Search

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]

To reduce the risk of pulmonary aspiration, fasting before general anesthesia is essential. Studies reported that despite that traditional "NPO (nothing by mouth) after midnight" regulations are being liberalized, noncompliance with NPO status is still a threat to patient safety and may result in delays of elective surgical procedures, reduce the efficiency of ambulatory surgery setting, and compromise patient safety. This study aimed to assess the community's knowledge of preoperative fasting, as well as their attitudes toward preoperative fasting in Saudi Arabia. This is a cross-sectional study conducted among the Saudi general population. A self-administered questionnaire was distributed among the targeted population using an online surgery. The questionnaire includes socio-demographic data (i.e., age, gender, education, etc.) and a 12-item questionnaire to measure the knowledge and attitude toward preoperative fasting. The result of 4257 participants was recruited, 67.2% were females and 39.3% were aged between 18 to 24 years old. The prevalence of participants who had surgery that required anesthesia was 48.9%. The overall mean knowledge score was 4.80 (standard deviation (SD) 2.36) out of 12 points. 60.1% were considered poor knowledge, 38.3% were moderate and only 1.6% were considered good knowledge levels. Factors associated with increased knowledge were being older in age, female gender, living in Northern Region, and having undergone surgery that required anesthesia. The level of knowledge among the general population regarding the importance of fasting before the surgery was inadequate. Older females who were living in the Northern Region and who previously received general anesthesia during their previous operation were more likely to demonstrate better knowledge about preoperative fasting as compared to the rest of the groups. More research is needed to determine the level of understanding of the community toward the importance of fasting before surgical intervention. [ABSTRACT FROM AUTHOR]

There is limited knowledge in the literature and lack of clear protocols among practitioners regarding preoperative steroids administration for patients undergoing endoscopic sinus surgery (ESS). This study aimed to identify the practice patterns of rhinologists in Saudi Arabia as well as systematically review all health-related evidence regarding the use of preoperative steroids for ESS. A previously used questionnaire was modified and distributed in Saudi Arabia among rhinologists who finished their residency training. It entailed questions about their qualifications and preoperative steroids use, preferred regimen, and possible benefits. Also, a systematic literature review using four major databases was conducted to build a scoping view of the current evidence. A total of 94 subjects responded to the mailed survey. Of them, 72(76.6%) used preoperative steroids; 40 subjects believed that there is a strong supporting evidence while 32 reported that there is no solid evidence. The commonest indication was chronic rhinosinusitis with nasal polyp followed by allergic fungal rhinosinusitis. More than half of subjects (54.2%) preferred medium-dose prednisone (30–40 mg/day). A considerable number believed that steroids decreased surgical bleeding (n = 57, 79.2%), improved surgical field visualization (77.8%), decreased surgical time (77.8%), and decreased mucosal inflammation (61.1%). Thirteen studies including 1028 patients were eligible for the systematic review. Only three studies reported a statistically significant effect of steroids in reducing intraoperative hemorrhage, while only two studies revealed that steroids significantly improved surgical field quality. In two studies, steroids showed a significant effect in reducing eosinophil infiltration. There is a major number of rhinology experts using preoperative steroids for patients undergoing ESS but there is a wide variation among their practice patterns. The current potential advantages of steroids need to be supported by further large randomized clinical trials to establish clear guidelines. [ABSTRACT FROM AUTHOR]

A role for incisional biopsy in preoperative prognostication is increasingly being advocated in oral tongue squamous cell carcinomas (OTSCC). Biopsies at two locations were compared, and prognostic factors in biopsies and their corresponding resections were evaluated. A total of 138 OTSCC biopsy slides from Finland and Saudi Arabia were compared for size (horizontal and vertical) and invasive front. The Finnish cases were assessed for tumor stroma ratio (TSR) and tumor‐infiltrating lymphocytes (TILs) using light microscopy and digital image analysis assessment and compared. Furthermore, TSR, TILs, and previously analyzed budding and depth of invasion (BD) score in biopsies were compared with their evaluation in the corresponding resections. Fifty‐nine percent of Finnish and 42% of Saudi Arabian biopsies were ≥ 5 mm deep, while 98% of Saudi Arabian and 76% of Finnish biopsies were ≥ 5 mm wide. Assessment of invasion front was possible in 72% of Finnish in comparison with 40% of Saudi Arabian biopsies. There was 86.8% agreement between TSR and 75% agreement between TIL evaluation using light microscopy and digital assessment. Significant agreement was obtained on comparing the TSR (p = 0.04) and BD (p < 0.001) values in biopsies and resections. Biopsies of ≥ 5 mm depth from representative OTSCC areas are essential for prognostic information. Clinical pathologists are advised to assess BD score and TSR for prognostic features in such biopsies. [ABSTRACT FROM AUTHOR]

Many patients with sickle cell disease (SCD) need surgical management during their lifetime. The best approach for preoperative transfusion in SCD is still to be determined. In this single-center retrospective study, we included HBSS/HBS-Beta0-thalassemia patients younger than 16 years of age who underwent surgery between January 2008 and July 2019. Preoperative transfusion assignment (PTA) was based on SCD severity and surgical risk. Patients were assigned to no transfusion, simple transfusion, or exchange transfusion. A total of 284 patients were identified and 66 (23%) underwent 78 procedures. Mean age at the time of procedure was 8 (5–11) years, mean baseline hemoglobin was 8.5 (7.8–9.3) g/dl, and mean hemoglobin F was 18.4 ± 8.2%. SCD severity was low-risk in 57 (73%) and high-risk in 21 (27%) patients. Surgical risk was low-risk in 20 (25.6%) and medium-risk in 58 (74.4%) procedures. PTA was no transfusion in 17 (22%), simple transfusion in 40 (51%), and exchange transfusion in 21 (27%) procedures. Postoperative complications occurred in five (6.4%) of procedures only in the simple transfusion group (three acute chest syndrome, one hemolytic anemia, one pain crisis) undergoing medium-risk surgery. Preoperative risk-based transfusion assignment is feasible. Despite a high baseline hemoglobin level in the no transfusion group, none of the patients developed postoperative complications. It is possible that the high baseline hemoglobin F phenotype was protective and indicates the need to study the risk/benefit of interventions used in this phenotype. [ABSTRACT FROM AUTHOR]

Introduction: Only a few studies (n=5) have focused on the importance of preoperative high white blood cell (WBC) count (leukocytosis) as a prognostic marker in patients with endometrial cancer (EC). Nevertheless, more related studies are needed to solidly corroborate these findings. To the best of our knowledge, no such study has been conducted in the Gulf region and Saudi Arabia in particular., Methods: A retrospective cross-sectional study was conducted at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. The medical records of 130 patients with endometrioid-type EC were reviewed for clinico-pathological factors (that is, age, tumor stage, endometrioid grade, myometrial invasion depth, lymphovascular space involvement and recurrence) and survival outcomes. Survival outcomes included disease-free survival (DFS) and overall survival (OS). Leukocytosis was defined as a WBC count level >10 x 103 cells/uL. Chisquare test was used for univariate analysis of categorical data. Survival analyses of DFS and OS were calculated according to the Kaplan-Meier estimates method and compared by using two-tailed log-rank test. Univariate and multivariate analyses of survival were performed using Cox proportional hazards model. Statistical significance was regarded as a p value <0.05., Results: The mean age was 59 ± 10.5 years (range: 36-99). The overall mean preoperative WBC count was 7.7 ± 2.4 x 103 cells/uL (range: 2.7-17 x 103). The frequency of preoperative leukocytosis was 18.5% (n=24). Patients with preoperative leukocytosis have statistically significant higher rates of advanced FIGO stage III-IV disease (p=0.007) and positive tumor recurrence (p=0.009) than patients with normal preoperative WBC count (chisquare test). Patients with preoperative leukocytosis have a higher statistically significant probability of developing recurrence than patients with preoperative normal WBC count (29.4 vs. 11.8%, p=0.008, log-rank test). Patients with preoperative leukocytosis have statistically significant lower mean DFS (58.3 ± 6.9 vs. 67.9 ± 2.3 months, p=0.015) and 5-year DFS rate (66.7 vs. 86.8%, p=0.015) than patients with normal preoperative WBC counts (log-rank test). However, there were no statistically significant differences between patients with preoperative leukocytosis and normal WBC counts in terms of mean OS (73.8 ± 4.5 vs. 79.3 ± 2.1, p=0.581) and 5-year OS rate (87.5 vs. 91.5%, p=0.581), respectively (log-rank test). Multivariate analyses using Cox proportional hazards model failed to significantly demonstrate preoperative WBC count as an independent prognostic factor of DFS and OS (log-rank test, p>0.05)., Conclusion: Preoperative leukocytosis is not rare in patients with endometrioid-type EC. Besides, preoperative leukocytosis is correlated with poor tumor FIGO stage, higher cumulative incidence of relapse and poor DFS in the univariate analysis. Our study suggests that preoperative leukocytosis may identify high-risk patients who may require more intensified therapy in terms of aggressive debulking and/or perioperative chemotherapy.