Patient Satisfaction and Quality of Life After Mastectomy at King Abdulaziz Medical City, Jeddah.

Background Overall well-being after surgical intervention is one of the most important aspects of assessing quality of life (QOL), yet it is not well explored in the literature. In this paper, it was necessary to involve the patient's perspective of the nature of their QOL. The burden of being diagnosed with breast cancer is an adaptation to a new lifestyle, having to deal with disease stigma, interpersonal relations problems, and being limited to specific clothing. This can be very challenging for patients. This study aims to identify which patient group, based on their treatment regimen, exhibits higher levels of satisfaction and dissatisfaction compared to other groups. Methods A retrospective, cross-sectional study analyzing the QOL among female breast cancer patients who underwent mastectomy, with or without breast reconstruction, in King Abdulaziz Medical City, Jeddah, between 2009 and 2022. Patients' demographics and phone numbers were obtained from each patient's medical record file in our hospital. Phone call-based interviews were conducted to contact patients to assess their QOL, satisfaction, and regrets after surgery. We excluded patients who do not speak Arabic, are illiterate, have memory disorders, patients who underwent lumpectomy or palliative mastectomy, patients with metastatic stage 4 cancer at the time of diagnosis, patients who are males, and patients who passed away. Results A total of 2,309 patients were screened during the period aforementioned; a total of 346 patients met our inclusion criteria. All of whom are female participants with a current mean age of 52.3 ± 11.5 years. There were 301 (86.99%) participants reported being satisfied, while only 45 (13.01%) participants reported being unsatisfied with surgery outcomes. Although the majority of participants were satisfied after mastectomy, many of them still struggled with psychological, social, and/or emotional challenges. These challenges can have a significant impact on a patient's overall well-being and QOL and must be addressed to provide patients with the highest quality of care possible. Conclusion The study findings highlight the significant impact of mastectomy on patients' lives. It is important to consider individual patient experiences and circumstances when evaluating treatment outcomes and patient satisfaction. We observed that patient satisfaction may vary depending on several factors, including patients' baseline satisfaction. Those factors may be psychological, such as body image issues, low self-esteem, the feeling of losing a body part, and fear of recurrence or metastasis. Other factors may be postoperative-related complications, including lymphedema, redundant skin, chronic pain, and operation scar. Additionally, factors may be socially related, such as loss of confidence, social withdrawal, embarrassment, inability to buy prostheses, being limited to specific clothes, and occupational impact.

Incidence of Surgical Site Infection Despite Preoperative Cefazolin Administration in Total Knee Arthroplasty Patients: A Tertiary Hospital Experience.

INTRODUCTION: Surgical site infection (SSI) is an infection that occurs after surgery on the incision site. Cefazolin is an old-generation antibiotic that decreases the risk of SSI. This study aimed to determine the relationship between the incidence of SSI, cefazolin administration, and the factors contributing to the relationship between them. METHODS: This is a retrospective study that used a data collection sheet to collect variables from the medical records of patients who underwent total knee arthroplasty (TKA) between 2016 and 2020. We looked mainly for the type of antibiotics given preoperatively, the number of doses given, discontinuation of antibiotics postoperatively, length of hospital stay, intensive care unit (ICU) admission, and SSI occurrence.  Results: A total of 195 patients were included. The majority (87.8%) were given two grams of cefazolin. Patients who have taken one gram of cefazolin had a slightly higher hospital stay than those who took two grams. However, all the patients did not develop an SSI. CONCLUSION: There was no incidence of SSI despite preoperative cefazolin administration in TKA patients. Patients who received higher doses of cefazolin had a shorter length of hospital stay.

Role of preoperative computed tomography in the diagnosis of acute appendicitis and reduction of negative appendectomy rates: Retrospective cross-sectional study.

Background: Negative appendectomy rate (NAR) is defined as the incidence of pathologically normal appendices removed from patients suspected of having appendicitis. The objective of the present study is to determine the accuracy of CT and other modalities in diagnosing acute appendicitis, aiming to lower NAR in Saudi Arabia. Method: Retrospective analytical study conducted across 4 hospitals in Makkah and Jeddah. A net total of 913 patients got included in the study. The data were entered and coded in excel sheet, then transformed to STATA R. software for analysis. Results: A total of 911 patients who underwent appendectomy were included in this study; positive appendectomies were proven in (96.49%) of cases resulting in overall (3.51%) of cases of negative appendectomy when analyzing data based on age groups; adult patients who proceeded to the surgery based on clinical examination only had a NAR of (13.16% vs 2.66% who had one or more imagining studies P = 0.000). Conclusion: Despite the fact that the diagnosis of acute appendicitis is often challenging, the patients who proceeded to the surgery based on clinical examination only had a NAR higher than those who underwent one or more imaging studies. The NAR was higher in women than men adult patients while no relation was observed in pediatric patients. Based on the present study's findings, efficient pre-operative radiological utilization is recommended in cases presented with suspicious acute appendicitis. Moreover, investing in radiological equipment and time for proper assessment can avoid the unnecessary appendectomy.

Risk Factors, Clinical Manifestations and Treatment Outcomes of Colon Cancer Patients in National Guard Hospital in Jeddah, Saudi Arabia.

Introduction Colon cancer is the third most common cancer worldwide and its incidence is increasing day by day. Provision of early management to cancer patients can lead to a good prognosis. Hence, we evaluated the risk factors, clinical manifestations and treatment outcomes for colon cancer patients in National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia from January 2010 to December 2020 by comparing those results according to their age groups. Methods A retrospective cohort study was performed on 251 colon cancer patients who underwent a surgical procedure. The patients were divided into the following age groups: ≤ 50 (young), 51-60 and > 60 (old) years old. The demographic variables such as age and gender were collected. The results were classified into risk factors, clinical features and treatment outcomes. The comparison between different age groups was made using Chi-square or Fisher's exact test. The data was stored in Excel 2016 (Microsoft Corporation, Redmond, USA) and analyzed using SPSS (IBM Corp, Armonk, USA). Results The results revealed that most patients were males and the median age for diagnosis was 58 years old. There were 15.1% of patients with a positive family history. Moreover, the most common anatomical position was the left side of the colon in all age groups. Most patients had moderately differentiated colon cancer in the histopathological diagnosis. Laparotomy was the most common procedure done to patients in all age groups. There was no difference between all age groups and the aggressiveness of colon cancer. Young patients (≤ 50 years) had a higher percentage to have 5-year recurrence rate (42 % vs 19% vs 25%, p-value < 0.05) in comparison to patients between 51-60 years and old patients (> 60 years) respectively. However, there was no association between all age groups and 5-year mortality rate (22% vs 9% vs 19%, p-value = 0.171). Conclusion In comparison to old patients (> 60 years), young patients (≤ 50 years) have a more rate of recurrent colon cancer. In relation to all age groups, there were no differences in terms of the aggressive presentation or 5-year mortality rates. In addition, it appears that there were some differences between our study results and worldwide results. This may be because of occupational, cultural and/or genetic variations. Further studies with a higher number of patients and multicenter data collection are highly recommended.

Surgical Excision of a Pilonidal Sinus at the Neck Region.

Pilonidal sinus (PNS) is a clinically diagnosed condition caused by hair entrapment underneath the skin leading to a granulomatous reaction and the formation of a tract. PNS is commonly found in the sacrococcygeal area (natal cleft). However, this is a rare case presentation of a male patient with PNS located at the back of his neck region as there were only four similar conditions reported in the literature review. The patient was first managed medically as a case of hidradenitis suppurativa by the dermatology department. Later on, when the treatment failed, he was treated surgically as a case of PNS with an excellent outcome. The patient was seen at the outpatient clinic one week after surgery. The wound was healed completely and totally recovered.

Recurrence Rate in a Patient Treated with Colon Resection Followed by Chemotherapy in Comparison to a Patient Treated with Colon Resection without Chemotherapy.

Given that colon cancer is one of the most prevalent cancers worldwide, it is essential to employ strategies to try to reduce its incidence and recurrence rate. Though colon cancer is a sporadic disease in the vast majority of cases, multiple risk factors are linked to this disease, namely, obesity and cigarette smoking. Additionally, not many studies have been done in Saudi Arabia studying the recurrence rate of colon cancer. Therefore, we conducted a retrospective cohort study at King Khalid Hospital, King Abdulaziz Medical City, National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia to investigate the recurrence rate of colon cancer in patients treated with complete colon resection followed by chemotherapy versus patients treated with colon resection alone via electronic and paper medical records. A total of 120 patients were included in this study; 61 were males (50.8%) and 59 were females (49.2%). According to our findings, the recurrence rate in patients who underwent surgical resection with adjuvant chemotherapy was 15.6% (n = 10), while the recurrence rate in patients with surgery alone was 21.4% (n = 12). Cancer recurrence is associated with significant morbidity and mortality. Therefore, further studies should be done to investigate the recurrence rate in patients with risk factors to identify and deal with the causes of recurrence.

Measuring Patient Satisfaction and Factors Affecting it in the General Surgery Setting in Jeddah.

Introduction A patient-centered approach is critical to improving the overall quality of healthcare, and this also applies to the general surgery setting. To achieve this, it is important to assess patient satisfaction with healthcare, but this topic has not been investigated in the context of Jeddah. Therefore, the present study is the first one to assess patient satisfaction with care in the general surgery department and associated factors in Jeddah. Methods This was a descriptive, cross-sectional study that used a convenience sampling technique to select 307 patients from the outpatient clinic of the general surgery department at King Abdulaziz Medical City from November to December 2018. The cohort comprised 53.1% women and the age range was 18-70 years. For data collection, we used the Short Assessment of Patient Satisfaction questionnaire, which contains seven items related to the core domains of patient satisfaction. We modified this by adding two additional items reported in other studies. We also included age, gender, and level of education as variables in the analysis. The scores assigned to each item were compared based on gender, age, and level of education. Results The analysis showed that age, gender, or level of education did not affect the overall satisfaction level, and the majority of participants (93.8%) reported that they were satisfied or very satisfied. Specifically, the majority reported that they were satisfied or very satisfied with the treatment effect, the explanation provided by the clinician, and the care provided at the clinic. Further, the majority of them also felt that they had received a thorough examination and enough time with the consultant, that they felt respected by the healthcare provider and their concerns were heard and respected, and that they were encouraged to voice their feelings and concerns. The lowest score was related to whether the participants felt like their choices were considered when it came to making healthcare decisions. This could, therefore, be a potential area of improvement. Conclusion Overall, the current findings indicate that the practitioners in the current setting use a patient-centered, adult-to-adult approach to healthcare, and the patients are highly satisfied. One area of improvement could be medical decision-making, where patients' preference could be given more consideration. Thus, these findings provide important insight into patient-centered care in this region.

Quality of Life among Surgical Residents at King Abdulaziz Medical City in Jeddah, Saudi Arabia.

BACKGROUND: Surgical residency program is considered one of the toughest residency programs, which affects quality of life of the residents during training years. To date, no study has evaluated quality of life among residents, especially surgical residents here in Saudi Arabia. AIM: The objective of this study is to evaluate quality of life among surgical residents. METHODS: The study is a cross-sectional study conducted during September 2018 in King Khalid Hospital at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. The study utilized the Work-Related Quality of Life, WRQoL, scale which measures perceived quality of life covering six domains: General Well-Being (GWB), Home-Work Interface (HWI), Job and Career Satisfaction (JCS), Control at Work (CAW), Working Conditions (WCS) and Stress at Work (SAW), in addition to demographic questions, asking about (age, gender, marital status, resident level, specialty, BMI, smoking, number of days of exercise per week, hours of sleep per day, on-calls per month, clinics per week, operations per week). RESULTS: Of the 99 surgical residents training at KAMC, 73 residents returned the survey with a response rate of 72.8%. The mean age of the residents was 28 ± 2.1 years with the mean BMI of 25 kg/m2. 54.8% were married, and 42.5% were smokers. Half of the residents (50.7%) working in King Abdulaziz Medical City have low work-related quality of life. In comparison between male and female residents' overall Quality of life, there was no significant difference between them (p = 0.363). CONCLUSIONS: Our main study finding is that half of the residents (50.7%) working at KAMC has low work-related quality of life, and there is no significant difference between male and female residents. Further studies are needed to determine the causes and improve the work-related quality of life among surgical residents.

Laparoendoscopic Rendezvous for Concomitant Cholecystocholedocholithiasis: A Successful Modality Even in the Most Difficult Presentations Including Pregnancy.

Background. Laparoendoscopic rendezvous (LERV) technique is emerging as an attractive treatment option for concomitant cholecystocholedocholithiasis. In this paper, we report our experience in performing the LERV technique in patients with unusual presentations in terms of anatomical difficulty, pregnancy, multiple comorbid diseases, and postlaparotomy. We aim to highlight the effectiveness of the LERV technique in some clinical situations where conventional methods would fail or carry high risks in adequately managing concomitant cholecystocholedocholithiasis. Methods. Four patients diagnosed to have concomitant cholecystocholedocholithiasis with associated difficult presentation or comorbid diseases were treated using the LERV technique. One patient presented with difficult anatomy where ERCP failed at initial attempts. Another patient was pregnant (first trimester). A third patient had complex comorbid diseases (bronchial asthma, hypertension, congestive heart failure, and end-stage renal disease on regular hemodialysis). A fourth patient had previous laparotomy and sigmoidectomy for diverticular disease and had severe hospital phobia. Results. All patients tolerated the LERV technique very well; no intraoperative occurrence was reported. The mean operative time was 86.3 ± 17.2 minutes; mean time of the endoscopic part was 29.4 ± 3.57 minutes. The mean blood loss was 44.3 ± 18.2 mL (range 20-85). Residual stone, postoperative complications, postoperative morbidity, and postoperative mortality were 0 (0%). Postoperative short hospital stay was reported in all patients, average 3 days (range 2-4). Conclusion. LERV procedure is a safe and effective treatment option for the management of concomitant cholecystocholedocholithiasis, even in difficult situations where other methods would fail or carry high risks, or in patients presenting with severe comorbid diseases or pregnancy. This procedure may emerge as an attractive alternative option for high-risk patients. A patient's wishes may also influence the selection of this procedure. More scientific studies recruiting more patients should be done in order to standardize the LERV procedure.