each hospital, and appropriate anxiety-reducing methods must be implemented. [ABSTRACT FROM AUTHOR]

Surgical procedures often improve health and function but can sometimes also result in iatrogenic effects, including chronic pain and opioid misuse. Due to the known risks of opioids and the physical, emotional, and financial suffering that often accompanies chronic pain, there has been a call for greater use of complementary non-pharmacological treatments like mindfulness-based interventions. Mindfulness can be broadly described as an attentional state involving moment-by-moment meta-awareness of thoughts, emotions, and body sensations. An expanding number of randomized clinical trials have found strong evidence for the value of mindfulness techniques in alleviating clinical symptomology relevant to surgical contexts. The purpose of this review is to examine the empirical evidence for the perioperative use of mindfulness interventions. We present a mindfulness-based stepped care approach that first involves brief mindfulness to treat preoperative pain and anxiety and prevent development of postoperative chronic pain or opioid misuse. More extensive mindfulness-based interventions are then provided to patients who continue to experience high pain levels or prolonged opioid use after surgery. Finally, we review psychophysiological mechanisms of action that may be integral to the analgesic and opioid sparing effects of mindfulness. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative education is an essential nursing task that can be affected by the nurses' perception. Patients may be receiving insufficient vital information before surgery. However, the essential information that should be provided to patients undergoing surgery is not fully addressed. Objective: To assess the essential elements of preoperative information as perceived by the surgical nurses. Methods: This was a cross-sectional study. A convenience sample of 224 registered nurses who were working at surgical units was recruited from two hospitals. A preoperative teaching questionnaire was used. Results: Details about the operation (4.39 ± 0.61) and preoperative preparation (4.36 ± 0.61) were the most important domains of preoperative education as perceived by nurses. The results show significant differences between the perceived and actual preoperative educational practice across all domains except the preoperative preparation. Conclusions: The delivery of preoperative education could be affected by nurses' perceptions. Efforts to facilitate the implementation of effective education as perceived by nurses should be conducted by minimizing potential barriers. [ABSTRACT FROM AUTHOR]

Background: The aim of this article is to evaluate radiological and pathological response rates and correlate them after neoadjuvant short-course radiotherapy (SCRT) followed by chemotherapy in resectable locally advanced adenocarcinoma of the rectum (LARC). Materials and Methods: It is a single institutional, prospective observational study from January 2021 to March 2022 including 45 patients with resectable adenocarcinoma of the rectum. Radiotherapy was delivered to a dose of 25 Gy in 5 Gy per fraction using image-guided radiotherapy followed by mFOLFOX-based chemotherapy. After completion of 4–8 cycles of chemotherapy, tumor regression grade (TRG) was evaluated using magnetic resonance imaging and whole-body positron emission tomography. In case of a satisfactory response on imaging (mrTRG), patients underwent appropriate locoregional surgery. Histopathological examination of the surgical specimen was carried out and response to neoadjuvant treatment was assessed (pTRG). Results: A significant downstaging of T and N stages (60% and 72%, respectively, p <.0001) was observed after neoadjuvant therapy with a pathological complete response rate of 16%. Conversion of positive circumferential resection margin (CRM) to negative CRM was observed in 71.4% patients. A poor agreement between mrTRG and pTRG (k 0.133, p.16) was noted. Conclusion: Preoperative SCRT in LARC is feasible and well-tolerated with encouraging radiological and pathological response rates. A significant number of patients achieve negative CRM, thereby improving the chances of R0 resection. Significant relief in pain and bleeding can be achieved rapidly leading to an improved quality of life. [ABSTRACT FROM AUTHOR]

Background: The decision to pursue bilateral mastectomy without pathological confirmation of additional preoperative MRI lesions is likely multifactorial. We investigated the association of demographic factors and biopsy compliance following preoperative breast MRI with changes in surgical management in patients with newly diagnosed breast cancer. Methods: A retrospective review of BI-RADS 4 and 5 MRIs performed across a health system from March 2018 to November 2021 for assessment of disease extent and preoperative planning. Patient characteristics, including demographics, Tyrer-Cuzick risk score, pathology from index cancer and biopsy of MRI findings, and pre- and post-MRI surgical plans were recorded. Analysis compared patients who underwent biopsy with those who did not. Results: The final cohort included 323 patients who underwent a biopsy and 89 who did not. Of patients who underwent a biopsy, 144/323 (44.6%) had additional cancer diagnoses. MRI did not change management in 179/323 patients (55.4%) who underwent biopsy and in 44/89 patients (51.7%) who did not. Patients with a biopsy were more likely to have additional breast conservation surgery (P < .001) and patients without a biopsy were more likely to have a change in management to bilateral mastectomy P = .009). Patients without a biopsy who underwent a management change to bilateral mastectomy were significantly younger (47.2 vs 58.6; P < .001) and more likely to be white (P = .02) compared to those choosing bilateral mastectomy after biopsy. Discussion: Biopsy compliance is associated with changes in surgical decisions, and younger, white women are more likely to pursue aggressive surgical management without definitive pathologic diagnoses. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence suggests preoperative opioid use may increase the risk of negative outcomes following orthopedic procedures. This systematic review evaluated the impact of preoperative opioid use in patients undergoing shoulder surgery with respect to preoperative clinical outcomes, postoperative complications, and postoperative dependence on opioids. Methods: EMBASE, MEDLINE, CENTRAL, and CINAHL were searched from inception to April, 2021 for studies reporting preoperative opioid use and its effect on postoperative outcomes or opioid use. The search, data extraction and methodologic assessment were performed in duplicate for all included studies. Results: Twenty-one studies with a total of 257,301 patients were included in the final synthesis. Of which, 17 were level III evidence. Of those, 51.5% of the patients reported pre-operative opioid use. Fourteen studies (66.7%) reported a higher likelihood of opioid use at follow-up among those used opioids preoperatively compared to preoperative opioid-naïve patients. Eight studies (38.1%) showed lower functional measurements and range of motion in opioid group compared to the non-opioid group post-operatively. Conclusion: Preoperative opioid use in patients undergoing shoulder surgeries is associated with lower functional scores and post-operative range of motion. Most concerning is preoperative opioid use may predict increased post-operative opioid requirements and potential for misuse in patients. Level of evidence: Level IV, Systematic review. [ABSTRACT FROM AUTHOR]

Background: Loss of knee extension (LOE) after anterior cruciate ligament reconstruction (ACLR) is associated with limited knee joint function and increased risk for knee osteoarthritis. Hypothesis: Preoperative LOE will affect postoperative LOE for up to 12 months after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: Included were patients who underwent anatomic ACLR between June 2014 and December 2018. In all patients, the postoperative rehabilitation protocol was the same. A heel height difference (HHD) ≥2 cm between the affected and the contralateral leg was used as a measure of LOE. Based on preoperative HHD, patients were divided into LOE and no-LOE groups. The HHD was reevaluated at 1, 3, 4, 6, 9, and 12 months postoperatively. Proportional hazards analysis was used, with the dependent variable being whether a postoperative HHD <2 cm was achieved; the independent variables being the presence or absence of preoperative LOE; and the adjusted variables being age, sex, time to surgery, and presence of meniscal sutures. Results: A total of 389 patients (208 female, 181 male; median age, 21.0 years) were included in the study. There were 55 patients in the LOE group and 334 patients in the no-LOE group. The incidence of LOE at 12 months after ACLR was 13.8% in the no-LOE group and 38.2% in the LOE group (P <.001), with an absolute risk difference of 24.4%. The hazard ratio for achieving postoperative HHD <2 cm was 2.79 for the LOE group versus the no-LOE group (P <.001). Conclusion: Patients with preoperative LOE were nearly 3 times more likely than those without LOE to have LOE at 12 months after ACLR. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. Methods: Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. Results: After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. Conclusions: Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers. [ABSTRACT FROM AUTHOR]

Background: Detecting distant metastases when staging lung cancer is critical to avoid unnecessary surgery and provide appropriate multidisciplinary treatment. However, it is controversial as to whether staging studies should be performed routinely for patients with early-stage lung cancer who have no evidence of distant metastasis. Thus, this study aimed to examine the need for extrathoracic metastasis screening in patients with clinical stage IA non-small cell lung cancer, understand the association between extrathoracic metastasis and other clinical features, and evaluate the diagnostic efficiency of imaging screening for preoperative extrathoracic metastasis in patients with early-stage lung cancer. Methods: From 2010 to 2019, 510 patients diagnosed with clinical T1N0 lung cancer, excluding contralateral lung metastases, pleural dissemination, malignant pleural effusion, and malignant pericardial effusion, were treated for primary lung cancer. Patients were divided into two groups, and their clinicopathological characteristics were investigated. Results: Five patients (1.0%) had extrathoracic metastases. The histological types were adenocarcinoma in three of the cases, and squamous cell carcinoma and large cell neuroendocrine carcinoma in the other two cases. The T factor was T1b in one case and T1c in four cases. Four patients had solid tumors and one had a solid predominant tumor with an average tumor diameter of 23.0 ±2.9 mm. The size of solid tumors with extrathoracic metastases was larger than their counterparts. Conclusion: When evaluating stage IA non-small cell lung cancer with a solid component diameter < 22 mm, or clinical T1mi-1bN0 in computed tomography evaluation, screening for preoperative extrathoracic metastasis may be omitted. [ABSTRACT FROM AUTHOR]

Introduction: Geriatric patients with hip fractures often experience unexpected falls and they may have unfamiliar and unpleasant experiences within a brief period. This study aimed to investigate the prevalence and levels of preoperative anxiety in patients undergoing surgical treatment for hip fractures, and to determine the anxiety-related characteristics experienced by patients during the period before and after surgery. Materials and methods: We recruited a total of 75 geriatric patients who underwent surgical treatment for hip fractures and returned complete questionnaires. We used the State-Trait Anxiety Inventory (STAI)-X type to measure state-anxiety and defined a total score of 52 or higher as clinically meaningful state-anxiety. And, we investigated main cause of anxiety, moment of the highest level of anxiety, and the most helpful factor in overcoming anxiety before surgery and in reducing anxiety after surgery. Results: The mean STAI score was 47.2 points and one-third of the patients experienced various levels of clinically meaningful state-anxiety. The most common cause of preoperative anxiety was the surgery itself and patients experienced the greatest level of anxiety from the night preceding the surgery to the day of the surgery. Further, patients' trust in the medical staff prior to surgery and the surgeon's explanation after the surgery were the most key factors in overcoming anxiety. Conclusion: This study investigates the state-anxiety of geriatric patients undergoing surgery for hip fractures and presents important findings which can help in developing evidence-based interventions to improve the experience of patients undergoing hip surgeries. [ABSTRACT FROM AUTHOR]

In this article, we describe a case of a 33-year-old female with Alagille syndrome complicated by bilateral branch pulmonary artery stenosis resulting in moderate pulmonary hypertension, end-stage liver disease complicated by portal hypertension, and chronic renal disease who presented for combined liver-kidney transplant. Alagille syndrome is an autosomal dominant disease affecting the liver, heart, and kidneys. Multidisciplinary preoperative evaluation was performed with a team consisting of a congenital heart disease cardiologist, a cardiac anesthesiologist, a nephrologist, and a transplant surgeon. We describe Alagille syndrome and our intraoperative management. To our knowledge, this is the first description of a combined liver-kidney transplant in an adult patient with Alagille syndrome. [ABSTRACT FROM AUTHOR]

We partnered with a leading US academic medical center to empirically examine the impact of operational process changes designed to improve preoperative flow of patients through the perioperative environment. We focus on the implementation of centralized decision‐making and the introduction of an information technology (IT)‐enabled intraoperative prompt, on efficiency, as measured by preoperative patient processing time. We analyze over 33,000 individual surgical cases in a unique field experimental setting to conduct an empirical investigation of the effects of each intervention on patients' time spent in preoperative processing. To identify the causal effect of each process change, we leverage our field experimental research design and cast our analyses in the difference‐in‐differences modeling framework. We compare the preoperative patient processing time of two distinct patient groups, a treatment group that is impacted by the implemented operational changes and a control group that was not impacted by the changes, before and after each process change. Our results suggest a 3.4% reduction in preoperative processing time with only centralized decision‐making in place, yet suggest a 10.8% reduction in preoperative processing time when centralized decision‐making is paired with the IT‐enabled intraoperative prompt. We also find evidence of a complementarity effect between our process changes and surgeon prior process experience. Our study contributes to the healthcare operations literature by demonstrating the benefits of coordinated information flow within the patient supply chain. We offer insights for hospital managers and healthcare operations scholars alike on the role of information coordination in improving preoperative patient flow with minimal impact on existing resources and staff. [ABSTRACT FROM AUTHOR]

This study was to investigate the incidences of DVT in lower extremities after pelvic fracture before and after operation, and explore the risk factors. The records of patients with pelvic fractures receiving operation were collected. The patients were examined by preoperative and postoperative ultrasonography, and divided into thrombosis group and non-thrombosis group according to the preoperative and postoperative ultrasonographic results. Totally, 128 patients with pelvic fractures were included in this study. The incidence of DVT was 21.09% preoperatively, and increased to 35.16% postoperatively. Peripheral DVT constituted 92.60% and 86.67% of preoperative and postoperative DVTs, respectively. The results showed that age (odds ratio [OR] = 1.07; 95% CI: 1.01-1.12; P = 0.013), fracture classification (OR = 3.80; 95% CI: 1.31-11.00; P = 0.014) and D-dimer at admission (OR = 1.04; 95% CI: 1.00-1.08; P = 0.029) were independent risk factors of preoperative DVT, and female (OR = 0.21; 95% CI: 0.06-0.81; P = 0.023) was independent protective factor. In addition, age (OR, 1.06; 95% CI, 1.00-1.11; P = 0.026), operative blood transfusion (OR, 1.34; 95% CI, 1.05-1.72; P = 0.020) were independent risk factors of postoperative DVT. In conclusion, the DVT prevention strategy has not changed the high incidence of DVT in pelvic fractures, and orthopedic surgeons should pay more attention to perioperative DVT. When a male or patient with Tile-C type pelvic fracture is at admission, it is should be reminded that the screening the DVT in lower extremities. In addition, the surgeon should stanch bleeding completely, to reduce the blood transfusion and formation of DVT. [ABSTRACT FROM AUTHOR]

Background: Previous research have suggested that chronic rhinosinusitis (CRS) patients with lower symptomatic scores, demonstrated by a 22-item Sinonasal Outcome Test (SNOT-22) score <20, may not achieve meaningful quality of life improvement following endoscopic sinus surgery (ESS). However, indications for ESS are continuing to be defined and many low SNOT-22 scoring patients still undergo elective surgery for CRS and other benign sinonasal pathologies. The outcomes for these patients have not been previously studied. Objectives: We sought to evaluate surgical indications and outcomes for those patients with limited symptoms undergoing ESS. Methods: We screened 2829 ESS procedures from 2010–2018 to identify patients with a preoperative SNOT-22 score <20. We reviewed disease characteristics, preoperative Lund–Mackay (LM) scores, and pre- and postoperative SNOT-22 scores in patients with at least 3 months' follow-up. Results: Of all surgical ESS patients screened, 114 had low preoperative SNOT-22 scores (4.0%). Indications for these surgeries included CRS (50.0%), odontogenic sinus disease (11.4%), mucocele (10.5%), recurrent acute sinusitis (7.0%), fungal ball (5.3%), and silent sinus syndrome (4.4%). Specifically, among CRS patients, 45.6% had pulmonary comorbidities and/or systemic immunodeficiencies. Moreover, 100% of CRS patients with nasal polyps and 73.1% of CRS without polyps had LM scores >5. Patients with preoperative SNOT-22 scores between 15 and 19 achieved an average 6.5 point reduction (P <.001) postoperatively, whereas those with scores between 10 and 14 had a 5.4 point reduction (P <.001), and preoperative scores <9 resulted in no significant decrease in postoperative symptom scores (P =.98). Overall, there was a 3.3 point SNOT-22 reduction among all patients at 3 months postoperatively (P <.001). Conclusion: Patients with limited sinonasal symptoms may benefit from surgical treatment despite asymptomatic clinical presentations. A case-by-case analysis of comorbidities or unique clinical features should inform surgical decision-making for patients with lower SNOT-22 scores. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data related to anxiety levels in patients undergoing day care surgery in India.Methods: Preoperative anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS) 1 day before surgery and on the day of surgery, and the patients were categorized as cases (APAIS score ≥13) and controls (APAIS score <13). Sociodemographic characteristics, clinical features, and fears associated with anesthesia and surgery were also noted. Results: Out of the 399 patients recruited, 58.1% experienced significant preoperative anxiety. The fear of needles (P = 0.002), fear of waking up during the surgery (P < 0.001), and the patient's need of additional information regarding anesthesia and surgery (P < 0.001) were significantly associated with preoperative anxiety. Conclusion: A significant proportion of patients scheduled for day care surgery have preoperative anxiety. A preanesthetic workup of a patient with adequate clarification about their doubts and fears related to anesthesia and surgery is recommended to bring down the level of anxiety. [ABSTRACT FROM AUTHOR]

Background: An international group of experts recommended reclassifying non-invasive follicular variant of papillary thyroid cancers (FVPTC) as 'non-invasive follicular thyroid neoplasm with papillary-like nuclear features' (NIFTP) in April 2016. The purpose of this study was to establish preoperative clinical, laboratory, ultrasonographic, and cytological variables, which can differentiate NIFTP from FVPTC. Methods: We conducted a retrospective chart review of consecutive patients from a single institution evaluated between January 2012 and December 2017. 203 adult patients underwent lobectomy or total thyroidectomy for a FVPTC during that period. Each patient's medical chart was reviewed and information on pre-operative variables was recorded. An expert pathologist reviewed all surgical specimens and reclassified a subset of FVPTC as NIFTP according to the specific criteria. Results: Overall, 44 patients were included in the NIFTP group and 159 in the non-NIFTP group. Mean age was 50.1 years in the NIFTP group and 50.7 in the non-NIFTP group. Most patients were female (86.4% (38/44) in the NIFTP group vs 79.8% (127/159) in the non-NIFTP group). More patients underwent lobectomy in the NIFTP group (50% (22/44) vs 16.4% (26/159) in the non-NIFTP group, p = < 0.0001). Less patients received radioactive iodine in the NIFTP group (31.8% (14/44) vs 52.2% (83/159) in the non-NIFTP group, p = 0.0177). Preoperative thyroglobulin levels were lower in NIFTP patients (Median 25.55 mcg/L +/− 67.8 vs 76.06 mcg/L +/− 119.8 in Non-NIFTP, p = 0.0104). NIFTP nodules were smaller (Mean size 22.97 mm +/− 12.3 vs 25.88 mm +/− 11.2 for non-NIFTP, p = 0.0448) and more often solid than non-NIFTP (93.2% (41/44) vs 74.8% (119/159) for non-NIFTP, p = 0.0067). 2017 ACR TIRADS nodule category of 1–4 on ultrasound had a negative predictive value and a sensitivity of 100% for NIFTP. ROC Curve Analysis demonstrated that a preoperative thyroglobulin level of 31.3 mcg/L had a sensitivity of 75% and a specificity of 62.5% to differentiate NIFTP from non-NIFTP cancers. Conclusion: Lower preoperative thyroglobulin levels, smaller nodule size, solid texture and 2017 ACR TIRADS Category of 1–4 are more strongly associated with NIFTP than FVPTC and can favour less invasive surgical options such as lobectomy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate preoperative scoring systems and operative management and their relation to complications in patients older than 75 years undergoing cystectomy at two academic institutions. Methods: In total, 212 patients aged 75–95 years with muscle invasive bladder cancer underwent cystectomy at the University of Utah and Central Hospital of Bolzano, Italy. The rates of Grade 3 Clavien-Dindo complications and above in radical cystectomy patients (n = 199) were compared using Eastern Cooperative Oncology Group Scores and American Society of Anesthesiologists Physical Status Classification. The rates of Grade 3 Clavien-Dindo complications and above were also compared by urinary diversion type. Logistic regression was used to control for source institution. Results: In total, 199 cases were included in the primary analysis. Neither of the preoperative scoring systems were predictive for identification of radical cystectomy patients with ⩾Grade 3 Clavien-Dindo complications. In secondary analysis (n = 212, including partial cystectomy), none of the urinary diversion types associated with radical cystectomy had a significantly different rate of complications. However, partial cystectomy (n = 13) had a significantly lower rate of complications. Conclusion: Complication rates among elderly patients undergoing cystectomy for muscle invasive bladder cancer were very high. For patients who are approved for surgery after the history and physical exam, none of our objective metrics adequately predicted operative risk. A unique diversion procedure described by the Bolzano group, uretero-ureterocutaneostomy, had equivalent complication rates to the more common diversion procedures. It also appears based on outcomes in this cohort that partial cystectomy is a particularly favorable option within the elderly population in terms of perioperative morbidity. [ABSTRACT FROM AUTHOR]

Background: The potential impact of the number and type of preoperative encounters on satisfaction rates prior to elective surgical procedures is unclear, specifically scheduling and medical clearance encounters. Methods: Questionnaires investigating satisfaction with the preoperative process were collected for 200 patients presenting for elective hand surgery. The number of telephone, surgeon, and medical clearance encounters were recorded, and satisfaction was determined for each type based on a 4-category Likert scale. All patients 18 years or older were included, while only patients providing incomplete questionnaires were excluded. Outcome data were assessed for associations between different encounter totals or types and satisfaction rates. Results: Among 200 patients, 197 completed the questionnaire and were included. Overall satisfaction with the preoperative process was 92.9%, with only 3% of patients dissatisfied. There was a significant association between satisfaction and the number of telephone and total encounters. Satisfaction fell below 90% after 4 or more telephone calls (66.6%, P = 0.005) and 5 or more total encounters (80%, P = 0.008). When considered individually, there was no significant association between satisfaction and the number of surgeon (P = 0.267) or medical office encounters (P = 0.087), or a patient's perceived health status (P = 0.14). Conclusions: Greater than 3 telephone or 4 total encounters significantly decreases patient satisfaction, while surgeon and medical office visits are not associated with satisfaction rates when considered individually. This suggests the number, not the type, of preoperative encounters impact satisfaction and highlight the importance of efficient communication between patients and providers. [ABSTRACT FROM AUTHOR]

Background: Receiving preoperative information is a right of all parents whose children are admitted for surgery. Information for parents can help to prepare children and lessen anxiety for both parent and child. Aim: This study aims to assess the preoperative information needs of parents. Methods: This was a cross-sectional descriptive study. A non-probability convenience sampling technique was used to select 100 parents whose children, aged between 0 and 18 years, were admitted for surgery. The Parents Desire for Information scale was used to collect the data, which were then analysed using descriptive statistics. Results: The majority of the sample indicated that it is essential to receive preoperative information. The aspects of preoperative information rated as essential were as follows: need for the surgery; duration of hospitalisation; informed consent; fasting time; investigations; medications; physical preparations; dress code for the child; waiting time and place; parental involvement in the operating theatre/recovery/ward; pain management; post-operative care including eating, drinking, ambulation, wound care, discharge instructions and follow up. The majority (60%) of the parents said that they prefer to receive verbal instructions. The majority (63%) of the study participants said that it was the doctors who provided the information, and of these, 70% rated the information received as good. Conclusions: The present study concludes that parents of children undergoing surgery welcome comprehensive preoperative information. [ABSTRACT FROM AUTHOR]

Objectives: Research selectively investigating non-eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP) is lacking. The inflammatory patterns seen in non-eosinophilic CRSwNP are still poorly understood. The present study is the first to compare blood eosinophil, basophil, and neutrophil counts before/after surgery in patients with non-eosinophilic CRSwNP stratified by their clinical features. Methods: The study concerned 107 consecutive patients with histologically confirmed non-eosinophilic CRSwNP who underwent endoscopic sinus surgery (ESS). Results: Statistical analysis ruled out any significant change in mean blood eosinophil, basophil, and neutrophil counts after ESS. A significant positive correlation emerged between blood eosinophil and basophil counts in both pre- and post-ESS laboratory tests. In the subcohort of allergic patients, a significant negative correlation was found after ESS between eosinophil and neutrophil levels and between basophil and neutrophil levels. Conclusions: In eosinophilic CRSwNP, ESS can clear polyps, remove inflammatory tissue, and reduce the inflammatory cytokines it generates, with a consequent reduction in blood eosinophil levels. The different results in non-eosinophilic CRSwNP support the conviction that the 2 types of CRSwNP are entities with distinct inflammatory response patterns. [ABSTRACT FROM AUTHOR]

Dabigatran is an oral anticoagulant used for atrial fibrillation and venous thromboembolism. While an effective antibody reversal agent is available, its cost precludes routine use and the mainstay of preoperative management is timely dabigatran interruption. Unlike warfarin, there are no universally accepted protocols for interruption of dabigatran in the preoperative period and there is uncertainty around the interpretation of standard coagulation tests in the presence of dabigatran. We performed a prospective, observational pilot study in patients presenting for elective surgery to examine: 1) the preoperative plasma dabigatran concentrations on day of surgery associated with the local dabigatran interruption protocol, 2) the potential utility of dabigatran concentrations on day of surgery, and 3) the utility of standard coagulation tests in determining whether dabigatran concentrations were below a 'safe' threshold for surgery. We recruited patients presenting to pre-admission clinics for elective surgery. Dabigatran concentrations below 30 µg/L were considered adequate for proceeding with surgery. Data were obtained and analysed from 21 patients with a median (range) age of 70 (20-86) years. Median (range) dabigatran concentrations on the day of surgery were 5 (0-59) µg/L. Two patients had day of surgery concentrations exceeding 30 µg/L. Of the standard coagulation tests examined, only the thrombin clotting time (TCT) was abnormal for these two patients. Our interruption protocol was associated with safe dabigatran concentrations in most patients on the day of surgery. A minority of patients had dabigatran concentrations above the safe threshold, which were detectable by abnormal TCT results. [ABSTRACT FROM AUTHOR]

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemoradiation treatment (CRT) in rectal cancer patients is associated with a reduction in physical capacity, lean mass and increased fatigue. As a countermeasure to these treatment-related adverse effects, we examined the feasibility and preliminary efficacy of a 10-week exercise program during CRT. Methods: Ten rectal cancer patients (7 men, aged 27-70 years, body mass index = 26.4 ± 3.8 kg/m2) receiving CRT undertook supervised resistance and aerobic exercise twice weekly. Assessments were undertaken pre- and post-intervention for upper and lower body muscle strength by 1-RM, muscle endurance, physical performance tests, body composition by dual X-ray absorptiometry, quality of life, and fatigue. Results: There was a significant loss in appendicular skeletal muscle (−1.1 kg, P = .012), and fat mass (−0.8 kg, P = .029) following CRT. Despite the loss in skeletal muscle, leg press (P = .030) and leg extension (P = .046) strength improved by 27.2% and 22.7%, respectively, and leg press endurance by 76.7% (P = .007). Changes in strength were accompanied by improved performance (P < .05) in 6-m fast walking speed (6.9%) and dynamic balance as determined by the 6-m backwards walk (15.5%). There was minimal change in quality of life and fatigue, and no adverse events related to training. Conclusions: Exercise during neoadjuvant CRT appears to be feasible and well tolerated in rectal cancer patients and may enhance physical function while minimizing adverse changes in body composition and cancer-related fatigue. These initial findings need to be confirmed in randomized controlled trials. [ABSTRACT FROM AUTHOR]

Background The Draf 3 procedure has been demonstrated to be effective in the treatment of refractory frontal sinus disease. A variety of clinical factors may contribute to the change of frontal neo-ostium (FNO) area after this procedure. Imaging plays a vital role in the evaluation and follow-up after surgery and provides useful prognostic information. Objectives (1) To investigate the influence of local anatomic factors on FNO after a Draf 3 procedure by radiological measurements on imaging software and (2) to explore other predictive factors of FNO restenosis. Methods Twenty-four patients with chronic rhinosinusitis who underwent a Draf 3 procedure and were followed up for more than 12 months (2012–2014) were enrolled in this study. Data on patient demographics, medical history, and computed tomography scans were collected. Anatomic dimensions were measured with OsiriX® (Pixmeo, Geneva, Switzerland). Stenotic ostium was defined as a loss of more than 50% of the original intraoperative area. Multivariate linear regression was used to assess independent factors linked to frontal neo-osteogenesis 1 year after the surgery. A receiver operating characteristic curve was built for the cutoff value of preoperative dimension to predict restenosis of FNO area. Results A significant association was demonstrated between the minimum anteroposterior diameter (FOAPMIN) of the frontal ostium preoperatively and FNO area 1 year postoperatively. Multivariate linear regression showed that FOAPMIN of the frontal ostium preoperatively and the percentage of serum eosinophils (EOSs) correlated with the contour area of the FNO 1 year postoperatively. FOAPMIN ≤ 3.592 mm yielded a sensitivity of 95% and a specificity of 75% for the diagnosis of FNO restenosis. Conclusions Both FOAPMIN and EOS are independent predictors of the contour area of the FNO 1 year postoperatively. Patients with a higher risk of developing frontal ostium restenosis can be identified preoperatively by measurements of the frontal sinus anatomic dimensions. [ABSTRACT FROM AUTHOR]

Background: The 2009 NHS Blood and Transplant national comparative audit on blood use following primary total hip arthroplasty (THR) highlighted that preoperative anaemia was common and undertreated. They recommended that hospitals have a written policy for treating anaemia preoperatively. In our centre, we found that preoperative optimisation of anaemia, significantly reduced blood transfusion rate to <5%. The 2015 national audit showed that even though 48% of patients received tranexamic acid, 85% of patients required transfusion. By conducting a systematic review of literature on blood management for preoperative anaemia in primary THR; we aimed to validate the recommendations of the national audit and increase its awareness in the orthopaedic community. Methods: A PubMed Search was performed to identify suitable literature limited to randomised controlled trials, cohort studies, meta-analyses and systematic reviews involving primary THR. We excluded any THRs performed for trauma and revision arthroplasty. Our exclusion criteria for the intervention was the use of autologous methods such as cell salvage techniques and preoperative autologous blood donation. Results: Analysis of 13 publications showed widespread study heterogeneity, which precluded meta-analysis. Preoperative blood management (PBM) interventions included the use of recombinant human erythropoietin and oral iron supplementation in 12/13 and 11/13 studies respectively. There were significant differences in transfusion rates between PBM and control groups in 12/13 studies. Conclusions: The findings overwhelmingly support preoperative optimisation of anaemia. The main barrier to wider implementation remains the cost effectiveness. We recommend using our validated protocol, which has shown to significantly reduce transfusion rates, length of stay and remain cost effective. [ABSTRACT FROM AUTHOR]

Introduction To investigate if preoperative assessment delivered by occupational therapists, physiotherapists and social workers for people awaiting a total hip arthroplasty decreased the length of stay in hospital postoperatively. Method A retrospective data review was conducted on all patients who had a primary total hip arthroplasty across a 6-month period. A total of 101 patients (mean age 67.16 years) was included in this evaluation. Clinical notes were used to determine which patients attended or did not attend preoperative assessment. Statistical modeling was used to analyse the association of a series of variables and time spent in hospital after a total hip arthroplasty. Results There was no significant difference in the length of stay for patients who attended preoperative assessment (P < 0.05) while patients who were medically unfit, lived alone and/or required a care package experienced a significantly higher length of stay (P < 0.05). Conclusion These results do not support the British Orthopaedic Association’s recommendation that preoperative assessment delivered by allied health professionals helps reduce length of stay. However, it identifies variables which could be managed potentially to reduce length of stay. A large multisite clinical trial is required to determine if preoperative assessment reduces length of stay for people undergoing this surgical procedure. [ABSTRACT FROM AUTHOR]

The Australian and New Zealand College of Anaesthetists (ANZCA) 'Guidelines on Smoking as Related to the Perioperative Period (PS12)' recommends that anaesthetists should always ask about smoking, advise quitting and refer patients to their general practitioner (GP) or a telephone quit-line for quit support. In this study we evaluated the effect of adding tick-boxes for 'quit advice given' and 'referral to GP/Quitline' to anaesthesia charts of elective surgical patients to assess whether this intervention changed documentation of compliance with the ANZCA guideline. The anaesthesia charts of all smokers were reviewed for evidence of asking, advising and referring, over two three-month periods (n=999) separated by the intervention of placing a sticker to modify the preoperative charts of all elective patients which added tick-box prompts of advice and referral. No educational campaigns occurred to encourage tick-box use. No changes were made to non-elective charts. Evidence of advice to quit was 1.8% prior to, rising to 18.7% after, the intervention (P <0.001), while evidence of referral rose from 0.9% to 5.8%. There was negligible change in non-elective patients, who did not receive the intervention. The addition of tick-boxes improved the documentation of smoking cessation support, but as documented rates of quit support remained relatively low even after the intervention, tick-boxes alone cannot be relied upon to improve alignment of care with the ANZCA guidelines. [ABSTRACT FROM AUTHOR]

The Quick disabilities of the arm, shoulder and hand (QuickDASH) patient-reported outcome measure is frequently used to assess disabilities and symptoms of the upper extremity. This study compares real preoperative QuickDASH scores and remembered preoperative QuickDASH scores. Remembered preoperative QuickDASH scores were obtained 45 months (39–67) after surgery. Patient material consisted of 160 patients operated for Dupuytren’s contracture, carpal tunnel syndrome, thumb basal joint arthrosis, and shoulder pain. All patients had completed QuickDASH questionnaires before surgery. Paired T-tests, linear mixed models, and limits of agreement were used for analyses. There was a significant difference between remembered and real preoperative scores (mean 7.6, SD 15.6; SEM 1.2). Neither diagnosis, age, gender, nor time between surgery and review influenced the difference significantly. A linear mixed model was constructed to investigate the ability to retrospectively predict preoperative QuickDASH scores. Remembered preoperative QuickDASH cannot be used in individual patients because of the high inaccuracy.Level of evidence: III [ABSTRACT FROM AUTHOR]

Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients. [ABSTRACT FROM AUTHOR]

Optimal preoperative management of dialysis patients remains challenging. Patients with end-stage renal disease (ESRD) have higher mortality in the perioperative setting compared with non-ESRD patients. However, it is well established that dialysis should be done on the day before surgery. Additional dialysis session prior to surgery does not improve outcomes. All dialysis patients should undergo blood work to check electrolytes and especially serum potassium prior to any surgery. Some medications, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics, should be stopped prior to surgery to minimize hemodynamic changes during surgery. The dialysis access should be carefully examined for any signs of infection. The arteriovenous fistula or graft should be evaluated for patency. Glycemic control in diabetic ESRD and chronic kidney disease patients is very important, and clinicians should be aware of the risk of bleeding and the appropriate analgesics that can be used in dialysis patients in the perioperative setting. In conclusion, preoperative evaluation in patients with ESRD should be a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

In the past decade, the armamentarium of targeted therapy agents for the treatment of metastatic renal cell carcinoma (RCC) has significantly increased. Improvements in response rates and survival, with more manageable side effects compared with interleukin 2/interferon immunotherapy, have been reported with the use of targeted therapy agents, including vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitors (sunitinib, sorafenib, pazopanib, axitinib), mammalian target of rapamycin (mTOR) inhibitors (everolimus and temsirolimus) and VEGF receptor antibodies (bevacizumab). Current guidelines reflect these new therapeutic approaches with treatments based on risk category, histology and line of therapy in the metastatic setting. However, while radical nephrectomy remains the standard of care for locally advanced RCC, the migration and use of these agents from salvage to the neoadjuvant setting for large unresectable masses, high-level venous tumor thrombus involvement, and patients with imperative indications for nephron sparing has been increasingly described in the literature. Several trials have recently been published and some are still recruiting patients in the neoadjuvant setting. While the results of these trials will inform and guide the use of these agents in the neoadjuvant setting, there still remains a considerable lack of consensus in the literature regarding the effectiveness, safety and clinical utility of neoadjuvant therapy. The goal of this review is to shed light on the current body of evidence with regards to the use of neoadjuvant treatments in the setting of locally advanced RCC. [ABSTRACT FROM AUTHOR]

Introduction: Criterion standard treatment of allergic fungal sinusitis (AFS) is primary surgery followed by adjuvant therapy. Even after good surgery, recurrence rates vary from 10 to 79%. Antifungals, e.g., itraconazole, and steroids have shown varying success rates in delaying recurrences given after surgery. Itraconazole decreases the need for steroids given as a primary treatment in allergic bronchopulmonary aspergillosis. This study investigated the efficacy of itraconazole given preoperatively for allergic fungal rhinosinusitis. Methodology: A prospective study was carried out from July 2011 to November 2013 with 27 patients with histologically proven AFS, who were given itraconazole for 1 month in the preoperative period and operated after completion of the course of itraconazole. They were compared with 25 matched controls of patients with AFS who were operated on directly without preoperative itraconazole. Both groups were given oral steroids in tapering doses for 6 weeks during the postoperative period and followed up at regular intervals. Evaluations were done by using symptomatic (Sino-Nasal Outcome Test [SNOT-20]), radiologic (Lund Mackay scores), and endoscopic (Kupferberg nasal endoscopic grades) parameters. Results: Symptomatology scores (SNOT-20) decreased significantly (p = 0.000) with itraconazole. There was a decrease (p = 0.007) in the Lund Mackay scores that reached up to 0. There was complete resolution of disease in 15% of the patients. Reductions in hyperdensities were noted on computed tomography in all the patients after preoperative itraconazole. Polyp sizes decreased and nasal endoscopic grades improved after itraconazole. Postoperative fungal cultures were positive in 60% of the patients in the preoperative itraconazole group compared with 76% of the patients in the control group, which indicated a decreased fungal burden. Conclusion: We found improvements in clinical, radiologic, and endoscopic parameters in AFS after preoperative itraconazole administration, which decreased the disease load significantly and also reduced the extent of surgery in the short-term follow-up. It may prove to be a good preoperative adjunct that needs further research [ABSTRACT FROM AUTHOR]

The aim of the present study is to assess the disease profile, outcome and prognostic factors in patients treated with surgery combined with radiotherapy (RT), with or without chemotherapy (CXT), for soft-tissue sarcoma (STS) in a multidisciplinary setting. One hundred and sixty-four patients with STS treated between 1980 and 2010 at the Centre Hospitalier Universitaire Vaudois were enrolled in this retrospective study. Seventy-six percent of patients underwent postoperative RT with (24%), or without (52%) CXT, 15% preoperative RT with (5%), or without (10%) CXT, surgery alone (7%), or RT alone (2%) with or without CXT. The median follow-up was 60 months (range 6-292). Local failure was observed in 18%, and distant failure in 21% of the patients. Overall survival (OS), diseasefree survival (DFS), local control (LC) and distant metastases-free survival (DMFS) were 88%, 68%, 83%, and 79% at 5 years, and 80%, 56%, 76%, and 69% at 10 years, respectively. In univariate analyses, favorable prognostic factors for OS, DFS, and DMFS were tumor size 6 cm or less, World Health Organization (WHO)/Zubrod score 0, and stage 2 or less. Age and superficial tumors were favorable only for OS and DMFS respectively. STS involving the extremities had a better outcome regarding DFS and LC. Histological grade 2 or less was favorable for DFS, DMFS, and LC. Radical surgery was associated with better LC and DMFS. RT dose more than 60 Gy was favorable for OS, DFS, and LC. In multivariate analyses, independent factors were age for OS; tumor size for OS, DFS and DMFS; WHO/Zubrod score for OS, DFS and LC; hemoglobin level for DFS; site for DFS and LC; tumor depth for DMFS; histological grade for DFS and LC; surgical procedure for LC and DMFS; and RT dose for OS. This study confirms that in a multidisciplinary setting, STS have a fairly good prognosis. A number of prognostic and predictive factors, including the role of surgery combined with RT, were identified. Regarding RT, a dose of more than 60 Gy was associated with a better outcome, at the price of a higher toxicity. We could not demonstrate a superiority of preoperative RT over postoperative RT. [ABSTRACT FROM AUTHOR]

The article offers information on the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery. Patients were randomly assigned to receive physical therapy with respiratory and global exercises before surgery, and another group without practicing any. It was found that patients in the intervention group had higher inspiratory strength. The preoperative physical therapy improved pulmonary function and physical performance.

Background:: The femoral canal is frequently measured preoperatively in cases where an intramedullary device is planned for operative fixation of a fracture. To our knowledge, a formal assessment of validity and reliability of preoperative canal measurements has not been previously performed. Questions/Purposes:: This study aims to determine the validity and reliability of preoperative canal measurements of the femur made on plain radiographs using comparison with curved planar reformation software as the gold standard. Methods:: Fifty-six patients were identified based on availability of anterior-posterior (AP) and lateral radiographs of the femur and computed tomography (CT) of the lower extremity. Four 'raters' measured the canal diameter at its narrowest point and the distance from the lesser trochanter to the isthmus on the AP, lateral radiograph, and CT. The width of the femoral nail on AP radiographs was also measured to determine magnification error. Curved planar reformation (CPR) was used to provide the most accurate calculation of the canal diameter. Results:: Compared to the isthmus position determined by CPR, the measurement was most accurate on an AP and the diameter of the canal was most accurate using coronal CT, followed by AP radiographs. The measured canal diameter of the fractured femur on APs was compared to that of the used implant and varied by 1 mm. Discussion/Conclusion:: The AP plain radiographic measurement was found to be more accurate for determination of the canal diameter compared to the lateral radiograph. These findings confirm the utility of preoperative canal measurements in predicting the feasibility of placing a specific size intramedullary implant. [ABSTRACT FROM AUTHOR]

Results of large randomized trials have shown that survival rates after breast conserving surgery are equivalent to those obtained by radical mastectomy. Breast conserving surgery with wide local excision in women with early stage breast cancer who are thought to have a single and resectable tumour as determined by clinical examination and conventional imaging followed by postoperative irradiation is the standard of care in early breast cancer. Mapping of local disease is the key element to guide optimal surgery to obtain tumour-free margins, thereby decreasing risk of local recurrence. The usual preoperative workup of breast malignancy consists of clinical breast examination and mammography with or without ultrasound. However, mammography and ultrasound fail to accurately assess tumour extent in as many as a third of patients eligible for breast conserving therapy. It is well established that magnetic resonance imaging is far superior to mammography (with and without ultrasound) for mapping the local extent of breast cancer. Experts advocate its use despite its high costs, high number of false positive findings, and lack of evidence from randomized prospective trials and, notably, fear of "overtreatment." This article discusses the current role of breast magnetic resonance imaging with its clinical advantages and applications. [ABSTRACT FROM AUTHOR]

Individually, inguinal hernias and acute appendicitis are common, but the combination of the two, acute appendicitis within an inguinal hernia or Amyand hernia (AH), is rare. The overwhelming majority of AH cases are in males and discovered during surgery. To date, only three case reports in the literature of this pathology have been diagnosed with sonography. This is a report of an AH diagnosed in a woman with sonography. [ABSTRACT FROM PUBLISHER]

Imaging and electrodiagnostic studies form an essential part of the evaluation of the patient with traumatic brachial plexopathy, enabling clarification of surgical options, prognostication of outcome and formulation of postoperative management. The primary objective of imaging is to identify pre-ganglionic injury indicative of nerve root avulsion. The presence of one or more nerve root avulsion injuries is a critical factor in surgical decision-making and the prognosis of surgical reconstruction. CT myelography is the current imaging modality of choice for this purpose. Initial electrodiagnostic (EDX) testing is ideally performed no sooner than 4 weeks following injury unless otherwise clinically indicated. Follow-up testing can be helpful at approximately 6 week intervals. The sensory nerve amplitudes are the most important component of nerve conduction testing in distinguishing between pre- and post-ganglionic injuries. Electromyographic studies will also assist in the determination of a pre- from post-ganglionic injury, the level of plexus involvement and identify potential donor nerves that may be suitable for use as transfers. [ABSTRACT FROM PUBLISHER]

The article discusses the results of a study which examines the occurrence of blood transfusion in patients who underwent lower limb arthroplasty. According to the authors, the overall incidence of transfusion was 16 percent while the incidence of primary arthroplasty was 11 percent and 44 percent for revision surgery during a six-month period after the surgery. They suggest that patients with primary lower limb arthroplasty with a preoperative hemoglobin of 120 g/l or less should make a follow-up for their anemia and optimization of erythropoeisis.

Objectives: To investigate the effect of septal deviation, septoplasty, and smoking upon nasal mucociliary clearance by using saccharine test. Methods: Included in this study were 40 patients (15 women and 25 men) who had septal deviation and septoplasty surgery performed between March and June 2006. Patients are classified into three groups: group I (n = 20) nonsmoking patients who had septoplasty surgery, group II (n = 20) smoking patients who had septoplasty surgery, and the control (n = 20) group. None of the control group has nasal breathing problem or smoking history. For determining preoperative and postoperative nasal mucociliary clearance (MCC) time, a saccharine test was performed on the patients 1 day before surgery and at the third month of postoperative control. Results: Preoperative and postoperative nasal MCC time in patients of group I are statistically significantly lower than the group II (p < 0.01). Postoperative MCC time in group I and II is significantly decreased compared with preoperative MCC time, statistically (p < 0.01). Preoperative and postoperative MCC time of group I and group II is significantly higher than MCC time of the control group (p < 0.01). Conclusion: Nasal septal deviation and smoking deteriorates nasal MCC time and this result can be shown easily with the saccharine test. Properly performed septoplasty surgery decreases nasal MCC time during the late postoperative period but MCC times are still longer than normal. The saccharine test can be used for following up the effect of septoplasty upon nasal mucosa. [ABSTRACT FROM AUTHOR]

To investigate knowledge of perioperative events, a questionnaire was administered to 111 elective surgical patients. Six topics were covered: the operation, the anaesthetic, time spent in the operating theatre, amount of post-operative pain, duration of hospital admission and time required to return to normal fitness. Apart from evaluating information-sources for each topic, the questionnaire assessed degree of knowledge and satisfaction with this information, and the relationship of these to anxiety. More than 30% of the patients responded that they had received no information about anaesthesia, time in theatre, return to fitness or pain. For each topic more than 40% desired further information. Nursing staff provided most information, although for the anaesthetic, time in theatre, return to fitness and pain, more than 60% of patients responded that nobody had provided explanation. There was no correlation between knowledge relating to the topics per se and anxiety, but there was a significant correlation between satisfaction with information and anxiety. This survey shows a considerable need for improved information provision, especially for patients in whom anxiety is associated with a desire for further explanation of operative care. [ABSTRACT FROM AUTHOR]

Purpose: To determine the preoperative visual acuity of cataract patients over a 10-year period in a tertiary facility as a means of auditing the cataract surgical services. Methods: A retrospective study of patients with age-related cataracts who had cataract surgery performed between January 2007 and December 2016 at the University College Hospital, Ibadan. Systematic random sampling and probability proportionate to size were used to recruit a representative sample. Information on sociodemographic characteristics, preoperative visual acuity, ocular and systemic comorbidities were retrieved and analysed. Results: Of the 499 patients studied, males were 268 (53.7%) and their mean age was 67.69 (±9.51) years. The predominant visual acuity was hand motion 184 (36.9%) and yearly mean preoperative visual acuity was in the range of 0.0037–0.04 decimal. Conclusion: The mean preoperative visual acuity of patients in this facility did not change over the 10-year study period. Mean value of preoperative visual acuity remained within the range of blindness and did not improve over the decade. This could either be a reflection of visual impairment at which our patients seek care or an indication of the range of visual acuities at which surgeons are willing to offer cataract surgery in our environment. This trend has negative implications on the burden of cataract blindness as it reflects poor coverage of surgery for other levels of visual impairment due to cataract. [ABSTRACT FROM AUTHOR]