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Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common val-vulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction. [ABSTRACT FROM AUTHOR]

Background: Pulmonary endarterectomy (PEA) is recognized as the best surgical choice for treatment of chronic thromboembolic pulmonary hypertension caused by pulmonary vascular occlusion in eligible patients. This study aims to describe correlations between the daily walk (DW), and the demographic^ and clinical characteristics of patients undergoing pulmonary endarterectomy. Methods: This was a cross-sectional study using data from 32 consecutive patients who had undergone PEA operations and were admitted to the cardiac ward to complete their post-operative rehabilitation. Results: Those with a body mass index of ≥25 kgm2 walked a greater distance during the postoperative rehabilitation phase after PEA compared with those with body mass index <25 kgm2. We also found differences in daily walk distances between women and men: by day 3, the men had already walked a median distance of 240 metres, while women had walked a median distance of 15 metres. Conclusions: The authors found that estimation of the DW was a simple, inexpensive, and reliable pleasure that can help professionals to evaluate patients' post-operative course after PEA. [ABSTRACT FROM AUTHOR]

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Background: Canadians are increasingly engaging in medial tourism. The purpose of this study was to review Canadians' experiences with travelling abroad for cosmetic surgery, including primary motivations for seeking care outside of Canada. Methods: A qualitative analysis was conducted using semistructured interviews following a pre-determined topic guide. People who had undergone cosmetic surgery outside of Canada were interviewed. The interviews were transcribed and coded to determine motivational themes. Patients were recruited until thematic saturation was achieved. Results: Thematic saturation was achieved after recruitment of 11 patients. The most common motivational themes identified in this study for seeking cosmetic surgery outside of Canada included cost, post-operative care provided, marketing/customer service, and word-of-mouth. Member checking and theory triangulation were validation techniques used to verify identified themes. Mexico was the most common location for cosmetic tourism. The most common procedures were breast augmentation, mastopexy, and abdominoplasty. Participants gathered pre- and post-operative information primarily through pamphlets and contact with surgeons' offices. Follow-up was only available for half of the participants in this study, and only 5 of the participants felt that they had received informed consent. Conclusions: The majority of participants engaged in cosmetic tourism due to cost reasons and the level of post-operative care provided., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2021 The Author(s).)

Importance: Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients., Observations: The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation., Conclusions and Relevance: Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.

Importance: Single ventricle CHD affects about 5 out of 100,000 newborns, resulting in complex anatomy often requiring multiple, staged palliative surgeries. Paediatricians are an essential part of the team that cares for children with single ventricle CHD. These patients often encounter their paediatrician first when a complication arises, so it is critical to ensure the paediatrician is knowledgeable of these issues to provide optimal care., Observations: We reviewed the subtypes of single ventricle heart disease and the various palliative surgeries these patients undergo. We then searched the literature to detail the general paediatrician's approach to single ventricle patients at different stages of surgical palliation., Conclusions and Relevance: Single ventricle patients undergo staged palliation that drastically changes physiology after each intervention. Coordinated care between their paediatrician and cardiologist is requisite to provide excellent care. This review highlights what to expect when these patients are seen by their paediatrician for either well child visits or additional visits for parental or patient concern.

Introduction Generalized anxiety disorder has become one of the most prevalent mental health disorders in the United States. In addition, postoperative delirium has been shown to increase hospital stay, increase mortality, and increased healthcare costs. Few studies have looked at the prevalence of postoperative delirium in patients diagnosed with anxiety undergoing elective spinal deformity procedures. The purpose of this study was to determine if anxiety is a risk factor for postoperative delirium in elective spinal deformity surgeries. Methods The authors performed a retrospective analysis using the TriNetX Research Database. Patients diagnosed with kyphosis or lordosis who then underwent elective spinal correction surgeries were identified. This group was then separated based on the diagnosis of a generalized anxiety disorder before the operation versus no diagnosis. Propensity score adjustment, based on mental disorders and other risk factors, was then used to match cohorts on baseline demographics and characteristics. Analysis was performed on the primary outcome of postoperative delirium, with secondary outcomes of upper respiratory tract infections, surgical site infections, sepsis, ventilator dependence, convulsions, stroke, emergency department visits, myocardial infarction, pulmonary embolism, and urinary retention within 30 days after surgery. Results Our search included 1,211 patients with a diagnosis of anxiety and 8,055 patients without anxiety. After propensity score matching, 996 patients remained in each cohort. Statistical analysis showed significant outcomes between the matched cohorts in the anxiety group for postoperative delirium (OR 2.788; 1.587-4.899) and convulsions (OR 1.615; 1.006-2.592). All other outcomes were not significant after propensity score matching. Conclusion These results showed generalized anxiety disorder is a risk factor for postoperative delirium and convulsions after elective spine surgery. Further research is necessary on the effects of mental health disorders on postoperative delirium and other outcomes to better understand the risks in this population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Freedman et al.)

Abstract: A best evidence topic in ear, nose and throat surgery was written according to a structured protocol. The question addressed was: In patients who are undergoing pinnaplasty for prominent ears, does the use of post-operative head bandages as compared to not using post-operative head bandages improve clinical outcomes? A total of 121 papers were identified using the reported search protocol, of which five articles represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All five studies showed that no advantage exists in using head bandages with patients who have undergone pinnaplasty. Four of the five studies concluded that head bandages should not be utilised at all, whereas two of the five studies suggested that there is little reason to use head bandages after the first 24 h post-pinnaplasty. Therefore, the clinical bottom line is that provided the pinnaplasty result is good at time of surgery, there is reasonable evidence to suggest that head bandages have no effect on complications or patient satisfaction, so at best they are unnecessary and at worst, their physical drawbacks may actually outweigh any of their perceived benefits. [Copyright &y& Elsevier]

Enhanced recovery involves the adoption of a selected number of evidence-based interventions used together and implemented in a 'fast track' care pathway during preoperative management, surgery itself and throughout the immediate postoperative period. Aimed at promoting effective patient recovery after surgery, this has been shown to improve the patient experience and facilitate early patient discharge following major surgery in some clinical areas (Department of Health, 2010). Applied to the clinical management and nursing care of women affected by gynaecological malignancies in one London tertiary referral centre hospital, enhanced recovery has been seen to improve patient experience and shorten the length of overall hospital stay. Implementation requires careful planning, appointment of key practitioners and commitment of the multidisciplinary team to realise successful outcomes. The authors' experience suggests that challenges are associated with changing practice and that while careful planning is essential, successes are to be gained, which significantly benefit patients, staff and the NHS Trust. In sharing this experience of implementing enhanced recovery, the authors hope to encourage others to consider application of this innovative strategy. [ABSTRACT FROM AUTHOR]

Two audits in the same hospital, one retrospective and the other prospective, are compared in this article to establish the frequency of urinary retention among children with orthopaedic conditions for whom the main post-operative analgesic treatment was epidural. The effects of the position and type of epidural administration, number of reported urinary infections associated with an indwelling urinary catheter, a hip spica cast and/or toilet training were evaluated. [ABSTRACT FROM AUTHOR]

Introduction:This article reviews the literature pertaining to bismuth iodoform paraffin paste.Overview:Bismuth iodoform paraffin paste is used in most otolaryngology departments on a daily basis. Questions about its properties are common in postgraduate otolaryngology examinations. This article reviews bismuth iodoform paraffin paste's current and historical usage, constituents, properties, side effects, and radiographic properties, and its alternatives in otological and rhinological practice. [ABSTRACT FROM PUBLISHER]

Angioedema is a rare event (Incidence: 100 to 3000/100,000 persons) which can lead to a life threatening airway emergency in a very short time and this necessitates urgent intervention. We present a case of potentially life-threatening postoperative swelling of the tongue, oro-pharynx and submandibular area that developed in a patient after giving second dose of antibiotic (Cefotaxime). With the treatment, the patient had an uneventful outcome. The principal treatment of angioedema is the discontinuation of the precipitating agent and airway management. Patients with swelling limited to face and oral cavity may require monitoring only. However, those with swelling in the floor of mouth, tongue and supraglottic or glottic areas should have their airway secured by fibre-optic guided tracheal intubation. [ABSTRACT FROM AUTHOR]

Objective:There is currently no standardised management protocol following functional endoscopic sinus surgery. This study assessed frequent endoscopic cleaning versus minimal intervention in the early post-operative period following such surgery.Study design:Prospective, randomised controlled, single-blinded, within-subject trial involving 24 patients with bilateral chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery.Main outcome measure:The primary outcome measure was ethmoid cavity healing, based on endoscopic appearance, graded using a modified Lund–MacKay endoscopic score.Secondary outcome measure:Lund–MacKay symptom score before and after surgery.Results:There was no overall statistically significant difference between the two groups (p = 0.37). Subgroup analysis revealed a significant effect of regular suction clearance on adhesions at three months (p = 0.048), but not on oedema, polyps, granulation, discharge or crusting.Conclusion:There is no evidence from this study to support frequent endoscopic cleaning in the early post-operative period after functional endoscopic sinus surgery. Less intensive post-operative management is recommended, resulting in decreased patient morbidity and fewer post-operative follow-up appointments. [ABSTRACT FROM PUBLISHER]

Abstract: Recovery is defined as a return to original state. With regards to post-anaesthetic care, it implies the return of normal physiological function following the derangement of anaesthesia and surgery, particularly cardiovascular/respiratory function and the reflexes of airway protection. The purpose of the recovery room is to monitor for return of function, support until that time, and prevent or treat complications as required. All patients after general, epidural or spinal anaesthesia should be recovered in a specially designated area that complies with the standards and recommendations from the 2002 guidance from the Association of Anaesthetists. [Copyright &y& Elsevier]

The aim of this study was to explore factors influencing children's (7-13 years) tonsillectomy experiences and outcomes. A prospective, repeated measures, design was used to investigate the effect of age, gender, ethnicity, time, and previous pain, hospitalization and surgery on children's (N = 60) perceptions of anxiety, pain intensity, quality of pain and sleep, and oral intake. The relationship between postoperative pain and anxiety was also examined. Using a diary, three days of data were collected. Descriptive statistics, Pearson correlation coefficient, and a mixed linear regression model were used for analysis. Children's tonsillectomy experiences and outcomes were affected by time, previous experience, age, and anxiety. Moderate correlations were found between level of anxiety and pain intensity. These findings provide clinicians with additional knowledge to guide their perioperative practice and care of children. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that hyperglycaemia is associated with postoperative complications in cardiac surgical patients. Conversely, well-controlled glucose levels are said to reduce major infectious complications in diabetic patients. Aim/Objectives: The purpose of this clinical audit was to evaluate the blood glucose levels of diabetic patients undergoing cardiac surgery and to determine the effectiveness of postoperative glycaemic control. Methods: A group of 150 patients from a large Irish cardiac surgery centre was selected by convenience sampling. An audit tool was designed to capture the patients' blood glucose levels, treatment regimes and postoperative complications. Findings: The findings showed major variations between ‘high’, ‘good’ and ‘borderline’ blood glucose levels in the pre- and postoperative phase. Although blood glucose testing practices seemed inconsistent, mean levels measured ‘borderline’. Furthermore, the treatment regimes varied greatly and suggest a lack of consensus regarding the management of postoperative hyperglycaemia. A total of 52% ( n = 78) patients developed 114 complications with a level of 21·4% ( n = 32) postoperative wound infections. Conclusion: The findings from this audit highlight the importance of regular blood glucose testing to enable early detection of hyperglycaemia and timely initiation of appropriate treatments regimes for diabetic patients undergoing cardiac surgery. Findings also show that hyperglycaemia derangement may make a difference in the recovery phase. While patients will benefit from lesser wound infections, hospitals might save costs involved with treating postoperative complications. Relevance to practice: More consistent blood glucose testing might be achieved through the use of evidence-based protocols. However, the education of staff is as important as it develops knowledge on the complex metabolic interactions of diabetic patients undergoing cardiac surgery. While this means investing in staff education and policy development, costs for daily care and expensive treatments for complications will be saved as patient recovery will be speedier and less eventful. [ABSTRACT FROM AUTHOR]

There is a lack of clarity as to why some nurses are not delivering optimal pain management to children post-operatively. This retrospective chart review study examined nurses' pain scoring on 175 children during the first 24 hours post-operatively. Data were analysed on the amount of assessments made, assessment scores recorded, as well as the age, gender and type of surgery performed. One-quarter of children had no assessment record of their pain in the first 24 hours post-operatively. When the pain tool was part of an observation chart, nurses recorded more pain scores. Nurses' scoring of children's pain is influenced positively by children under five years of age and those who undergo abdominal surgery. Nurses who had access to one document for recording vital signs as well as pain scores were more likely to assess and record a child's pain score than nurses who had to use a separate chart. [ABSTRACT FROM AUTHOR]

This article outlines the fundamental aspects of stoma care required by individuals undergoing surgery requiring stoma formation. For health care professionals who may be unfamiliar with the basic principles of stoma care and who are involved in the care of this group of patients, it aims to provide an overview of post-operative stoma care, emotional support for the patient and ongoing support after discharge. The importance of selecting the correct appliance, the role of the stoma care nurse specialist and common stoma complications are also addressed. [ABSTRACT FROM AUTHOR]

Objectives: To provide an overview of the surgical management of early stage non–small cell lung cancer (NSCLC) and its impact on survival and quality of life. Data Sources: Published articles, book chapters, websites, and research studies. Conclusion: The primary treatment choice for early stage NSCLC is surgical resection. Advances have been made in all phases of care from diagnosis to rehabilitation, including better technology for staging, less invasive surgical techniques, and intra-operative and post-operative care that focuses on decreasing complications and improving survival and quality of life. New indications for the addition of adjuvant therapy to surgery can improve disease-free and long-term survival in a disease where the 5-year survival of stage I and II can be less than 50% and overall survival regardless of stage only 15%. Implications for Nursing Practice: As health care educators and caregivers, nurses should be informed of the advancements in staging and surgical technique associated with early stage NSCLC and its impact on survival and quality of life. [Copyright &y& Elsevier]

Background: The administration of insulin has been shown to exert cardioprotective and immunomodulatory properties. Ischemia and inflammation are typical features of acute coronary syndrome, thus it was hypothesized that high-dose glucose–insulin–potassium (GIK) treatment could suppress the systemic inflammatory reaction and attenuate myocardial ischemia–reperfusion injury in patients with unstable angina pectoris after urgent coronary artery bypass surgery. Methods: Forty patients with unstable angina pectoris scheduled for urgent coronary artery bypass surgery and cardiopulmonary bypass were randomly assigned to receive either high-dose insulin treatment (short-acting insulin 1 IU/kg/h with 30% glucose 1.5 ml/kg/h administered separately) or control treatment (saline). Blood glucose levels were targeted to 6.0–8.0 mmol/l in both groups by adjusting the rate of glucose infusion in the GIK group and by additional insulin in the control group as needed. Results: High-dose insulin treatment was associated with significantly lower average C-reactive protein (23.8 vs. 40.1 mg/l, P= 0.008) and free fatty acid levels (0.22 vs. 0.41 mmol/l, P= < 0.001) post-operatively. Average blood glucose levels were comparable during the intensive care unit (ICU) stay (7.1 vs. 6.9 mmol/l, P= 0.5) and 95% of the control patients received supplemental insulin. The pro-inflammatory cytokine response [interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α)] did not differ between the groups and beneficial effects on myocardial injury were not detected. Conclusions: High-dose insulin treatment has potential anti-inflammatory properties independent of its ability to lower blood glucose levels. Even profound suppression of free fatty acid levels, the attenuation of myocardial ischemia–reperfusion injury was not detected. [ABSTRACT FROM AUTHOR]

Early mobilization and aggressive physical therapy are essential in patients who receive left ventricular assist devices (LVADs) due to long-term, end-stage heart failure. Some of these patients remain ventilator dependent for quite some time after device implantation. We report our regimen of mobilization with the aid of a portable ventilator, in patients with cardiac cachexia and LVAD implantation. Further, we describe the specific physical therapy interventions used in an LVAD patient who required prolonged mechanical ventilation after device implantation. The patient was critically ill for 5 weeks before the surgery and was ventilator dependent for 48 days postoperatively. There were significant functional gains during the period of prolonged mechanical ventilation. The patient was able to walk up to 600 feet by the time he was weaned from the ventilator and transferred out of the intensive care unit. He underwent successful heart transplantation 6 weeks after being weaned from the ventilator. We believe that improving the mobility of LVAD patients who require mechanical ventilation has the potential both to facilitate ventilator weaning and to improve the outcomes of transplantation. [ABSTRACT FROM AUTHOR]

OBJETIVO: Apresentar uma rotina de atendimento para crianças submetidas à cirurgia cardíaca. FONTES DOS DADOS: Realizada revisão bibliográfica através de bancos de dados (Medline, Mdconsult, PubMed), analisando as condutas sugeridas por diversos serviços fora do Brasil e comparando com a rotina de atendimento no Hospital Infantil Pequeno Príncipe, de Curitiba, onde foram realizadas cerca de 8.000 cirurgias cardíacas desde 1977 até abril de 2003. SÍNTESE DOS DADOS: O serviço citado é referência em cardiologia e cirurgia cardíaca no estado do Paraná e estados vizinhos. A evolução das condições de diagnóstico, preparo da equipe clínica e cirúrgica, unidade de terapia intensiva (UTI) melhor equipada com monitorização mais avançada, equipe da UTI com pessoal treinado em todas as áreas para fazer pós-operatório de cirurgia cardíaca, estrutura hospitalar adequada, oferecendo atendimento avançado em todas as especialidades pediátricas e paramédicas, fazem com que o resultado das intervenções cirúrgicas realizadas em crianças com cardiopatias congênitas ou adquiridas, principalmente nos recém-nascidos e lactentes jovens com cardiopatias complexas, apresente sensível melhora quando comparado com anos anteriores. CONCLUSÃO: As crianças com cardiopatias, principalmente as complexas, devem ser encaminhadas para um local que seja centro de referência, onde haja condições para um atendimento global no pré, per e pós-operatório.OBJECTIVE: To present a care routine for children submitted to heart surgery. SOURCE OF DATA: Literature review of Medscape, MD Consult and PubMed. Analysis of the suggested conducts adopted by various services from different countries and comparison with the care routine at the Pequeno Príncipe Children's Hospital (Curitiba, state of Paraná), where approximately 8,000 heart surgeries were performed in children from 1977 to April 2003. SUMMARY OF THE FINDINGS: Our hospital is a reference center for Cardiology and Heart Surgery in the state of Paraná and neighboring states. The improvement of conditions for diagnosis, training of the clinical and surgical teams, better equipped ICU with more modern monitoring, training of ICU personnel from all areas to handle the post-operative requirements of patients submitted to heart surgery, an adequate hospital structure with advanced care in all pediatric and paramedic specialties have resulted in marked improvement in relation to previous years in terms of the results of surgical interventions in children with congenital or acquired heart disease, especially newborns and young babies with complex heart problems. CONCLUSION: Children with heart diseases, especially complex conditions, should be receive care at reference centers that can provide global care before, during and after the surgery.

Children undergoing congenital heart surgery require postoperative mechanical ventilation. Despite recent advances, prolonged mechanical ventilation (PMV) 1.5 necessary in some patients and may increase the risk of post-operative complications. The purpose of this study was to identify incidence and risk factors for PMV. The authors performed a retrospective chart review. They defined PMV as ventilation longer than 48 hours. Mixed-effects linear regression models were used to assess the relationship between each factor and duration of mechanical ventilation. Separate models were developed for preoperative, intraoperative, and postoperative periods. To determine the extent to which a combination of risk factors would predict PMV, the most significant variables were adopted to fit a model using number of risk factors to predict PMV. Two hundred twelve children ≤ 36 months were included. Eleven (5.2%) children died perioperatively. Of the patients, 72.6% (143/197) were extubated by 48 hours. Age <6 months, perioperative infection, inotrope use > 48 hours, total parenteral nutrition use, and failed extubation were associated with PMV. PMV occurred in 28% of the patients in this study. The presence of 2 risk factors predicted PMV with a sensitivity of 86% and a specificity of 94%. [ABSTRACT FROM AUTHOR]

Introduction: Given the geographical area of the Kimberley region in Western Australia (WA) and the nomadic nature of its residents and medical staff, widespread access and clarity of surgical clinical information are necessary to provide accurate and timely post-surgical care. The aims of this project were: to evaluate the quality of operation notes and secondly, to evaluate multidisciplinary staff perceptions of the impact of the introduction of typed operation notes for general surgery in the Kimberley region from 2019 to 2020., Methods: The quality of 100 general surgery operation notes (50 typed and 50 handwritten) were reviewed against the Royal College of Surgeons England (RCSEng) operation note guidelines. Cases were selected at random and reviewed by a resident medical officer. Multidisciplinary staff perceptions of communication were assessed through an anonymous electronic survey across emergency departments, general practices, nursing staff, and allied health staff members from the top three population centres: Broome, Derby and Kununurra., Results: Typed operation notes with pre-loaded data (date, time, etc.) and mandatory fields (surgical count correct, etc.) increased recorded information and quality of content by 45% when compared to handwritten notes. When compared to RCSEng standards for free text, anticipated blood loss (one typed note) and abbreviation use (44 typed and 37 handwritten) showed ongoing user-dependent areas for improvement. A review of multidisciplinary staff perceptions (79 returned surveys) showed 60% of handwritten notes were seen to have a negative impact on timely post-operative care. Overall, typed notes increased legibility with a perceived improvement in acronyms/abbreviations and completeness of documentation. More than 90% of staff suggested an extension of typed notes for all surgical operations would be beneficial., Conclusion: The Kimberley region poses a unique set of challenges to the continuity of post-surgical care. This review shows typed operation notes improve legibility (100%) and increased congruence with established guidelines by 45%. It also shows a successful model for increased local and metropolitan multidisciplinary access across remote WA for timely post-operative care. In an unprecedented time where elective surgical procedures are being reduced to meet pandemic demands, now is the time to review, consider and institute practices that improve intra-operative and post-operative care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Davis et al.)

Summary The post-operative period is particularly dangerous for obese patients. The aim of this study was to compare the immediate post-operative course after either laparoscopic or open gastroplasty. We studied retrospectively 20 and 14 consecutive patients who underwent laparoscopic or open adjustable silicone gastric banding, respectively. After the laparoscopic procedure, patients had a significantly shorter stay in the post-anaesthesia care unit (0.3±0.4 and 1.1±1 days), reduced analgesic requirements, a shorter period of intravenous catheter use (2.3±1.9 and 4.8±1.4 days), were able to walk sooner (1±0.4 and 2.1±1.6 days) and had a significantly shorter duration of in-hospital stay (5.4±2.3 and 15.8±4.5 days) than after an open procedure. This report suggests that the use of laparoscopy for gastroplasty in morbidly obese patients may significantly improve the immediate post-operative course. [ABSTRACT FROM AUTHOR]

• As part of a trust-wide practice development project to improve post-operative pain management, a descriptive study was conducted in the orthopaedic directorate of a large teaching hospital in the north of England. • Sixty-five patients were included in this prospective study. • Patients were interviewed post-operatively about their pain experience, and present and worst pain scores were recorded. • The nursing documentation relating to pain management was also transcribed and a content analysis of this nursing documentation is reported. • Findings indicate that individual assessment of pain was poorly documented and that the nurses' record of the patient's post-operative pain experience differed from the patient report. • Reliance on pharmacological methods of pain relief was evident and interventions to help patients cope with night time pain were rarely documented. • The results are discussed in light of a theoretical framework for acute pain management and current research. • Implications for practice are discussed and areas for further research are suggested. [ABSTRACT FROM AUTHOR]

By its ability to differentiate the densities of various intracranial tissues, computed tomography is an ideal tool to investigate the postoperative course and complications of neurosurgical patients. The most important immediate postoperative complications are intracerebral edema and epidural, subdural or intracerebral hematomas. The extent of surgical resection of neoplasms can also be studied easily by CT. The method of investigation and representative cases are described. [ABSTRACT FROM AUTHOR]

The past decades have seen considerable shifts of emphasis in surgical care. The recognition that pus was not laudable, was followed by a realisation that not all complications were inevitable and that prophylaxis could effectively reduce the incidence of most common problems in the post-operative period. As anaesthesia has become safer, it has been possible to embark on more intricate and prolonged procedures and for sufficient time to be available to ensure adequate intraoperative care. These two phenomena have firstly increased the complexity of management in the post-operative period, and have brought this aspect of surgical care more obviously to the limelight. However, many separate disciplines are involved in the care of the patient post-operatively, and the Symposium was organised to bring the different groups together to identify the areas of recent development in the different specialities and to integrate the overall care of the individual patient. [ABSTRACT FROM AUTHOR]

The consequences of altered immunocompetence resulting from anaesthesia and surgery are potentially hazardous to the patient with malignant disease. Malnutrition also produces reduction in cell mediated immunity, a condition which is commonly incurred in patients with neoplastic disorders. Numerous agents have been claimed to stimulate the immune responses but few have proved to be of practical value. This paper reports the use variously of protease inhibitors, using Aprotinin, and post operative nutritional therapy, following major surgical resection for carcinoma - specifically as regards their influence on parameters believed to relate to cell mediated immunity. No clinical, metabolic or immunologic benefit was identified from either method of post operative stimulation of cell mediated immunity, although this study did confirm post operative depression of these parameters. The significance of these changes is unclear but there is no evidence to support an immunological mechanism for either of these approaches being of benefit in clinical practice. [ABSTRACT FROM AUTHOR]

Undergoing bariatric surgery is a life-changing experience for adolescents. However, little is known about post-bariatric surgery management among Israeli adolescents. We aimed to identify the post-operative needs and support from a qualitative aspect. Seventeen adolescents who underwent bariatric surgery were interviewed by semi-structure telephone interview. The interview guide was validated by 10 content experts from different hospitals across the country. Data were collected in 2018. Analysis of the interviews revealed three major themes: "multi-disciplinary team management," "patient satisfaction," and "follow-up." The "multi-disciplinary team management" theme was further divided into three major categories: "pain management," "physiotherapy," and "nutrition." "Patient satisfaction" was further divided into "guidance" and "team handling" categories. The "follow-up" theme included recommendations for improvement. The analysis provides novel information about adolescents' needs after bariatric surgery. Healthcare professionals' awareness of the adolescents' perspective could contribute to providing optimal post-operative care to this population.

The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration., Competing Interests: None declared, (© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Background: Reliable strategies for reducing postoperative readmissions remain elusive. As the emergency department (ED) is a frequent source of post-operative admissions, we investigated whether hospitals with high readmission rates also have high rates of post-discharge ED visits and high rates of readmission once an ED visit occurs., Methods: We conducted a retrospective analysis of 1,947,621 Medicare beneficiaries undergoing 1 of 5 common procedures in 2,894 hospitals between 2008 and 2011. We stratified hospitals into quintiles based on risk-standardized, 30-day post-discharge readmission rates (RSRR) and then compared rates of post-discharge ED visits, proportion readmitted from the ED, and readmissions within 7 days of ED discharge across these quintiles., Results: RSRR varied widely across extremes of hospital quintiles (3.9% to 17.5%). Hospitals with either very low or very high RSRR had modest differences in rates of ED visits (12.4% versus 14.6%). In contrast, the proportion readmitted from the ED was nearly 3 times greater in Hospitals with very high RSRR compared with those with very low RSRR (12% versus 32.2%). These findings were consistent across all procedures. Importantly, hospitals with a low proportion readmitted from the ED did not exhibit an increased rate of readmission within 7 days of ED discharge., Conclusions: Although hospitals experience similar rates of ED visits following major surgery, some EDs and their affiliated surgeons and health system may deliver care preventing readmissions without an increased short-term risk of readmission following ED discharge. Reducing 30-day readmissions requires greater attention to the coordination of care delivered in the ED., (Copyright © 2021. Published by Elsevier Inc.)

Background: Access to pediatric surgical intervention in low-income countries is expanding, but investments in post-surgical care have received less attention. This study explored the barriers and supports for school-aged children to access post-surgical, community-based follow-up care in Uganda as perceived by community stakeholders., Materials and Methods: This qualitative exploratory case study used in-depth, semi-structured interviews and in-country site visits among Ugandan organizations providing follow-up care to school-aged children in Uganda after surgery. Data from eight interviews and eight site visits were coded, analyzed, and cross-tabulated with a modified grounded theory approach., Results: Four key barriers to community-based follow-up care were identified: discrimination, financial barriers, geographical barriers (including transportation), and caregiver limitations to support recovery. Three key supports to successful access to and participation in community-based post-surgical recovery were identified: disability awareness, the provision of sustained follow-up care, and caregiver supports for reintegration., Conclusions: Increasing awareness of disability across local Ugandan communities, educating caregivers with accessible and culturally aware approaches, and funding sustainable follow-up care programming provide promising avenues for pediatric post-surgical recovery and community reintegration in contemporary Uganda.Implications for rehabilitationMultiple, intersecting factors prevent or promote access to post-surgical community-based services among school-aged children in Uganda.The most prominent barriers to pediatric community reintegration in Uganda include discrimination, lack of financial resources, geographical factors, and caregiver limitations.Community and interprofessional alliances must address disability awareness and sources of stigma in local contexts to promote optimal recovery and reintegration after surgery.Collaborative efforts are needed to develop sustainable funding for community-based care programs that specifically support pediatric post-surgical recovery and reintegration.Efforts to provide appropriate and empowering caregiver education are critical, particularly in geographical regions where ongoing access to rehabilitation professionals is minimal.

Background: Even though the need has been challenged, admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice. We have introduced a "no ICU, unless" policy for tumor craniotomy patients and evaluate costs, complications, and length of stay., Methods: A prospective cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 2 years after introduction of the new policy with the year before., Results: A reduction in ICU/MCU admittance from 88 to 23% of patients was found resulting in 13% cost reduction. Also, the new policy resulted in a 1.4-day shorter post-operative length of stay. Minor complications were reduced, while major complications remained the same. All major complications are reviewed., Conclusions: We show that routine post-operative ICU/MCU admittance after tumor craniotomy does not reduce complications, but actually interferes with recovery of our patients. Changing the paradigm results in earlier discharge and cost reduction.

Introduction and Objective: Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians., Methods: A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU., Results: 360 physicians participated in the study, with median time of 10 (5-18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p < 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p < 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p < 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p < 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care., Conclusion: Anesthesiologists, surgeons, and intensive care physicians presented different perspectives on postoperative referral to the ICU., (Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass., Methods: We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass., Results: We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety., Conclusion: In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

Introduction: This study aimed to assess the long-term effects of postoperative debridement on the 4 th and 8 th postoperative weeks versus no debridement in terms of subjective and objective outcomes., Materials and Methods: The statistical population of this study (n=80) consisted of 40 patients having chronic rhinosinusitis with nasal polyposis (CRSwNP) and 40 patients having chronic rhinosinusitis without nasal polyposis (CRSsNP). These samples were randomly divided into two groups of debridement and control., Results: According to the results, 8 weeks after endoscopic sinus surgery (ESS), the 22-item Sino-Nasal Outcome Test questionnaire score (P =0.03), Lund-Kennedy score (P<0.001), nasal blockage (P=0.02), and loss/decrease in sense of smell (P=0.02) in CRSwNP were significantly lower in the debridement group than in the control group. Moreover, 6 months after ESS, in both CRSwNP and CRSsNP, no significant difference was observed between the two groups considering the outcomes (P>0.05)., Conclusion: This study showed that debridement could lead to short-term improvements in CRSwNP patients; however, no long-term benefit was observed.