Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study / 대한마취과학회지

Background@#Same-day discharge, defined as discharge from the hospital within 24 h of surgery, has been shown to be safe for joint arthroplasty. We examined demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty in adult patients. @*Methods@#Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program database, we extracted information of all patients that underwent shoulder arthroplasty. The primary and secondary outcome of interest was same-day discharge and 30-day unplanned readmission, respectively. We utilized multivariable logistic regression to identify covariates associated with these outcomes. @*Results@#There were 17,011 patients analyzed when identifying predictors for same-day discharge. There was an increase in same-day discharge from 2007 to 2016. The odds of same-day discharge were significantly better for males (P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, chronic obstructive pulmonary disease, congestive heart failure, bleeding disorder, and comorbidity burden (all P < 0.001). There were 14,276 patients analyzed for hospital readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, congestive heart failure, bleeding disorder, and higher comorbidity burden (all P < 0.001). @*Conclusions@#The results of this study show that preoperative comorbidities and advanced age reduce the odds of same-day discharge. Risk stratification, preoperative optimization, and coordinated care after surgery may be helpful to optimize patients for same-day discharge.

Association of trainee involvement in an acute pain service with postoperative opioid use in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy / 대한마취과학회지

Background@#Several hospitals have implemented a multidisciplinary Acute Pain Service (APS) to execute surgery-specific opioid sparing analgesic pathways. Implementation of an anesthesia attending-only APS has been associated with decreased postoperative opioid consumption, time to ambulation, and time to solid food intake for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. In this study, we evaluated the impact of introducing an APS trainee on postoperative opioid consumption in patients undergoing hyperthermic intraperitoneal chemotherapy during POD 0–3. @*Methods@#We performed a retrospective propensity-matched cohort study where we compared opioid consumption and hospital length of stay among two historical cohorts: attending-only APS service versus service involving a regional anesthesia fellow. @*Results@#In the matched cohorts, the median postoperative day (POD) 0–3 opioid use [25%, 75% quartile] for the single attending and trainee involvement cohort were 38.5 mg morphine equivalents (MEQ) [14.1 mg, 106.3 mg] and 50.4 mg MEQ [28.4 mg, 91.2 mg], respectively. The median difference was –9.8 mg MEQ (95% CI -30.7–16.5 mg; P = 0.43). There was no difference in hospital length of stay between both cohorts (P = 0.67). @*Conclusions@#We found that the addition of a regional anesthesia fellow to the APS team was not associated with statistically significant differences in total opioid consumption or hospital length of stay in this surgical population. The addition of trainees to the infrastructure, with vigilant supervision, is not associated with change in outcomes.

Ultrasound-guided percutaneous intercostal cryoanalgesia for multiple weeks of analgesia following mastectomy: a case series / 대한마취과학회지

Background@# Acute post-mastectomy pain is frequently challenging to adequately treat with local anesthetic-based regional anesthesia techniques due to its relatively long duration measured in multiple weeks.Case: We report three cases in which preoperative ultrasound-guided percutaneous intercostal nerve cryoneurolysis was performed to treat pain following mastectomy. Across all postoperative days and all three patients, the mean pain score on the numeric rating scale was 0 for each day. Similarly, no patient required any supplemental opioid analgesics during the entire postoperative period; and, no patient reported insomnia or awakenings due to pain at any time point. This was a significant improvement over historic cohorts. @*Conclusions@# Ultrasound-guided percutaneous cryoanalgesia is a potential novel analgesic modality for acute pain management which has a duration that better-matches mastectomy than other currently-described techniques. Appropriately powered randomized, controlled clinical trials are required to demonstrate and quantify both potential benefits and risks.

High frequency of low serum levels of vitamin B [12] among patients attending Jordan University Hospital

This study aimed to estimate the status of serum vitamin B[12] level in patients attending Jordan University Hospital in Amman, and to examine the relationship with demographic data, chronic illness, dietary habits, haematological parameters and symptoms related to vitamin B[12] levels. A total of 838 patients completed a questionnaire and gave blood samples; 44.6% were vitamin B[12] deficient [< 180 pg/mL] and 34.2% had hypovitaminosis [180-300 pg/mL]. Vitamin B[12] deficiency was associated with memory impairment, low meat intake and strict vegetarian [vegan] diets. The high frequency of low vitamin B[12] warrants the development of a strategy to correct this problem in Jordan

combined pretransplantation seropositivity of kidney transplant recipients for cytomegalovirus antigens [pp150 and pp28] a predictor for protection against infection?

This study was aimed at detecting antibodies to the antigens which may contribute to protection against cytomegalovirus [CMV] infection after organ transplantation. A total of 203 kidney transplant patients were enrolled in the study. Based on CMV antigenemia assay, 23 patients were antigen-positive and of the remaining 180 antigen-negative patients, 46 were selected as controls matched for age, gender and source of kidney. The 69 kidney recipients [KR] had CMV antibody due to previous infection and were followed up for a period of 6 months after transplantation for the development of active CMV infections by the antigenemia assay. Antibody responses to five CMV-related peptide antigens [pp65, gB, pp150, pp28 and pp38] were investigated by enzyme immunoassay and their presence was correlated with the results of the CMV antigenemia assay. Of the five CMV-related peptide antigens, only gB antigen showed response to the antibody in 10/23 [43.5%] antigen-positive patients and 9/46 antigen-negative patients and the difference was statistically significant [p = 0.048]. On the other hand, there was no significant difference in antibody responses between the antigen-positive and antigen-negative KR to the other four CMV peptide antigens [p > 0.05]. However, among the antigen-positive KR there was only 1 patient who had antibodies to both pp150 and pp28 antigen, while among the antigen-negative KR, 22 of 46 [47.8%] had the antibodies [p < 0.001]. The findings suggest that the combined presence of antibodies against the pp150 and pp28 antigens may indicate a lower risk of CMV reactivation after kidney transplantation

Surgical management of hydatid liver cysts; inra-operative pair, cysto-pericystectomy and omentoplasty

Liver hydatid cysts caused by Echinococcus granulosus presents medical, veterinary and economic problems worldwide. In an attempt to eradicate liver hydatid cysts by eliminating the parasite, disappearance of the residual cavity, preventing complications and recurrence, the present study was done in Theodore Bilharz Research Institute on 36 patients. They were 11 females and 25 males with age ranging between 18-55 years old. All patients were sub to a full history taking and clinical examination, a full battery of hematological, biochemical, immunological and radiological investigations. Intra-operative Puncture Aspiration Injection and Re-aspiration [PAIR] was performed to all cysts before surgical intervention. Total cysto-pericystectomy [CPC] was done in 25 patients with both open and closed technique. Partial cysto-pericystectomy was done in 11 patients due to firm adherence of the cyst to the liver structures. Omentoplasty [OP] was performed to fill all cavities accompanied with external open system drainage tube. There were no mortalities in this study. Post operative complications were found in 7 patients. Cystectomy and omentoplasty related complication were found in 3 patients, General surgical complications were found in 1 patient. Biliary related complications occurred in 3 patients in the form of biliary leak in 2 patients and biliary fistulae in 1 patients. All these complications responded well to conservative management. A combination of different radical and conservative surgical modalities in the same sitting in the form of intra-operative Puncture Aspiration Injection and Re-aspiration, cystopericystectomy and omentoplasty could be considered the surgical method of choice with no mortality

Intravesical immunotherapy for superficial bladder cancer

To compare and evaluate the efficacy and tolerance of intravesical instillation of Bacillus Calmette-Guerin [BCG] and interferon alpha-2b immunotherapy for superficial transitional cell carcinoma [TCC] of the urinary bladder. Thirty-five patients with superficial TCC of the urinary bladder, primary and recurrent tumors, stage Ta, T1, and grade 1 and 2, were prospectively enrolled for intravesical immunotherapy at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1992 and December 2000. The treatment regimes used were either 120 mg of BCG weekly for 6 weeks followed by a 2nd 6 week course given only on first tumor recurrence, or 50 million i.u. of interferon alpha-2b weekly for 3 months, bi-weekly for the next 3 months and monthly for 6 months. Twenty-two patients received BCG and 13 received interferon alpha-2b. Adequate blood counts, renal and hepatic function profiles, and informed consent were required. Cystoscopy was repeated every 3 months for the first 2 years, then 6 monthly for another 2 years and then yearly. The follow-up period ranged from 9-96 months [median 31.33 months]. Twenty patients attended the follow-up and were evaluable in the BCG group and 13 in the interferon alpha-2b group. In the BCG versus interferon alpha-2b group, the rates of complete response were 80% and 41.6%, partial response were 5% and 33.3%, and progression were 15% and 8.3%. Mild side effects occurred in 5 patients and all of them completed their treatments. There was only one cancer related death in each group after 6 and 7 years of starting the treatment. Bacillus Calmette-Guerin was confirmed as a more effective intravesical immunotherapy for superficial TCC of the urinary bladder as compared to interferon alpha-2b. Both agents' treatments are well tolerated