Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature / Fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica: revisão integrativa / Factores de riesgo para el desarrollo de infección del sitio quirúrgico en cirugía bariátrica: una revisión integradora

Abstract Objective: to evaluate evidence on risk factors for the development of surgical site infection in bariatric surgery. Method: integrative review. The search for primary studies was performed in four databases. The sample consisted of 11 surveys. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Data analysis and synthesis were performed in a descriptive manner. Results: surgical site infection rates ranged from 0.4% to 7.6%, considering the results of primary studies, in which patients underwent laparoscopic surgery. In surveys of participants undergoing surgical procedures with different approaches (open, laparoscopic or robotic), infection rates ranged from 0.9% to 12%. Regarding the risk factors for the development of this type of infection, antibiotic prophylaxis, female sex, high Body Mass Index and perioperative hyperglycemia are highlighted. Conclusion: conducting the integrative review generated a body of evidence that reinforces the importance of implementing effective measures for the prevention and control of surgical site infection, by health professionals, after bariatric surgery, promoting improved care and patient safety in the perioperative period.

Resumo Objetivo: avaliar as evidências sobre os fatores de risco para o desenvolvimento de infecção de sítio cirúrgico em cirurgia bariátrica. Método: revisão integrativa. A busca dos estudos primários foi realizada em quatro bases de dados. A amostra foi composta por 11 pesquisas. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. A análise e a síntese dos dados foram realizadas de maneira descritiva. Resultados: as taxas de infecção de sítio cirúrgico variaram de 0,4% até 7,6%, considerando os resultados dos estudos primários, cujos pacientes foram submetidos à cirurgia por via laparoscópica. Nas pesquisas com os participantes submetidos aos procedimentos cirúrgicos com diferentes abordagens (aberta, via laparoscópica ou robótica), as taxas de infecção variaram de 0,9% até 12%. Com relação aos fatores de risco para o desenvolvimento deste tipo de infecção, ressaltam-se antibioticoprofilaxia, sexo feminino, Índice de Massa Corporal elevado e hiperglicemia perioperatória. Conclusão: a condução da revisão gerou corpo de evidências que reforça a importância na implementação de medidas efetivas para prevenção e controle de infecção de sítio cirúrgico pelos profissionais de saúde após cirurgia bariátrica, promovendo a melhoria da assistência e da segurança do paciente no perioperatório.

Resumen Objetivo: evaluar las evidencias sobre los factores de riesgo para el desarrollo de infección de sitio quirúrgico en cirugía bariátrica. Método: revisión integradora. La búsqueda de estudios primarios se realizó en cuatro bases de datos. La muestra estuvo compuesta por 11 investigaciones. La calidad metodológica de los estudios incluidos se evaluó mediante herramientas propuestas por el Joanna Briggs Institute. El análisis y la síntesis de los datos se realizaron de manera descriptiva. Resultados: las tasas de infección del sitio quirúrgico oscilaron entre 0,4% y 7,6%, considerando los resultados de los estudios primarios, en los que los pacientes fueron sometidos a cirugía mediante laparoscopia. En investigaciones con participantes que se sometieron a procedimientos quirúrgicos con diferentes enfoques (abierto, laparoscópico o robótico), las tasas de infección oscilaron entre el 0,9 % y el 12 %. En cuanto a los factores de riesgo para el desarrollo de este tipo de infección, se destacan la profilaxis antibiótica, el sexo femenino, el Índice de Masa Corporal elevado y la hiperglucemia perioperatoria. Conclusión: la realización de la revisión generó un cuerpo de evidencia que refuerza la importancia de implementar medidas efectivas para la prevención y el control de la infección de sitio quirúrgico, por parte de los profesionales de la salud, después de la cirugía bariátrica, promoviendo la mejora de la atención y la seguridad del paciente en el período perioperatorio.

Effectiveness of perioperative family-centered educational interventions in the anxiety, pain and behaviors of children/adolescents and their parents: Systematic Review Protocol / Eficacia de las intervenciones educativas perioperatorias familiares centradas en la ansiedad, el dolor y las conductas de las personas menores y adolescentes y de sus progenitores: protocolo de revisión sistemática

Introduction: Every year, millions of children and adolescents undergo surgery, 50%-75% of them experience fear and anxiety. Children are particularly susceptible to stress and anxiety surrounding surgery as a result of their cognitive development, previous experiences, and knowledge about healthcare; this leads to additional interventions to prevent and reduce these symptoms. Objective: To evaluate the effectiveness of family-centered educational interventions in the children's and adolescents' anxiety, pain, and behaviors and their parents' anxiety during the perioperative period. Methods: This review will follow the Joanna Briggs Institute guidelines for systematic reviews of effectiveness and will consider those studies (experimental and quasi-experimental) in which perioperative educational interventions have been applied to children and adolescents and their parents; these studies measured children and adolescents' pain, anxiety, and behaviors, as well as their parent's anxiety. An initial search of MEDLINE and CINAHL will be followed by a second search for published and unpublished studies from January 2007 on, available in English, Spanish and Portuguese. After all full texts are retrieved, the methodological quality assessment and data extraction will be independently and critically evaluated by two reviewers, and the data will then be presented in a tabular format. An explanatory synthesis will accompany the results. Whenever possible, a meta-analysis will be performed, and a Grading of Recommendations, Assessment, Development, and Evaluation Summary of Findings will be presented. Expected Results: This review will provide guidance on how family-centred educational interventions can be used as a resource to manage anxiety, pain, and behavior in children, adolescents and their relatives during the perioperative processes.

Introducción: Cada año, millones de personas menores y adolescentes se someten a cirugía, de las cuales entre el 50-75 % experimenta miedo y ansiedad. Las niñas y los niños son particularmente susceptibles al estrés y la ansiedad que rodea a la cirugía, como resultado de su desarrollo cognitivo, experiencias previas y conocimiento de la salud, lo que requiere intervenciones para prevenir y reducir estos síntomas. Objetivo: Esta revisión tiene como objetivo evaluar la efectividad de las intervenciones educativas familiares centradas en la ansiedad, el dolor y los comportamientos de las personas menores y adolescentes y de sus progenitores en el período perioperatorio. Métodos: Esta revisión seguirá las pautas del Instituto Joanna Briggs para revisiones sistemáticas de efectividad y considerará estudios experimentales y cuasiexperimentales en los que las intervenciones educativas perioperatorias para medir el dolor, la ansiedad y los comportamientos en niñas, niños y adolescentes y la ansiedad de sus progenitores. Se ha realizado una búsqueda inicial limitada de MEDLINE y CINAHL. Además, una segunda búsqueda de estudios publicados y no publicados de enero de 2007 disponibles en inglés, español y portugués. Una vez recuperados los textos completos, dos revisores evaluarán críticamente, de forma independiente, la calidad metodológica y la extracción de datos y se presentarán en forma de tabla. Una síntesis narrativa acompañará a los resultados y, si es posible, se realizará un metanálisis y se presentará un Grading of Recommendations, Assessment, Development and Evaluation. Resultados esperados: Esta revisión brindará orientación sobre cómo las intervenciones educativas centradas en la familia pueden usarse como un recurso para controlar la ansiedad, el dolor y el comportamiento en niñas, niños, adolescentes y sus familias en el contexto perioperatorio.

Introdução: Todos os anos, milhões de crianças e adolescentes são submetidos a cirurgias e 50-75% apresentam medo e ansiedade. Crianças/adolescentes são particularmente suscetíveis ao stress e ansiedade em torno da cirurgia devido ao seu desenvolvimento cognitivo, experiências anteriores e conhecimento que possuem sobre os cuidados de saúde, necessitando de intervenções para a prevenção/redução destes sintomas. Objetivo: Avaliar a eficácia de intervenções educacionais centradas na família na ansiedade, dor e comportamentos de crianças/adolescentes e ansiedade dos pais no período perioperatório. Métodos: Esta revisão seguirá a metodologia do Instituto Joanna Briggs para revisões sistemáticas de eficácia e considerará estudos (experimentais e quase-experimentais) em que as intervenções educacionais perioperatórias tenham sido aplicadas a crianças/ adolescentes e seus pais e avaliadas a dor, ansiedade e comportamento em crianças/adolescentes e ansiedade dos pais como resultados. Uma pesquisa inicial limitada de MEDLINE e CINAHL foi realizada. Será seguida por uma segunda busca por estudos publicados e não publicados de janeiro de 2007 disponíveis em inglês, espanhol e português. Após a recuperação dos textos completos, a avaliação da qualidade metodológica e a extração de dados serão avaliadas de forma crítica e independente por dois revisores e apresentadas em forma de tabela. Uma síntese narrativa acompanhará os resultados e, se possível, uma meta-análise será realizada e um resumo das Grading of Recommendations, Assessment, Development and Evaluation apresentado. Resultados esperados: Esta revisão fornecerá orientações sobre como as intervenções educativas centradas na família podem ser utilizadas como um recurso para gestão da ansiedade, dor e comportamento em crianças, adolescentes e suas famílias no contexto perioperatório.

The Impact of COVID-19 on the Timing of Rotator Cuff Repair and Method of Postoperative Follow-up / Impacto da COVID-19 no momento de reparo do manguito rotador e método de acompanhamento pós-operatório

Abstract Objective Rotator cuff repair (RCR) is one of the most common arthroscopic procedures. Our investigation aims to quantify the impact that the COVID-19 pandemic had on RCR, specifically on patients with acute, traumatic injuries. Methods Institutional records were queried to identify patients who underwent arthroscopic RCR between March 1st to October 31st of both 2019 and 2020. Patient demographic, preoperative, perioperative, and postoperative data were collected from electronic medical records. Inferential statistics were used to analyze data. Results Totals of 72 and of 60 patients were identified in 2019 and in 2020, respectively. Patients in 2019 experienced shorter lengths of time from MRI to surgery (62.7 ± 70.5 days versus 115.7 ± 151.0 days; p = 0.01). Magnetic resonance imaging (MRI) scans showed a smaller average degree of retraction in 2019 (2.1 ± 1.3 cm versus 2.6 ± 1.2 cm; p = 0.05) butnodifference in anterior toposterior tear size between years (1.6 ± 1.0 cm versus 1.8 ± 1.0 cm; p = 0.17). Less patients in 2019 had a tele-health postoperative consultation with their operating surgeon compared with 2020 (0.0% versus 10.0%; p = 0.009). No significant changes in complications (0.0% versus 0.0%; p > 0.999), readmission (0.0% versus 0.0%; p > 0.999), or revision rates (5.6% versus 0.0%; p = 0.13) were observed. Conclusion From 2019 to 2020, there were no significant differences in patient demographics or major comorbidities. Our data suggests that even though the time from MRI to surgery was delayed in 2020 and telemedicine appointments were necessary, RCR was still performed in a time in early complications. Level of Evidence III.

Resumo Objetivo Oreparodomanguitorotador (RMR) é um dos procedimentos artroscópi-cos maiscomuns. Nossapesquisavisaquantificar o impacto da pandemia de COVID-19 sobre o RMR, especificamente em pacientes com lesões agudas e traumáticas. Métodos Os prontuários institucionais foram consultados para identificação de pacientes submetidos ao RMR artroscópico entre 1° de março e 31 de outubro de 2019 e de 2020. Dados demográficos, pré-operatórios, perioperatórios e pós-operatórios dos pacientes foram coletados de prontuários eletrônicos. Os dados foram analisados por estatística inferencial. Resultados Totais de 72 ede60pacientes foramidentificados em 2019 e 2020, respectivamente. Os pacientes de 2019 apresentaram menor intervalo entre a ressonância magnética (RM) e a cirurgia (62,7 ± 70,5 dias versus 115,7 ± 151,0 dias; p = 0,01). Os exames de RM mostraram menor grau médio de retração em 2019 (2,1 ± 1,3 cm versus 2,6 ± 1,2 cm; p = 0,05), mas nenhuma diferença foi observada na extensão anteroposterior da laceração entre os anos (1,6 ± 1,0 cm versus 1,8 ± 1,0 cm; p = 0,17).Em 2019,o número de pacientes atendidos por seus cirurgiões em consultas pós-operatórias por telemedicina foi menor em comparação com 2020 (0,0% versus 10,0%; p = 0,009). Não foram observadas alterações significativas nas taxas de complicação (0,0% versus 0,0%; p > 0,999), de readmissão (0,0% versus 0,0%; p > 0,999) ou de revisão (5,6% versus 0,0%; p = 0,13). Conclusão Não houve diferenças significativas nos dados demográficos dos pacientes ou nas principais comorbidades entre 2019 e 2020. Nossos dados sugerem que, embora o intervalo entre a RM e a cirurgia tenha sido maior em 2020 e tenha havido necessidade de consultas por telemedicina, o RMR ainda foi realizado em tempo hábil e sem alterações significativas nas complicações precoces. Nível de Evidência III.

Importance of assessing biomarkers and physiological parameters of anemia-induced tissue hypoxia in the perioperative period

Abstract Anemia is associated with increased risk of Acute Kidney Injury (AKI), stroke and mortality in perioperative patients. We sought to understand the mechanism(s) by assessing the integrative physiological responses to anemia (kidney, brain), the degrees of anemia-induced tissue hypoxia, and associated biomarkers and physiological parameters. Experimental measurements demonstrate a linear relationship between blood Oxygen Content (CaO2) and renal microvascular PO2 (y = 0.30x + 6.9, r2= 0.75), demonstrating that renal hypoxia is proportional to the degree of anemia. This defines the kidney as a potential oxygen sensor during anemia. Further evidence of renal oxygen sensing is demonstrated by proportional increase in serum Erythropoietin (EPO) during anemia (y = 93.806*10−0.02, r2= 0.82). This data implicates systemic EPO levels as a biomarker of anemia-induced renal tissue hypoxia. By contrast, cerebral Oxygen Delivery (DO2) is defended by a profound proportional increase in Cerebral Blood Flow (CBF), minimizing tissue hypoxia in the brain, until more severe levels of anemia occur. We hypothesize that the kidney experiences profound early anemia-induced tissue hypoxia which contributes to adaptive mechanisms to preserve cerebral perfusion. At severe levels of anemia, renal hypoxia intensifies, and cerebral hypoxia occurs, possibly contributing to the mechanism(s) of AKI and stroke when adaptive mechanisms to preserve organ perfusion are overwhelmed. Clinical methods to detect renal tissue hypoxia (an early warning signal) and cerebral hypoxia (a later consequence of severe anemia) may inform clinical practice and support the assessment of clinical biomarkers (i.e., EPO) and physiological parameters (i.e., urinary PO2) of anemia-induced tissue hypoxia. This information may direct targeted treatment strategies to prevent adverse outcomes associated with anemia.

Factors associated with posoperative mortality in high perioperative risk patients. Cohort study / Factores asociados a mortalidad posoperatoria en pacientes de alto riesgo perioperatorio. Estudio de cohorte

Abstract Introduction: Determining perioperative risk is part of the strategies implemented with the aim of reducing morbidity and mortality in the surgical population in the world. Although there is no established definition, high perioperative risk is associated with the group of patients with the highest disease burden. Objective: To determine postoperative mortality and its associated factors in patients with high perioperative risk. Methods: Analytical observational cohort study of high perioperative risk patients included in the database (n = 843) of the anesthesia program in a high complexity hospital in Colombia, between January 2011 and April 2018. Pre and postoperative variables were analyzed using uni and multivariate logistic regression per protocol. Overall and stratified mortality were estimated and factors associated with their occurrence were analyzed. Finally, survival was analyzed, the primary outcome being overall cohort mortality and stratified high cardiovascular risk mortality. Results: Cumulative 7-day mortality was 3.68% (95% CI 2.40-4.95%) and 30-day mortality was 10.08% (95% CI 8.05-12.12%). Perioperative mortality in the high cardiovascular risk group in the first 7 days was 3.60% (95% CI 1.13-6.07%) and 14.86% (95% CI 10.15-19.58%) at 30 days. The following preoperative variables were associated with mortality: chronic obstructive pulmonary disease, chronic kidney disease, limited functional class and abdominal aortic aneurysm. A strong association was observed between postoperative complications and a significant increase in mortality rate; the most relevant complications were cerebrovascular events and cardiogenic shock. Conclusions: In this group of high perioperative risk patients, and in the subgroup of high cardiovascular risk patients, overall mortality at 7 and at 30 days was estimated to be above values reported in various countries. Mortality was significantly increased by the presence of preoperative factors and postoperative complications.

Resumen Introducción: La determinación del riesgo perioperatorio hace parte de las estrategias de reducción de la morbimortalidad en la población quirúrgica mundial. El alto riesgo perioperatorio, a pesar de no tener una definición establecida, corresponde al grupo con mayor carga de enfermedad. Objetivo: Establecer la mortalidad posoperatoria en pacientes de alto riesgo perioperatorio y sus factores asociados. Métodos: Estudio observacional analítico con diseño de cohorte, que incluyó pacientes del programa de anestesiología de alto riesgo perioperatorio de un hospital de alta complejidad en Colombia. Base de datos compuesta por n = 843, entre enero de 2011 y abril de 2018. Se analizaron variables pre y posoperatorias mediante regresión logística uni y multivariada por protocolo. Se calculó la mortalidad global y estratificada y se analizaron factores asociados a su ocurrencia. Finalmente, se realizó análisis de supervivencia. El desenlace primario fue la mortalidad global de la cohorte y la mortalidad estratificada para el alto riesgo cardiovascular. Resultados: La mortalidad acumulada a los primeros 7 días fue de 3,68 % (IC 95 %; 2,40 %-4,95 %) y a los 30 días 10,08 % (IC 95 %; 8,05 %-12,12 %). La mortalidad perioperatoria en el grupo de alto riesgo cardiovascular a los primeros 7 días fue de 3,60 % (IC 95 %; 1,13 %-6,07 %) y a los 30 días 14,86 % (IC 95 %; 10,15 %-19,58 %). Las siguientes variables preoperatorias estuvieron asociadas a la mortalidad: enfermedad pulmonar obstructiva crónica, enfermedad renal crónica, clase funcional limitada y aneurisma de aorta abdominal. Se observó una fuerte asociación entre complicaciones posoperatorias y un significativo incremento de la tasa de mortalidad; los más relevantes fueron el evento cerebro-vascular y el choque cardiogénico. Conclusiones: En este grupo de pacientes de alto riesgo perioperatorio, la mortalidad global a los 7 días y a los 30 días, y en el subgrupo de alto riesgo cardiovascular, se estimó por encima de los valores reportados en diversos países. La presencia de factores preoperatorios y las complicaciones posoperatorias aumentaron significativamente la mortalidad.

Effect of COVID-19 on Shoulder Arthroplasty at a Tertiary Care Medical Center in New York City / Efeito da COVID-19 na artroplastia de ombro em um centro médico terciário na cidade de Nova York

Abstract Objective The COVID-19 pandemic led to an unprecedented pause in elective surgeries, including shoulder arthroplasty. We sought to determine whether clinical and/or demographic differences would be seen between patients who presented for shoulder arthroplasty during the pandemic compared with the previous year (2019). Methods Institutional records were queried for patients who underwent shoulder replacement between March 1 and July 1 of 2019 and 2020. Demographics, range of motion, surgical duration, hospitalization time, discharge disposition, and postoperative management were analyzed. Results The mean duration of surgery was 160 ± 50 minutes in 2020 and 179 ± 54 minutes in 2019 (p= 0.13). The mean hospitalization time was 36 ± 13 hours in 2020 and 51 ± 40 hours in 2019 (p= 0.04). In 2019, 96% of the patients participated in physical therapy, while 71% did it in 2020 (p= 0.003). A total of 100% of the 2019 patients and 86% of the 2020 patients participated in an in-person postoperative follow-up (p= 0.006). The 2019 patients reported for an office visit on average 14 ± 11 days after surgery; the 2020 patients waited 25 ± 25 days to return for a follow-up (p= 0.10). Range of motion, age, American Society of Anesthesiologists (ASA) scores, and complication rates did not differ between the cohorts. Conclusion Patients presenting for surgery during the initial phase of the pandemic were demographically and clinically similar to 2019 patients. However, the length of stay was significantly reduced during the COVID-19 pandemic. Postoperative follow-up and physical therapy were delayed in 2020, but this did not lead to differences in complication or readmission rates compared with those of the 2019 cohort. Level of EvidenceIII.

Resumo Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019). Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados. Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p= 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p= 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p= 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p= 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p= 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes. Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019. Nível de EvidênciaIII.

Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery

ABSTRACT Introduction: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery. Methods: A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes. Results: Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees> of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%). Conclusions: The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings.

Effect of perioperative clinical application of enhanced recovery after surgery on elderly recipients undergoing liver transplantation / 器官移植

Objective To evaluate the application value of perioperative interventional strategy guided by enhanced recovery after surgery (ERAS) in elderly recipients undergoing liver transplantation. Methods Clinical data of 405 liver transplant recipients were retrospectively analyzed. According to age, all recipients were divided into the elderly (≥60 years, n=122) and non-elderly groups (< 60 years, n=283). All patients received perioperative interventions under the guidance of ERAS. Intraoperative and postoperative indexes, incidence of postoperative complications and discharge were analyzed between two groups. Results There were no significant differences in the duration of anesthesia, operation time, anhepatic phase, hemorrhage volume, blood transfusion volume, lactic acid level before abdominal closure, ventilator-assisted time, the length of intensive care unit (ICU) stay, Caprini score, CHIPPS score, time of gastric tube, urinary tube and drainage tube removal, time to first drinking, time to first physical activity and time to first flatus between two groups (all P > 0.05). In the elderly group, the time to first feeding was later than that in the non-elderly group (P < 0.05). There were no significant differences in the incidence of fever, ascites, pulmonary infection, delayed gastric emptying, hemorrhage and inactive venous thrombosis between two groups (all P > 0.05). No significant differences were observed in the levels of aspartate aminotransferase, total bilirubin, direct bilirubin, serum creatinine before discharge and total length of hospital stay between two groups (all P > 0.05). The alanine aminotransferase level in elderly recipients was lower than that in non-elderly counterparts, and the difference was statistically significant (P < 0.05). No unplanned reoperation was performed within postoperative 30 d in two groups. There was no significant difference in the re-hospitalization rate within 30 d after discharge (P > 0.05). Conclusions ERAS-guided interventional strategy contributes to perioperative recovery of elderly recipients undergoing liver transplantation, and yields equivalent postoperative recovery between elderly and non-elderly recipients.

Efficacy and safety of parecoxib versus ketorolac tromethamine for perioperative analgesia：a systematic review / 中国药房

OBJECTIVE To compare the efficacy and safety of parecoxib and ketorolac tromethamine for perioperative analgesia， and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed， Embase， the Cochrane Library， CNKI， VIP， Wanfang Data， Baidu and Google， randomized controlled trials （RCT） about parecoxib （trial group） versus ketorolac tromethamine （control group） for perioperative analgesia were collected from the inception to Jun. 17th， 2022. After screening the literature and extracting the data， the quality of the included literature was evaluated using the bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0. Meta-analysis， sensitivity analysis and publication bias analysis were performed with RevMan 5.4 software. RESULTS A total of 12 RCTs were included， with 1 118 patients. Meta- analysis results showed that at the time of administration before anesthesia induction， there was no statistically significant difference between the 2 groups in visual analogue scale （VAS） [MD＝－0.16， 95%CI （－0.41， 0.09）， P＝0.20]， numerical rating scale （NRS） [MD＝0.01， 95%CI （－0.36， 0.38）， P＝0.97]， postoperative bleeding [MD＝0.15， 95%CI （－0.63， 0.93）， P＝0.71]， and consumption of opioid analgesics [MD＝0.12， 95%CI （－0.77， 1.01）， P＝0.79]. At the time of postoperative administration， VAS and bleeding volume at 48 h after operation of trial group were significantly lower than control group （P＜0.05）. The results of subgroup analysis by different com assessment time points showed that the VAS of patients in trial group at 0 h after operation were significantly lower than control group at the time of administration before anesthesia induction； at the time of postoperative administration， VAS of patients in the trial group at 12 h and 48 h after operation were significantly lower than control group （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups [RR＝0.93，95%CI （0.78，1.11），P＝0.43]. The results of subgroup analysis according to different types of adverse reactions showed that the incidence of nausea and vomiting of trial group was significantly lower than control group， and the incidence of other adverse reactions was significantly higher than control group （P＜0.05）. Results of sensitivity analysis showed that study results were stable and reliable. Results of publication bias analysis showed that there was great possibility of publication bias in this study. CONCLUSIONS The efficacy of parecoxib is equivalent to that of ketorolac tromethamine for perioperative analgesia before operation； at the time of administration after operation， parecoxib has better analgesic effect and less postoperative bleeding； the incidence of nausea and vomiting caused by parecoxib is lower at any time of administration.

Nutrition management by a multidisciplinary team for prevention of nutritional deficits and morbidity following esophagectomy

This study evaluated the effects of perioperative nutrition management by a multidisciplinary team on nutrition and postoperative complications of patients with esophageal cancer. A total of 239 patients with esophageal cancer who underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between February 2019 and February 2020 were included in the study. They were divided into the experimental group (120 patients) and the control group (119 patients) using the random number table method. Control group patients received routine diet management and experimental group patients received perioperative nutrition management by a multidisciplinary team. The differences of nutriture and postoperative complications between the two groups were compared. At 3 and 7 days after surgery, the experimental group patients had higher total protein and albumin levels (P<0.05), shorter postoperative anal exhaust time (P<0.05), lower incidence of postoperative gastrointestinal adverse reactions, pneumonia, anastomotic fistula, hypoproteinemia (P<0.05), and lower hospitalization costs (P<0.05) than the control group. Nutrition management by a multidisciplinary team effectively improved the nutriture of patients, promoted the rapid recovery of postoperative gastrointestinal function, reduced postoperative complications, and reduced hospitalization costs.

Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results

ABSTRACT Introduction: The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. Methods: One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun's operation. Results: The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun's operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun's operation and two cases of other operations. Conclusion: ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.

Assistência perioperatória de enfermagem voltada à segurança do paciente cirúrgico: uma revisão integrativa / Perioperative nursing care aimed at surgical patient safety: an integrative review

Objetivo: Identificar na literatura científica as práticas assistenciais de enfermagem perioperatória que visam à segurança do paciente cirúrgico. Método: Revisão integrativa da literatura realizada no mês de dezembro de 2022, com busca por estudos primários nas bases de dados da Biblioteca Virtual em Saúde (BVS), da National Library of Medicine (PubMed), Scopus e Embase, com recorte temporal de cinco anos. Resultados: Após leitura e análise, seis artigos foram incluídos na revisão. Em síntese, eles abordam três grupos de práticas assistenciais realizadas a fim de promover a segurança do paciente, a saber: aplicar a lista de verificação de segurança em cirurgia; usar escala preditiva a formação de lesão por pressão; e planejar a assistência por meio de protocolos. Conclusão: A utilização de instrumentos que sistematizem as ações, tais como listas de verificação, escalas de cuidados e protocolos são práticas assistenciais que oportunizam a segurança do paciente cirúrgico em período perioperatório, reduzindo assim possíveis eventos adversos no período

Objective: To identify, in the scientific literature, the perioperative nursing care practices aimed at the surgical patient safety. Method: This is an integrative literature review carried out in December 2022, with a search for primary studies in the Virtual Health Library (VHL), National Library of Medicine (PubMed), Scopus, and Embase databases, with a five-year time frame. Results: After reading and analysis, we included six articles in the review. In short, they address three groups of care practices carried out to promote patient safety, namely: applying the checklist for safety in surgery; using the predictive risk scale for developing pressure ulcer; and planning the provision of care by using protocols. Conclusion: Using instruments that systematize actions, such as checklists, care scales, and protocols, are care practices that provide surgical patient safety in the perioperative period, thus reducing possible adverse events in the period

Actualidades en valoración preoperatoria y riesgo anestésico: un enfoque práctico para cirugía no cardíaca / Currents in preoperative assessment and anesthetic risk: a practical approach on non cardiac surgery

Resumen: Nuevas herramientas han surgido como modelos predictores de riesgo cardiovascular y pulmonar en valoración preoperatoria y riesgo anestésico. Desde el estudio publicado por Goldman en 1977, han surgido diversas escalas ya validadas, predictoras de complicaciones cardiovasculares como el riesgo cardíaco revisado por Lee y las calculadoras del National Surgical Quality Improvement Program (NSQIP). La valoración de la capacidad funcional es obligatoria, estudios de gabinete como electrocardiograma, radiografía de tórax y, en algunos casos, el uso adecuado de un ecocardiograma, espirometría, entre otros. Las complicaciones pulmonares postoperatorias pueden predecirse basados en el modelo de ARISCAT. En una era en la que las consultas de subespecialistas y el exceso de estudios sólo agregan costo sin mejorar los resultados sustancialmente, los anestesiólogos debemos tomar una responsabilidad clara para la valoración preoperatoria de pacientes quirúrgicos.

Abstract: New tools have emerged as predictive models of cardiovascular and pulmonary risk, in preoperative assessment and anesthetic risk. Since the study published by Goldman in 1977, several scales have already been validated, predictors of cardiovascular complications such as the cardiac risk reviewed by Lee and the National Surgical Quality Improvement Program (NSQIP) calculators. The assessment of functional capacity is mandatory, extension studies such as electrocardiogram, chest radiography, and in some cases, the proper use of an echocardiogram, spirometry, among others. Postoperative pulmonary complications can be predicted based on the ARISCAT model. In an era in which subspecialist consultations and overstudies only add cost without substantially improving results, anesthesiologists must take a clear responsibility for the preoperative assessment of surgical patients.

The Surgical Safety Checklist from the resident's perspective. Observational study / La lista de cirugía segura desde la perspectiva del residente. Estudio observacional

Abstract Introduction The Surgical Safety Checklist implemented by the World Health Organization has proven to decrease perioperative morbidity and mortality; however, the barriers and limitations to its implementation are consistently reported in the literature. Objective To establish the level of appropriation of the surgical safety checklist in the training of human resources in anesthesiology, in addition to identifying the perception and the level of implementation of such checklist at the national scale. Methods Descriptive cross-sectional study conducted through a survey administered to the residents of anesthesiology in Colombia. Likert-type questions were included, distributed into three domains: appropriation, perception and implementation. Results 215 answers corresponding to 54.5 % of the population were analyzed, comprising participants from all of the anesthesiology programs in the country. 20% of the residents have never been subject to formal academic reviews about checklists, and this trend did not change throughout the residency; 97.2 % considers that the implementation of the lists improves the safety of surgical procedures and 40 % have seen rejection or indifference by surgeons. 80.5 % of the residents have seen the frequent use of the checklist, while only 13.5% have seen the use of the checklist during the three surgical moments - before the induction of anesthesia, before the surgical incision, and before the patient leaves the operating room 88 % have observed that the form is completed without actually doing the verification. Conclusions There is limited exposure to education about the surgical safety checklist in anesthesiology postgraduate programs in the country. The residents have a favorable perception about the value of the list, however, there are some shortcomings in its administration.

Resumen Introducción: La lista de verificación de cirugía segura implementada por la Organización Mundial de la Salud ha demostrado disminuir la morbimortalidad perioperatoria; no obstante, en la literatura se reportan de manera sistemática las barreras y limitaciones en su aplicación. Objetivo: Establecer el grado de apropiación de la lista de verificación de cirugía segura en la formación del talento humano en anestesiología en entrenamiento, así como determinar la percepción y el nivel de implementación de dicha lista a escala nacional. Métodos: Estudio descriptivo de corte transversal realizado mediante una encuesta a los residentes de anestesiología en Colombia. Se incluyeron preguntas tipo Likert distribuidas en 3 dominios: apropiación, percepción e implementación. Resultados: Se analizaron 215 respuestas correspondiente a un 54,5 % de la población y se contó con la participación de todos los programas de anestesiología del país. El 20 % de los residentes nunca ha tenido revisiones académicas formales sobre listas de verificación y esta tendencia no se modificó a lo largo de la residencia, el 97,2 % considera que la implementación de las listas incrementa la seguridad de los procedimientos quirúrgicos y el 40 % ha observado rechazo o indiferencia por parte de los cirujanos. El 80,5 % de los residentes ha observado su aplicación frecuente, solo el 13,5 % ha observado aplicar la lista en los tres momentos (antes de la inducción anestésica, antes de la incisión quirúrgica, antes de la salida del paciente del quirófano) y el 88 % ha observado diligenciar el formato sin realizar la verificación. Conclusiones: Existe poca exposición a la enseñanza de la lista de verificación de cirugía segura en los posgrados de anestesiología del país. Los residentes tienen una percepción favorable sobre la utilidad de la lista; sin embargo, su implementación tiene falencias en cuanto a la forma de aplicación.

Nursing Care during the Perioperative within the Surgical Context / Cuidado de enfermería durante el perioperatorio dentro del contexto quirúrgico / Cuidados de enfermagem no período perioperatório no contexto cirúrgico

Abstract The study describes basic nursing care during the perioperative. Introduces the origins of perioperative nursing, general care that must be practiced with patient in this context. During the preoperative, care related with risk assessment and preparation of patient from the emotional and physical point of view are important. The trans-operative is related with the anesthesia used, surgical position, preparation of the skin, maintenance of normothermia, among many others. The postoperative depends on the type of anesthesia and surgical procedure, emphasizing on airway permeability, hemodynamic stability, pain, and symptomatology being presented by patients until they are stable and suitable for transfer to another service or their home.

Resumen Se describen los cuidados de enfermería básicos durante el perioperatorio. Se presentan los orígenes de la enfermería perioperatoria, los cuidados generales que se deben tener con el paciente en este contexto. En el preoperatorio es importante los cuidados relacionados con la valoración del riesgo, la preparación del paciente desde el punto de vista emocional y físico. Durante el transoperatorio se relacionan con la anestesia utilizada, la posición quirúrgica, la preparación de la piel, el mantenimiento de la normotermia, entre muchos otros. En el posoperatorio dependen del tipo de anestesia y procedimiento quirúrgico, realizando énfasis en la permeabilidad de la vía aérea, la estabilidad hemodinámica, el dolor, y la sintomatología que va presentando el paciente hasta que este estable y apto para trasladarse a otro servicio o para su casa.

Resumo São descritos os cuidados básicos de enfermagem durante o período perioperatório. São apresentadas as origens da enfermagem perioperatória, bem como os cuidados gerais que devem ser tomados com o paciente nesse contexto. No pré-operatório, são importantes os cuidados relacionados à avaliação de risco e o preparo do paciente do ponto de vista emocional e físico. Durante o transoperatório, estão relacionados à anestesia utilizada, à posição cirúrgica, ao preparo da pele, à manutenção da normotermia, entre muitos outros. No pós-operatório, dependem do tipo de anestesia e procedimento cirúrgico, enfatizando a permeabilidade da via aérea, estabilidade hemodinâmica, dor e os sintomas que o paciente apresenta até que esteja estável e apto a se transferir para outro serviço ou para sua casa.

Desenvolvimento de protocolo clínico assistencial para prevenção e tratamento da hipotermia perioperatória / Desarrollo de un protocolo clínico de atención para la prevención y el tratamiento de la hipotermia perioperatoria / Development of a clinical care protocol for the prevention and treatment of perioperative hypothermia

RESUMO Objetivo: desenvolver um protocolo de prevenção e tratamento da hipotermia perioperatória. Método: pesquisa do tipo desenvolvimento tecnológico em saúde, realizada em três etapas: i) revisão de diretrizes clínicas sobre fatores de risco para desenvolvimento de hipotermia perioperatória; ii) identificação da ocorrência de hipotermia perioperatória e dos fatores de risco associados ao seu desenvolvimento em um centro cirúrgico; e iii) elaboração do protocolo de prevenção de hipotermia perioperatória. Resultados: os fatores de risco identificados nas diretrizes foram categorizados em características clínicas (idade, Índice de Massa Corporal, comorbidades e temperatura corporal) e anestésico-cirúrgicas (tipo e duração da anestesia e da cirurgia e temperatura da sala cirúrgica). Na segunda etapa, 90 pacientes cirúrgicos foram avaliados. A ocorrência de hipotermia foi de 28,9% na admissão cirúrgica, 77,8% na admissão da Sala de Recuperação Pós-Anestésica e 45,6% na alta do centro cirúrgico. Houve associação estatisticamente significativa entre ocorrência de hipotermia e índice ASA (p = 0,049), idade (p = 0,037), comorbidades (p = 0,031) e hipotermia pré-operatória (p = 0,015). Conclusão: para elaboração do protocolo, foram considerados os fatores de risco descritos na literatura, os resultados de estudo local e o acesso às tecnologias disponíveis na instituição. As ações incluíram os seguintes aspectos: avaliação de fatores de risco e de situações desencadeantes; monitorização e registro da temperatura e outros parâmetros; aquecimento passivo para pacientes normotérmicos; aquecimento ativo para pacientes hipotérmicos; infusão de soluções endovenosas aquecidas; suporte de oxigênio para pacientes hipotérmicos.

RESUMEN Objetivo: de sarrollar un protocolo paralaprevención y el tratamiento de la hipotermia perioperatoria. Método: una investigación de desarrollo tecnológico sanitario, desarrollada en tres etapas: Revisión de las directrices clínicas sobre los factores de riesgo para el desarrollo de la hipotermia perioperatoria; Identificación de la ocurrencia de la hipotermia perioperatoria y de los factores de riesgo asociados a su desarrollo en un centro quirúrgico y Elaboración de un protocolo de pre vención de la hipotermia perioperatoria. Resultados: los factores de r iesgo identificados en las directrices se clasificaron en caracterí st icas clínica s (edad, Índice de Masa Corporal, comorbilidades, temperatura corporal) y anestésico-quirúrgicas (tipo y duración de la anestesia y la cirugía, temperatura del quirófano). En la segunda etapa, se evaluaron 90 pacientes quirúrgicos. La apar ición de hipotermia fue del 28,9% al ingreso quirúrgico, del 77,8% al ingreso en la Sala de Recuperación Postanestésica y del 45,6% al alta del quirófano. Se encontró una a sociación estadísticamente significativa entre la aparición de hipoter mia y el índice ASA (p = 0,049), la edad (p = 0,037), las comorbilidades (p = 0,031), la hipotermia preoperatoria (p = 0,015). Conclusión: para desarrollar el protocolo, se consideraron los factores de r iesgo descritos en el documento, los resultados de un estudio local y el acceso a las tecnologías disponibles en la institución. Las acciones incluían la evaluación de los factores de rie sgo y las situaciones desencadenantes, la monitorización y el registro de la temperatura y otros parámetros, el calentamiento pasivo para los pacientes normotérmicos, el calentamiento act ivo para los pacientes hipotérmicos, la infusión de soluciones intravenosas calentadas y el apoyo de oxígeno para los pacientes hipotérmicos.

ABSTRACT Objective: to develop a protocol for the prevention and treatment of perioperative hypothermia. Method: research of the technological development in health type, carried out in three stages: i) review of clinical g uidelines on risk factors for the development of perioperative hypothermia; ii) identification of the occur rence of perioperative hypothermia and the risk factors a ssociated with its development in a surgical center; and iii) development of a protocol for the prevention of perioperative hypothermia. Results: the risk factors identified in the guidelines were categorized into clinical characteristics (age, Body Mass Index, comorbidities and body temperature) and anesthetic-surgical characteristics (type and duration of anesthesia and surgery and operat ing room temperature). In the second stage, 90 surgical patients were evaluated. The occurrence of hypothermia was 28.9% at surgical admission, 77.8% at admission to the Post-Anesthesia Care Unit and 45.6% at discharge from the operating room. There was a statistically significant association bet ween the occurrence of hypothermia and ASA index (p = 0.049), age (p = 0.037), comorbidities (p = 0.031) and preoperative hy pothermia (p = 0.015). Conclusion: for the elaboration of the protocol, the risk factors described in the literat ure, the results of a local study and the access to the technologies available in the instit ution were considered. The actions included the following aspects: a ssessment of risk factors and triggering situations; monitoring and recording of temperature and other parameters; passive warming for normothermic patients; active warming for hypothermic patients; infusion of war med intravenou s solutions; oxygen support for hypothermic patients.

Proadrenomedullin in Patients with Preserved Left Ventricular Systolic Function Undergoing Coronary Artery Bypass Grafting

Abstract Introduction: A potentially new marker of cardiovascular diseases — proadrenomedullin is the precursor of adrenomedullin, which is a multifunctional peptide hormone, produced in most of the tissues in response to cellular stress, ischemia, and hypoxia. Methods: Ninety-three people, aged 51-79 years, were included in the study. Exclusion criteria were severe or corrected valvular disease, acute coronary syndrome, age ≥ 80 years, glomerular filtration rate < 45 ml/min, active infectious diseases, and cancer. The subjects were observed for adverse events, including reduced left ventricular ejection fraction (LVEF) by ≥ 10%, first incidence of atrial fibrillation (AF), and the necessity of using dopamine during hospitalization. Results: Use of pressure amines, occurrence of the first AF episode, and left ventricular dysfunction defined by a decrease in LVEF by at least 10% compared to the value before surgery were reported in the perioperative period. No death, sudden cardiac arrest with effective resuscitation, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, or heart failure were observed. Significantly higher proadrenomedullin concentration was observed in the group with reduced postoperative LVEF (1.68 vs. 0.77 nmol/l, P=0.005). The relative risk of a decrease in ejection fraction in the group of patients with proadrenomedullin concentration ≥ 0.77 nmol/l was more than twelve-fold higher (95% confidence interval 1.69-888.33; P=0.013) than in the group of patients with a concentration of proadrenomedullin < 0.77 nmol/l. Conclusion: The higher baseline concentration of proadrenomedullin has a predominantly predictive value of postoperative left ventricular systolic dysfunction.

Tools and scores for perioperative pulmonary, renal, hepatobiliary, hematological, and surgical site infection risk assessment: an update / Ferramentas e escores para avaliação de risco perioperatório pulmonar, renal, hepatobiliar, hematológico e de infecção do sítio cirúrgico: uma atualização

ABSTRACT Introduction: perioperative risk assessment is essential to mitigate surgical complications, which suggests individual and collective interest since the number of surgical procedures in Brazil has been expanding steadily. The aim of this study was to summarize and detail the main calculators, indexes and scores regarding perioperative pulmonary, renal, hepatobiliary, hematological and surgical site infection risks for general non-cardiac surgeries, which are dispersed in the literature. Method: a narrative review was performed based on manuscripts in English and Portuguese found in the electronic databases Pubmed/MEDLINE and EMBASE. Results: the review included 11 tools related to the systems covered, for which the application method and its limitations are detailed. Conclusion: the non-cardiovascular perioperative risk estimation tools are beneficial when disturbances are identified in the preoperative clinical examination that justify a possible increased risk to the affected system, so the use of these tools provides palpable values to aid in the judgment of surgical risk and benefit as well as it identifies factors amenable to intervention to improve outcomes.

RESUMO Introdução: a avaliação de risco perioperatório é essencial para mitigação das complicações cirúrgicas, o que aventa interesse individual e coletivo uma vez que o número de procedimentos cirúrgicos no Brasil vem se expandindo de maneira crescente. O objetivo deste estudo foi resumir e detalhar as principais calculadoras, índices e escores dos riscos perioperatórios pulmonar, renal, hepatobiliar, hematológico e de infecção de sítio cirúrgico para cirurgias gerais não cardíacas, os quais encontram-se dispersos na literatura. Método: foi realizada revisão narrativa a partir de manuscritos em inglês e português encontrados nas bases eletrônicas Pubmed/MEDLINE e EMBASE. Resultados: a revisão incluiu 11 ferramentas relativas aos sistemas abordados, para as quais detalha-se o método de aplicação e suas limitações. Conclusão: as ferramentas de estimativa de risco perioperatório não cardiovascular encontram benefício quando se identifica no exame clínico pré-operatório alterações que justifiquem possível risco aumentado ao sistema afetado, assim a utilização destas ferramentas fornece valores palpáveis para auxílio no julgamento de risco e benefício cirúrgico bem como identifica fatores passíveis de intervenção para melhoria dos desfechos.

Effects of transurethral resection of the prostate versus plasmakinetic resection of the prostate on erectile function in patients with giant benign prostatic hyperplasia / 中国基层医药

Objective:To investigate the efficacy of transurethral resection of the prostate (TURP) versus plasmakinetic resection of the prostate (PKRP) in the treatment of patients with giant benign prostatic hyperplasia and their effects on erectile function. Methods:A total of 100 patients with GBPH who received treatment in the General Hospital of Taiyuan Iron and Steel (Group) Co., Ltd., from February 2017 to January 2020 were included in this study. They were randomly assigned to undergo either PKRP (PKRP group, n = 50) or TURP (TURP group, n = 50). Perioperative indicators were recorded. Urodynamic indicators and serum indicators pre- and post-operation were compared between the two groups. Erectile function and quality of life were compared between the two groups. The incidences of postoperative complications such as erectile dysfunction, urinary incontinence and urethral stricture were calculated. Results:Operative time, hospital stay, catheter indwelling time, and intraoperative blood loss in the PKRP group were significantly shorter and less than those in the TURP group ( t = 14.35, 8.74, 6.20, 8.34, all P < 0.001). There were no significant differences in residual urine volume and maximum urine flow rate measured before surgery between the two groups ( t = 0.59, 0.73, both P > 0.05). After surgery, residual urine volume decreased and maximum urine flow rate increased in each group. Residual urine volume was significantly lower and maximum urine flow rate was significantly higher in the PKRP group compared with the TURP group ( t = 19.85, 11.67, both P < 0.001). Before surgery, there were no significant differences in serum prostate-specific antigen and free prostate-specific antigen between the two groups ( t = 0.43, 0.33, both P > 0.05). After surgery, both serum prostate-specific antigen and free prostate-specific antigen decreased in each group, and both serum prostate-specific antigen and free prostate-specific antigen were significantly lower in the PKRP group than those in the TURP group ( t = 16.01, 5.09, both P < 0.001). Before surgery, there were no significant differences in quality of life (QOL) score and International Index of Erectile Function (IIEF) score between the two groups ( t = 0.62, 0.63, both P > 0.05). After surgery, IIEF score was increased and QOL score was decreased in each group. After surgery, IIEF score in the PKRP group was significantly higher than that in the TURP group [(25.06 ± 3.61) points vs. (21.52 ± 3.05) points, t = 5.29, P < 0.001], and QOL score in the PKRP group was significantly lower than that in the TURP group [(1.05 ± 0.18) points vs. (1.58 ± 0.29) points, t = 5.29, 10.98, both P < 0.001]. The incidence of complications in the PKRP group was significantly lower than that in the TURP group ( χ2 = 5.98, P < 0.05). Conclusion:This study investigated the effects of TURP versus PKRP on giant benign prostatic hyperplasia from the aspects including erectile function, QOL, and perioperative indicators. This study is of certain innovation. Findings from this study confirm that both PKRP and TURP can improve erectile function, serum indicators, and urodynamic indicators in patients with giant benign prostatic hyperplasia. PKRP is preferred because it is less invasive, results in better improvements in erectile function, serum indicators, and urodynamic indicators, and has fewer complications than TURP.

Research advances in influencing factors for long-term quality of life after esophagectomy in patients with esophageal cancer / 中华消化外科杂志

Esophageal cancer constitutes the sixth leading cause of cancer-associated death worldwide. Recently, due to the development of minimally invasive techniques and perioperative treatment modality, the 5-year overall survival rate has been improved in patients with esophageal cancer undergoing esophagectomy. Therefore, long-term quality of life (QOL) after esophagectomy in patients with esophageal cancer has attracted more and more attention. In China, unfortunately, the concern of long-term QOL of patients after esophagectomy is absent and few QOL-related clinical trial has been launched. The authors summarize the influencing factors for long-term QOL after esophagectomy in patients with esophageal cancer, so as to raise more concern of long-term QOL of patients after esophagectomy in surgeons and nurses.