Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this pape...Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.展开更多
BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals.An Acute Hospit...BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals.An Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative rehabilitation.The core concept is to transfer patients out of AHs when clinically recommended and into CHs,where they can receive more beneficial dedicated care to aid in their recovery,while freeing up bed capacities in AHs.AIM To analyze the AH length of stay(LOS),costs,and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.METHODS A total of 8621:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital(SGH)before(2017-2018)and after(2019-2021)the care bundle intervention period was analyzed.Outcome measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)scores.The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention,the age distribution,sex,American Society of Anesthesiologists classification,Charlson Comorbidity Index,and surgical approach were comparable between both groups.Patients transferred to CHs after the surgery had a shorter median AH LOS(7 d vs 9 d,P<0.001).The mean total AH inpatient cost per patient was 14.9%less for the elderly group transferred to CHs(S$24497.3 vs S$28772.8,P<0.001).The overall AH U-turn rates for elderly patients within the care bundle were low,with a 0%mortality rate following orthopedic surgery.When elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.001).CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH.Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery.Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.展开更多
Background: Lower limb orthopaedic surgeries are commonly associated with moderate to severe postoperative pain. Adequate pain relief is essential for patients undergoing such procedures, as uncontrolled pain can lead...Background: Lower limb orthopaedic surgeries are commonly associated with moderate to severe postoperative pain. Adequate pain relief is essential for patients undergoing such procedures, as uncontrolled pain can lead to delayed recovery, prolonged hospitalization, and increased morbidity. Intrathecal administration of bupivacaine, a long-acting local anesthetic, has been shown to provide effective analgesia after lower limb orthopaedic surgery. However, the duration of analgesia with bupivacaine alone is limited, and the addition of an opioid, such as morphine, can prolong the duration of analgesia. Objective: The objective of this study was to document the comparative effect of adding morphine to intrathecal bupivacaine or only intrathecal bupivacaine for lower limb trauma orthopedic surgeries in terms of onset of action, duration of analgesia, pain severity, and side effects. Methods: This was a comparative longitudinal study design conducted at the Orthopaedic Unit of the Tamale Teaching Hospital. A simple random sampling technique was used to recruit 60 patients. A standard structured questionnaire was also used to collect data on the socio-demographics, and clinical features of patients, drug used,side effects and severity of pain at 24,48 and 72 hrs after surgery. Results: Co-administration of intrathecal bupivacaine with morphine produced good and long-lasting postoperative analgesia with a mean time of 1004.25 ± 310.43 minutes, whiles using only bupivacaine produced shorter postoperative analgesia with a mean time of 294.75 ± 195.53 minutes. The p-value p values of p = 0.635 and p = 0.689 respectively. Conclusion: The study revealed that co-administration of intrathecal bupivacaine with morphine emerged as a better option for postoperative pain management after lower limb orthopedic surgeries as compared to administering only bupivacaine regarding the duration of analgesia. Milder side effects like pruritus, nausea, and vomiting were seen in group B than in group A and were promptly well managed to the patient’s satisfaction.展开更多
BACKGROUND East Asia is the most dynamic region in the world and includes three major countries:Japan,South Korea and China.Due to rapid economic growth,orthopedics research in East Asia has achieved great advances du...BACKGROUND East Asia is the most dynamic region in the world and includes three major countries:Japan,South Korea and China.Due to rapid economic growth,orthopedics research in East Asia has achieved great advances during the past 10 years.However,the current status of orthopedic research in Japan,South Korea and China is still unclear.AIM To understand the current status of orthopedic research in Japan,South Korea,and China.METHODS Journals listed in the“Orthopedics”category of Science Citation Index Expanded subject categories were included.The PubMed and Web of Knowledge electronic databases were searched to identify scientific publications from the selected journals written by researchers from Japan,South Korea and China.A systematic analysis was conducted to analyze orthopedic research articles published in the three countries based on the number of articles,study design,impact factors(IFs)and citations.Furthermore,we also ranked the top 10 countries worldwide with the highest publications in the past 10 years.Additionally,we ranked the top 10 countries with the highest number of publications in the world in the past 10 years.Statistical analyses were performed using SPSS 20.0 software(SPSS Inc.,Chicago,IL,United States),and statistical results are given in Tables and Figures.The Kruskal-Wallis test and the Mann-Whitney test were used to detect differences between countries.The tendency regarding the number of articles was analyzed by curvilinear regression.A two-tailed P<0.05 was considered significant.RESULTS From 2012-2021,a total of 144518 articles were published in the 86 selected orthopedic journals.During this period,the number of worldwide published orthopedic articles has shown an annual increasing trend.A total of 27164 orthopedic research articles were published by Japan,South Korea and China during the past 10 years;44.32%were from China,32.98%were from Japan,and 22.70%were from South Korea.From 2012 to 2021,the annual number of articles markedly increased in each of the three countries.Over time,the worldwide share of articles increased substantially in South Korea(3.37%to 6.53%,P<0.001)and China(5.29%to 9.61%,P<0.001).However,the worldwide share of articles significantly decreased in Japan(5.22%to 3.80%,P<0.001).The annual total IFs of articles from China were well above those of articles from Japan and South Korea(36597.69 vs 27244.48 vs 20657.83,P<0.05).There was no significant difference among the articles in the top 10 high-IF orthopedics journals published from those three countries[South Korea(800)>China(787)>Japan(646),P>0.05].CONCLUSION Over the past 10 years,China’s scientific publications in orthopedic journals have shown an increasing trend.Considering the relative scale of the populations,Japan and South Korea have outpaced China with respect to quality.展开更多
BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM...BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.展开更多
Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral pals...Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.展开更多
Objective To create an unique new method of digital orthopedic surgery and widely apply to spinal surgery,treatment of bone and joint injuries,ligament reconstruction and repair,bone minor resection and reconstruction...Objective To create an unique new method of digital orthopedic surgery and widely apply to spinal surgery,treatment of bone and joint injuries,ligament reconstruction and repair,bone minor resection and reconstruction,serious bone and展开更多
Objective:To explore the effect of ulinastatin(UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery.Methods:Forty-five patients undergoing major ort...Objective:To explore the effect of ulinastatin(UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery.Methods:Forty-five patients undergoing major orthopedic surgery were randomly divided into three groups:ulinastatin continuous infusion(Uc) group,ulinastatin single injection(Us) group and control(C) group.All patients received patient-controlled intravenous analgesia(PCIA) after operation,and took Rivaroxaban 10 mg orally 12 hours after operation.Ulinastatin(5 000 U/kg)was given intravenously to both Uc and Us groups preoperatively.Group C was given isometric normal saline,group Uc was pumped UTI continuous intravenously at the end of surgery(10 000U/kg) to 48 hours through PCIA pump.The values of hematocrit(HCT),thrombomodulin(TM),Interleukin(IL-6),thrombin-antithrombin complex(TAT),D-Dimer(D-D) were normally tested before surgery(T1),at the end of the surgery(T2),12 hours(T3).24 hours(T4) and 48 hours(T5)after surgery.Results:Compared with T1,there was an upward tendency in TM,IL-6,TAT,and D-D after operation in group C group(P <0.05).The values of them were significandy increased from nearly 24-hour after surgery in Us group(P<0.05).In group Uc.there were no significant changes in these indices after operation(P>0.05).Conclusions:During the perioperative period,ulinastatin continuous infusion combined Rivaroxaban can correct blood hypercoagulability through different approaches in patients undergoing major orthopedic surgery.展开更多
AIM:To investigate the efficacy of lubiprostone compared to Senna on bowel symptoms and constipation in post-operative orthopedic patients treated with opioids.METHODS:In this double blind,randomized,active comparator...AIM:To investigate the efficacy of lubiprostone compared to Senna on bowel symptoms and constipation in post-operative orthopedic patients treated with opioids.METHODS:In this double blind,randomized,active comparator trial,adults who required opioids for analgesia following orthopedic procedures and who were admitted in inpatient rehabilitation were randomized following baseline assessments to lubiprostone(Amitza),orally twice aday or Senna(generic)two capsules administered daily for six days.Subjects were assessed using the patient assessment of constipation(PAC)-symptoms(PAC-SYM)and the PAC-quality of life(PAC-QOL)scales measured at baseline and Day 7;Subjects were assessed daily for secondary measures included the Bristol stool scale bowel consistency,specific bowel symptom score(Nausea,cramping,straining,completeness,abdominal pain,time per lavatory attempt,assistance needed),adverse events and rescue medications required.Function was measured using the functional independence measure(FIM)at admission and discharge;length of stay(LOS)and missed treatments due to gastrointestinal symptoms were also assessed.RESULTS:64 adults were enrolled;56 participants(28 in each group)had baseline and follow up measures and were included in the intention to treat(ITT)analyses.43 participants completed the study,21 in the active lubiprostone and 22 in the active Senna group.The mean age of the participants was 71.5years(SD=11.4 years,range:28-96 years).In the ITT analyses,participants showed significant improvement in bowel symptoms as measured by the PACSYM(mean±SD,-0.28±0.60,range:-1-2.33)and PAC-QOL(mean±SD,0.33±0.81,range:-1.5-2.0)over time,but there were no significant differences between the lubiprostone and Senna groups in mean change in the PAC-SYM(-0.20±0.60 vs-0.36±0.61,P=0.61 respectively)or the PAC-QOL(0.29±0.76 vs0.37±0.87,P=0.61 respectively).The mean change in each bowel symptom also did not significantly differ between treatment groups on ITT analyses,except for completeness of bowel movement,with the Senna group showing greater negative mean change in bowel movement completeness(-0.56±1.01 vs-2.00±1.41,P=0.03)and for reduction of abdominal pain,favoring Senna(-0.14±0.73 vs-0.73±1.08,P=0.04).Fifteen(75%)participants in the lubiprostone and in the Senna group requested rescue treatments.Participants made significant functional improvement from admission to discharge over a median LOS of 12 d,with a mean FIM change of 29.13±13.58 and no significant between group differences(27.0±9.2 vs 31.5±16.6,P=0.27).CONCLUSION:Both lubiprostone and Senna improved constipation-related symptoms and QOL in opioid-induced constipation,with no significant between-group differences.展开更多
Systemic lupus erythematosus(SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of...Systemic lupus erythematosus(SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedicrelated conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to andmanaged prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.展开更多
The association between glucose variability(GV)and adverse perioperative outcomes in type 2 diabetes mellitus(T2DM)patients undergoing orthopedic surgery was investigated.A retrospective cohort study was performed by ...The association between glucose variability(GV)and adverse perioperative outcomes in type 2 diabetes mellitus(T2DM)patients undergoing orthopedic surgery was investigated.A retrospective cohort study was performed by analyzing data on T2DM patients receiving continuous blood glucose(BG)monitoring and continuous subcutaneous insulin infusion treatment due to poorly controlled preoperative BG prior to orthopedic surgery.GV was assessed with coefficient of variation(CV).Postoperative and perioperative CV,hypoglycemia cases,and other perioperative outcomes(diabetes preparation time[DPT],length of stay[LOS],and perioperative and infective complication cases)were analyzed.Results showed that a total of 168 patients were grouped into preoperative CV tertiles:1st(n=56):0–0.2921,2nd(n=58):0.2922–0.3779,and 3rd(n=54):0.3780–0.5750.Fasting blood glucose(FBG),perioperative CV,rate of hypoglycemia cases(OR:5.53,95%CI:2.43–12.59)(all P<0.001)and DPT(P=0.024)were higher in the 3rd than in the 1st tertile.After adjustments of covariates,regression analysis indicated that the 3rd tertile was associated with increased perioperative CV(adjusted coefficient=0.515,P<0.001),DPT(adjusted coefficient=0.169,P=0.073),rate of hypoglycemia cases(OR:6.72,95%CI:2.69−16.82,P<0.001)and perioperative complication cases(OR:2.50,95%CI:0.90−7.01,P=0.080).In conclusion,preoperative GV is associated with increased perioperative GV and adverse perioperative outcomes including longer DPT and higher rates of hypoglycemia and perioperative complications.展开更多
<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous...<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.展开更多
Objective:To analysis the influence of operating room nursing care management on the incidence rate of nosocomial infection in orthopedic surgery patients.Methodology:Fifty six orthopedic surgery patients who admitted...Objective:To analysis the influence of operating room nursing care management on the incidence rate of nosocomial infection in orthopedic surgery patients.Methodology:Fifty six orthopedic surgery patients who admitted into the hospital between January to December 2018 were enrolled into this study and randomly divided into two groups,which were the control group(under general management)and the observation group(under the operating room nursing care management).Further,the incidence rate of nosocomial infections,the incidence rate of irregular nursing care phenomena,the satisfaction score of nursing care management,and the quality of life score were observed and recorded.Result:The incidence rate of nosocomial infection,the incidence rate of irregular nursing care management,the satisfaction score of nursing care management,and the quality of life score of the observation group were compared to that of the control group,and the result showed P<0.05,indicates the statistical significance between the data indicators.Conclusion:The use of operating room nursing care management in patients with orthopedic surgery has shown a significant effect.展开更多
BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors ...BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors and type of anesthesia and analgesia associated with the development of POD.AIM To investigate the following three questions:(1)What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital?(2)Does surgical procedure influence incidence of POD after nonambulatory orthopedic surgery?And(3)For POD after non-ambulatory orthopedic surgery,what are modifiable risk factors?METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014.Patients under 18 years were excluded from the cohort.Patient characteristics and medical history were obtained from electronic medical records.Patients with POD were identified using International Classification of Diseases,9^th Revision(ICD-9)codes that were not present on admission.For incidence analyses,the cohort was grouped into total hip arthroplasty(THA),bilateral THA,total knee arthroplasty(TKA),bilateral TKA,spine fusion,other spine procedures,femur/pelvic fracture,and other procedures using ICD-9 codes.For descriptive and regression analyses,the cohort was grouped,using ICD-9 codes,into THA,TKA,spinal fusions,and all procedures.RESULTS Of 78492 surgical inpatient surgeries,the incidence from 2009 to 2014 was 1.2%with 959 diagnosed with POD.The incidence of POD was higher in patients undergoing spinal fusions(3.3%)than for patients undergoing THA(0.8%);THA patients had the lowest incidence.Also,urgent and/or emergent procedures,defined by femoral and pelvic fractures,had the highest incidence of POD(7.2%)than all other procedures.General anesthesia was not seen as a significant risk factor for POD for any procedure type;however,IV patient-controlled analgesia was a significant risk factor for patients undergoing THA[Odds ratio(OR)=1.98,95%confidence interval(CI):1.19 to 3.28,P=0.008].Significant risk factors for POD included advanced age(for THA,OR=4.9,95%CI:3.0-7.9,P<0.001;for TKA,OR=2.16,95%CI:1.58-2.94,P<0.001),American Society of Anesthesiologists score of 3 or higher(for THA,OR=2.01,95%CI:1.33-3.05,P<0.001),multiple medical comorbidities,hyponatremia(for THA,OR=2.36,95%CI:1.54 to 3.64,P<0.001),parenteral diazepam(for THA,OR=5.05,95%CI:1.5-16.97,P=0.009;for TKA,OR=4.40,95%CI:1.52-12.75,P=0.007;for spine fusion,OR=2.17,95%CI:1.19-3.97,P=0.01),chronic opioid dependence(for THA,OR=7.11,95%CI:3.26-15.51,P<0.001;for TKA,OR=2.98,95%CI:1.38-6.41,P=0.005)and alcohol dependence(for THA,OR=5.05,95%CI:2.72-9.37,P<0.001;for TKA,OR=6.40,95%CI:4.00-10.26,P<0.001;for spine fusion,OR=6.64,95%CI:3.72-11.85,P<0.001).CONCLUSION POD is lower(1.2%)than previously reported;likely due to the use of multimodal regional anesthesia and early ambulation.Both fixed and modifiable factors are identified.展开更多
Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as t...Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as trauma, tumor, sepsis, or vascular disease, may necessitate hand salvage. The most frequent argument among surgeon from different subspecialties (orthopedics, plastics, trauma, and vascular surgery) are characterized by in what way each one can do his own part of the salvage operation, be it bony fixation, revascularization, or soft-tissue coverage, but none of them is sure whether it should be endeavored. What is necessary in such clinical situations is an interdisciplinary team attitude led by individual or groups of clinicians who are conversant not only with their identifiable subspecialized skills but also with those of their coworkers and the consequences accompanying the joined efforts at hand salvage. The perception of orthoplastic surgery is based on such an indication, where the integrated skills and techniques of the orthopedic surgeon and reconstructive microsurgeon are performed in recital to direct efforts concerning hand salvage or choose against it when it is not designated. The current article reviews the roles of orthopedic and plastic surgery and how this team can deal with the existing techniques to improve outcomes in hand salvage surgery.展开更多
Background:Venous thromboembolism(VTE)is a common postoperative complication in orthopedic surgery and warrants the use of pharmacologic thromboprophylaxis.The purpose of this study was to analyze current prescribing ...Background:Venous thromboembolism(VTE)is a common postoperative complication in orthopedic surgery and warrants the use of pharmacologic thromboprophylaxis.The purpose of this study was to analyze current prescribing practices at our institution and to assess outcomes of pharmacologic strategies used for VTE prophylaxis following major orthopedic surgery.Methods:This was a single center,retrospective analysis at a tertiary academic medical center.Patients were included if they were admitted for total hip or knee arthroplasties and received pharmacologic thromboprophylaxis(warfarin INR goal 1.8-2.3,aspirin at variable doses,low molecular weight heparin(LMWH),DOAC)post-operatively from January 2017 to June 2017.Patients were excluded if they had a history of VTE or were on long-term anticoagulation.Major endpoints included incidence of thrombotic and bleeding events within 30 days post-surgery.Results:A total of 476 patients were screened;89 were excluded and 387 were included(warfarin=183,aspirin=201,LMWH=2,apixaban=1).Two patients in the warfarin group experienced a deep vein thrombosis compared with one patient in the aspirin group(p=0.51).Major bleeding occurred in one patient in the warfarin group and none in the aspirin group.Total bleeding rates occurred in 2.7%and 1.0%in the warfarin and aspirin groups,respectively.Conclusion:There has been an increase in the use of aspirin at our facility in postoperative orthopedic surgery patients without an increase in DOAC use.No difference was detected in safety and efficacy endpoints in our warfarin versus aspirin patients.展开更多
Objective:To study the effect of parecoxib sodium intervention before induction on incision pain and inflammatory stress response after orthopedic surgery.Methods: Patients who underwent orthopedic surgery under lumba...Objective:To study the effect of parecoxib sodium intervention before induction on incision pain and inflammatory stress response after orthopedic surgery.Methods: Patients who underwent orthopedic surgery under lumbar anesthesia combined with epidural block anesthesia in Mianyang Central Hospital between March 2015 and June 2017 were selected and divided into two groups by random number table method, Par group received parecoxib sodium intervention before induction combined with routine postoperative patient-controlled intravenous analgesia, and control group only accepted routine postoperative patient-controlled intravenous analgesia. The pain neurotransmitters, inflammatory molecules and stress molecules in serum and peripheral blood were measured before surgery as well as 1 day and 3 days after surgery.Results: Compared with pain neurotransmitters of same group before surgery, serum PGE2, 5-HT, SP, NPY levels of both groups were significantly lower whereas serum COR and GH levels and peripheral blood JAK2, STAT3, IL-1, IL-6, IFIT1, Nrf2 and HO-1 mRNA expression were significantly higher 1 day and 3 days after surgery, and serum PGE2, 5-HT, SP, NPY, COR and GH levels as well as peripheral blood JAK2, STAT3, IL-1, IL-6, IFIT1, Nrf2 and HO-1 mRNA expression of Par group 1 day and 3 days after surgery were lower than those of control group.Conclusions: Parecoxib sodium intervention before induction can reduce the incision pain and inflammatory stress response after orthopedic surgery.展开更多
Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were sur...Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009. Results Totally, 208 surgeons (71.0%) responded, successfully completing the questionnaire. Of them, 57.6% respondents selected combined basic, mechanical, and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients' special conditions and needs upon discharge. "Safety" was the most repeated and emphasized factor during VTE prophylaxis. Conclusions Multimodal thromboprophylaxis is frequently used after major orthopedic surgery. Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery. Thromboprophylaxis regimen varies for discharged patients.展开更多
Objective:To study the effect of flurbiprofen axetil intervention before induction on incision pain and inflammatory stress response after orthopedic surgery.Methods: A total of 86 cases of elderly patients who underw...Objective:To study the effect of flurbiprofen axetil intervention before induction on incision pain and inflammatory stress response after orthopedic surgery.Methods: A total of 86 cases of elderly patients who underwent operative treatment of femoral neck fracture in Guangyuan Hospital of Traditional Chinese Medicine between March 2014 and December 2017 were selected as the research subjects. All patients were randomly divided into the experimental group who accepted flurbiprofen axetil intervention before induction + routine anesthesia induction and maintenance, and the control group who accepted routine anesthesia induction and maintenance, and each group included 43 cases. The pain levels of the two groups were assessed 24 h after surgery;the levels of pain mediators and inflammatory stress molecules in serum as well as the expression intensity of inflammatory stress molecules in peripheral blood were determined before surgery and 24 h after surgery.Results:24 h after surgery, serum SP, NPY, PGE2, TNF-α, IL-1β, IL-18, ACTH, COR and NE levels as well as peripheral blood NF-κB, NLRP3, Caspase-1, GLUT4 and FOXP3 expression intensity of both groups were significantly higher than those before surgery, and NRS pain score, serum SP, NPY, PGE2, TNF- , IL-1β, IL-18, ACTH, COR and NE levels as well as peripheral blood NF-κB, NLRP3, Caspase-1, GLUT4 and FOXP3 expression intensity of experimental group 24 h after surgery were significantly lower than those of control group.Conclusions:Flurbiprofen axetil intervention before induction can improve and inhibit the incision pain and inflammatory stress response after orthopedic surgery.展开更多
基金Natural Science Foundation of Xinjiang Uygur Autonomous Region(No.2019D01C244)Special Research Project for Health and Young Medical Science and Technology Talents in Xinjiang Uygur Autonomous Region(No.WJWY-202142)。
文摘Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.
文摘BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals.An Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative rehabilitation.The core concept is to transfer patients out of AHs when clinically recommended and into CHs,where they can receive more beneficial dedicated care to aid in their recovery,while freeing up bed capacities in AHs.AIM To analyze the AH length of stay(LOS),costs,and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.METHODS A total of 8621:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital(SGH)before(2017-2018)and after(2019-2021)the care bundle intervention period was analyzed.Outcome measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)scores.The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention,the age distribution,sex,American Society of Anesthesiologists classification,Charlson Comorbidity Index,and surgical approach were comparable between both groups.Patients transferred to CHs after the surgery had a shorter median AH LOS(7 d vs 9 d,P<0.001).The mean total AH inpatient cost per patient was 14.9%less for the elderly group transferred to CHs(S$24497.3 vs S$28772.8,P<0.001).The overall AH U-turn rates for elderly patients within the care bundle were low,with a 0%mortality rate following orthopedic surgery.When elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.001).CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH.Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery.Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.
文摘Background: Lower limb orthopaedic surgeries are commonly associated with moderate to severe postoperative pain. Adequate pain relief is essential for patients undergoing such procedures, as uncontrolled pain can lead to delayed recovery, prolonged hospitalization, and increased morbidity. Intrathecal administration of bupivacaine, a long-acting local anesthetic, has been shown to provide effective analgesia after lower limb orthopaedic surgery. However, the duration of analgesia with bupivacaine alone is limited, and the addition of an opioid, such as morphine, can prolong the duration of analgesia. Objective: The objective of this study was to document the comparative effect of adding morphine to intrathecal bupivacaine or only intrathecal bupivacaine for lower limb trauma orthopedic surgeries in terms of onset of action, duration of analgesia, pain severity, and side effects. Methods: This was a comparative longitudinal study design conducted at the Orthopaedic Unit of the Tamale Teaching Hospital. A simple random sampling technique was used to recruit 60 patients. A standard structured questionnaire was also used to collect data on the socio-demographics, and clinical features of patients, drug used,side effects and severity of pain at 24,48 and 72 hrs after surgery. Results: Co-administration of intrathecal bupivacaine with morphine produced good and long-lasting postoperative analgesia with a mean time of 1004.25 ± 310.43 minutes, whiles using only bupivacaine produced shorter postoperative analgesia with a mean time of 294.75 ± 195.53 minutes. The p-value p values of p = 0.635 and p = 0.689 respectively. Conclusion: The study revealed that co-administration of intrathecal bupivacaine with morphine emerged as a better option for postoperative pain management after lower limb orthopedic surgeries as compared to administering only bupivacaine regarding the duration of analgesia. Milder side effects like pruritus, nausea, and vomiting were seen in group B than in group A and were promptly well managed to the patient’s satisfaction.
基金Supported by National Natural Science Foundation of China,No.81860406Guangxi Natural Science Foundation,No.2023GXNSFAA026339Medical Excellence Award Funded by the Creative Research Development Grant from the First Affiliated Hospital of Guangxi Medical University.
文摘BACKGROUND East Asia is the most dynamic region in the world and includes three major countries:Japan,South Korea and China.Due to rapid economic growth,orthopedics research in East Asia has achieved great advances during the past 10 years.However,the current status of orthopedic research in Japan,South Korea and China is still unclear.AIM To understand the current status of orthopedic research in Japan,South Korea,and China.METHODS Journals listed in the“Orthopedics”category of Science Citation Index Expanded subject categories were included.The PubMed and Web of Knowledge electronic databases were searched to identify scientific publications from the selected journals written by researchers from Japan,South Korea and China.A systematic analysis was conducted to analyze orthopedic research articles published in the three countries based on the number of articles,study design,impact factors(IFs)and citations.Furthermore,we also ranked the top 10 countries worldwide with the highest publications in the past 10 years.Additionally,we ranked the top 10 countries with the highest number of publications in the world in the past 10 years.Statistical analyses were performed using SPSS 20.0 software(SPSS Inc.,Chicago,IL,United States),and statistical results are given in Tables and Figures.The Kruskal-Wallis test and the Mann-Whitney test were used to detect differences between countries.The tendency regarding the number of articles was analyzed by curvilinear regression.A two-tailed P<0.05 was considered significant.RESULTS From 2012-2021,a total of 144518 articles were published in the 86 selected orthopedic journals.During this period,the number of worldwide published orthopedic articles has shown an annual increasing trend.A total of 27164 orthopedic research articles were published by Japan,South Korea and China during the past 10 years;44.32%were from China,32.98%were from Japan,and 22.70%were from South Korea.From 2012 to 2021,the annual number of articles markedly increased in each of the three countries.Over time,the worldwide share of articles increased substantially in South Korea(3.37%to 6.53%,P<0.001)and China(5.29%to 9.61%,P<0.001).However,the worldwide share of articles significantly decreased in Japan(5.22%to 3.80%,P<0.001).The annual total IFs of articles from China were well above those of articles from Japan and South Korea(36597.69 vs 27244.48 vs 20657.83,P<0.05).There was no significant difference among the articles in the top 10 high-IF orthopedics journals published from those three countries[South Korea(800)>China(787)>Japan(646),P>0.05].CONCLUSION Over the past 10 years,China’s scientific publications in orthopedic journals have shown an increasing trend.Considering the relative scale of the populations,Japan and South Korea have outpaced China with respect to quality.
文摘BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.
文摘Objective: To compare and analyze the effect and safety of double tube laryngeal mask and endotracheal intubation general anesthesia in fast track anesthesia for limb orthopaedic surgery in children with cerebral palsy. Methods: 78 children with cerebral palsy undergoing limb orthopedic surgery were randomly divided into laryngeal mask group and intubation group, with 39 cases in each group. The perioperative hemodynamic indexes, anesthesia effect related indexes, anesthesia related complications or adverse reaction rates of the two groups were observed and compared between the two groups. Results: When the two groups of children entered the room, there was no significant difference in MAP and HR (P > 0.05);MAP and HR of children in the intubation group were higher than those in the laryngeal mask anesthesia group (P Conclusion: Laryngeal mask is used to establish the airway of intravenous general anesthesia in limb orthopaedic surgery of children with cerebral palsy, which is conducive to the stability of children’s circulatory and respiratory system, to reduce the impact of narcotic drugs on children, to reduce the incidence of postoperative anesthesia related complications, and to improve the anesthetic effect. It meets the requirements of fast track anesthesia, and can be widely used in clinical practice.
文摘Objective To create an unique new method of digital orthopedic surgery and widely apply to spinal surgery,treatment of bone and joint injuries,ligament reconstruction and repair,bone minor resection and reconstruction,serious bone and
基金supported in part by Scientific Research Fund of Hainan Provincial Health Department(No.2010-83)
文摘Objective:To explore the effect of ulinastatin(UTI) continuous infusion combined Rivaroxaban on the deep vein thrombosis in patients undergoing major orthopedic surgery.Methods:Forty-five patients undergoing major orthopedic surgery were randomly divided into three groups:ulinastatin continuous infusion(Uc) group,ulinastatin single injection(Us) group and control(C) group.All patients received patient-controlled intravenous analgesia(PCIA) after operation,and took Rivaroxaban 10 mg orally 12 hours after operation.Ulinastatin(5 000 U/kg)was given intravenously to both Uc and Us groups preoperatively.Group C was given isometric normal saline,group Uc was pumped UTI continuous intravenously at the end of surgery(10 000U/kg) to 48 hours through PCIA pump.The values of hematocrit(HCT),thrombomodulin(TM),Interleukin(IL-6),thrombin-antithrombin complex(TAT),D-Dimer(D-D) were normally tested before surgery(T1),at the end of the surgery(T2),12 hours(T3).24 hours(T4) and 48 hours(T5)after surgery.Results:Compared with T1,there was an upward tendency in TM,IL-6,TAT,and D-D after operation in group C group(P <0.05).The values of them were significandy increased from nearly 24-hour after surgery in Us group(P<0.05).In group Uc.there were no significant changes in these indices after operation(P>0.05).Conclusions:During the perioperative period,ulinastatin continuous infusion combined Rivaroxaban can correct blood hypercoagulability through different approaches in patients undergoing major orthopedic surgery.
基金Supported by A grant from Takeda Pharmaceuticals North America,Inc
文摘AIM:To investigate the efficacy of lubiprostone compared to Senna on bowel symptoms and constipation in post-operative orthopedic patients treated with opioids.METHODS:In this double blind,randomized,active comparator trial,adults who required opioids for analgesia following orthopedic procedures and who were admitted in inpatient rehabilitation were randomized following baseline assessments to lubiprostone(Amitza),orally twice aday or Senna(generic)two capsules administered daily for six days.Subjects were assessed using the patient assessment of constipation(PAC)-symptoms(PAC-SYM)and the PAC-quality of life(PAC-QOL)scales measured at baseline and Day 7;Subjects were assessed daily for secondary measures included the Bristol stool scale bowel consistency,specific bowel symptom score(Nausea,cramping,straining,completeness,abdominal pain,time per lavatory attempt,assistance needed),adverse events and rescue medications required.Function was measured using the functional independence measure(FIM)at admission and discharge;length of stay(LOS)and missed treatments due to gastrointestinal symptoms were also assessed.RESULTS:64 adults were enrolled;56 participants(28 in each group)had baseline and follow up measures and were included in the intention to treat(ITT)analyses.43 participants completed the study,21 in the active lubiprostone and 22 in the active Senna group.The mean age of the participants was 71.5years(SD=11.4 years,range:28-96 years).In the ITT analyses,participants showed significant improvement in bowel symptoms as measured by the PACSYM(mean±SD,-0.28±0.60,range:-1-2.33)and PAC-QOL(mean±SD,0.33±0.81,range:-1.5-2.0)over time,but there were no significant differences between the lubiprostone and Senna groups in mean change in the PAC-SYM(-0.20±0.60 vs-0.36±0.61,P=0.61 respectively)or the PAC-QOL(0.29±0.76 vs0.37±0.87,P=0.61 respectively).The mean change in each bowel symptom also did not significantly differ between treatment groups on ITT analyses,except for completeness of bowel movement,with the Senna group showing greater negative mean change in bowel movement completeness(-0.56±1.01 vs-2.00±1.41,P=0.03)and for reduction of abdominal pain,favoring Senna(-0.14±0.73 vs-0.73±1.08,P=0.04).Fifteen(75%)participants in the lubiprostone and in the Senna group requested rescue treatments.Participants made significant functional improvement from admission to discharge over a median LOS of 12 d,with a mean FIM change of 29.13±13.58 and no significant between group differences(27.0±9.2 vs 31.5±16.6,P=0.27).CONCLUSION:Both lubiprostone and Senna improved constipation-related symptoms and QOL in opioid-induced constipation,with no significant between-group differences.
文摘Systemic lupus erythematosus(SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedicrelated conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to andmanaged prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.
基金This study was supported by Science and Technology Program of Guangzhou,China(No.201604020007)。
文摘The association between glucose variability(GV)and adverse perioperative outcomes in type 2 diabetes mellitus(T2DM)patients undergoing orthopedic surgery was investigated.A retrospective cohort study was performed by analyzing data on T2DM patients receiving continuous blood glucose(BG)monitoring and continuous subcutaneous insulin infusion treatment due to poorly controlled preoperative BG prior to orthopedic surgery.GV was assessed with coefficient of variation(CV).Postoperative and perioperative CV,hypoglycemia cases,and other perioperative outcomes(diabetes preparation time[DPT],length of stay[LOS],and perioperative and infective complication cases)were analyzed.Results showed that a total of 168 patients were grouped into preoperative CV tertiles:1st(n=56):0–0.2921,2nd(n=58):0.2922–0.3779,and 3rd(n=54):0.3780–0.5750.Fasting blood glucose(FBG),perioperative CV,rate of hypoglycemia cases(OR:5.53,95%CI:2.43–12.59)(all P<0.001)and DPT(P=0.024)were higher in the 3rd than in the 1st tertile.After adjustments of covariates,regression analysis indicated that the 3rd tertile was associated with increased perioperative CV(adjusted coefficient=0.515,P<0.001),DPT(adjusted coefficient=0.169,P=0.073),rate of hypoglycemia cases(OR:6.72,95%CI:2.69−16.82,P<0.001)and perioperative complication cases(OR:2.50,95%CI:0.90−7.01,P=0.080).In conclusion,preoperative GV is associated with increased perioperative GV and adverse perioperative outcomes including longer DPT and higher rates of hypoglycemia and perioperative complications.
文摘<strong>Background:</strong> <span "=""><span>Anticipating postoperative evolution in surgical patients is an important issue in our daily practice. We demonstrated in a previous study </span><span>that there were multiple predictors of postoperative outcome, including</span><span> American Society of Anesthesiologists status (ASA), transfusion, emergency, surgery and age. A secondary analysis describing intraoperative and postoperative outcomes was undertaken in children aged between 6 and 10 years old included in the initial study. </span><b><span>Objective: </span></b><span>To describe intraoperative and postoperative outcomes in children aged between 6 and 10 years old included in the initial cohort in abdominal surgery, neurosurgery and orthopedics. </span><b><span>Methods: </span></b><span>The secondary analysis of postoperative outcomes in children aged between 6 and 10 years old w</span></span><span>as</span><span "=""><span> retrospectively included in the initial study of 594 patients. The study was approved by the Ethics Committee. </span><b><span>Results: </span></b><span>There were 88 patients with a mean age of 98.7 ±</span></span><span "=""> </span><span "=""><span>13.8 months. The most common surgical interventions were scoliosis in 23 patients (26.1%), limb tumor resection in 8 patients (9.1%), femoral osteotomy in 6 patients (6.8%), intracerebral tumor resection in 6 patients (6.8%), intestinal resection in 5 patients (5.6%), Chiari’s malformation in 4 patients (4.5%), pelvic osteotomy in 4 patients (4.5%) and renal transplantation in 4 patients (4.5%). Most patients (45%) were American Society of Anesthesiologists grade 3 (ASA 3), and 13 (14.8%) were ASA grade 4. Twenty-two (25%) patients had intraoperative and/or postoperative complications (organ dysfunction or sepsis). Two patients (2.3%) had intraoperative hemorrhage, 1 patient (1.1%) had intraoperative difficult intubation, and 1 patient experienced intraoperative anaphy</span><span>laxis. Nine patients (10.2%) had postoperative neurologic failure, and 2</span><span> (2.3%) had postoperative cardio-circulatory failure. Three patients (3.4%) had postoperative septicemia, 2 patients (2.3%) had postoperative pulmonary and urinary sepsis, and 1 patient (1.1%) had postoperative abdominal sepsis. 3 patients (3.4%) had re-operations. 42</span></span><span "=""> </span><span>(47.7%) patients had intra-operative transfusion. There was 1 in-hospital death (1.1%). The median total length of hospital stay was 9 days [5</span><span "=""> </span><span>-</span><span "=""> </span><span "=""><span>16]. </span><b><span>Conclusion: </span></b><span>Twenty-five percent of the patients had intraoperative and/or postoperative complications, and most of them were ASA grade </span></span><span>3</span><span> 3. Integrating goal-directed therapies to optimize intraoperative management in these patients could be necessary to improve postoperative outcomes in surgical pediatric patients.
文摘Objective:To analysis the influence of operating room nursing care management on the incidence rate of nosocomial infection in orthopedic surgery patients.Methodology:Fifty six orthopedic surgery patients who admitted into the hospital between January to December 2018 were enrolled into this study and randomly divided into two groups,which were the control group(under general management)and the observation group(under the operating room nursing care management).Further,the incidence rate of nosocomial infections,the incidence rate of irregular nursing care phenomena,the satisfaction score of nursing care management,and the quality of life score were observed and recorded.Result:The incidence rate of nosocomial infection,the incidence rate of irregular nursing care management,the satisfaction score of nursing care management,and the quality of life score of the observation group were compared to that of the control group,and the result showed P<0.05,indicates the statistical significance between the data indicators.Conclusion:The use of operating room nursing care management in patients with orthopedic surgery has shown a significant effect.
文摘BACKGROUND Postoperative delirium(POD)is one of the most common complications in older adult patients undergoing elective surgery.Few studies have compared,within the same institution,the type of surgery,risk factors and type of anesthesia and analgesia associated with the development of POD.AIM To investigate the following three questions:(1)What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital?(2)Does surgical procedure influence incidence of POD after nonambulatory orthopedic surgery?And(3)For POD after non-ambulatory orthopedic surgery,what are modifiable risk factors?METHODS A retrospective cohort study was conducted of all non-ambulatory orthopedic surgeries at a single orthopedic specialty hospital between 2009 and 2014.Patients under 18 years were excluded from the cohort.Patient characteristics and medical history were obtained from electronic medical records.Patients with POD were identified using International Classification of Diseases,9^th Revision(ICD-9)codes that were not present on admission.For incidence analyses,the cohort was grouped into total hip arthroplasty(THA),bilateral THA,total knee arthroplasty(TKA),bilateral TKA,spine fusion,other spine procedures,femur/pelvic fracture,and other procedures using ICD-9 codes.For descriptive and regression analyses,the cohort was grouped,using ICD-9 codes,into THA,TKA,spinal fusions,and all procedures.RESULTS Of 78492 surgical inpatient surgeries,the incidence from 2009 to 2014 was 1.2%with 959 diagnosed with POD.The incidence of POD was higher in patients undergoing spinal fusions(3.3%)than for patients undergoing THA(0.8%);THA patients had the lowest incidence.Also,urgent and/or emergent procedures,defined by femoral and pelvic fractures,had the highest incidence of POD(7.2%)than all other procedures.General anesthesia was not seen as a significant risk factor for POD for any procedure type;however,IV patient-controlled analgesia was a significant risk factor for patients undergoing THA[Odds ratio(OR)=1.98,95%confidence interval(CI):1.19 to 3.28,P=0.008].Significant risk factors for POD included advanced age(for THA,OR=4.9,95%CI:3.0-7.9,P<0.001;for TKA,OR=2.16,95%CI:1.58-2.94,P<0.001),American Society of Anesthesiologists score of 3 or higher(for THA,OR=2.01,95%CI:1.33-3.05,P<0.001),multiple medical comorbidities,hyponatremia(for THA,OR=2.36,95%CI:1.54 to 3.64,P<0.001),parenteral diazepam(for THA,OR=5.05,95%CI:1.5-16.97,P=0.009;for TKA,OR=4.40,95%CI:1.52-12.75,P=0.007;for spine fusion,OR=2.17,95%CI:1.19-3.97,P=0.01),chronic opioid dependence(for THA,OR=7.11,95%CI:3.26-15.51,P<0.001;for TKA,OR=2.98,95%CI:1.38-6.41,P=0.005)and alcohol dependence(for THA,OR=5.05,95%CI:2.72-9.37,P<0.001;for TKA,OR=6.40,95%CI:4.00-10.26,P<0.001;for spine fusion,OR=6.64,95%CI:3.72-11.85,P<0.001).CONCLUSION POD is lower(1.2%)than previously reported;likely due to the use of multimodal regional anesthesia and early ambulation.Both fixed and modifiable factors are identified.
文摘Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as trauma, tumor, sepsis, or vascular disease, may necessitate hand salvage. The most frequent argument among surgeon from different subspecialties (orthopedics, plastics, trauma, and vascular surgery) are characterized by in what way each one can do his own part of the salvage operation, be it bony fixation, revascularization, or soft-tissue coverage, but none of them is sure whether it should be endeavored. What is necessary in such clinical situations is an interdisciplinary team attitude led by individual or groups of clinicians who are conversant not only with their identifiable subspecialized skills but also with those of their coworkers and the consequences accompanying the joined efforts at hand salvage. The perception of orthoplastic surgery is based on such an indication, where the integrated skills and techniques of the orthopedic surgeon and reconstructive microsurgeon are performed in recital to direct efforts concerning hand salvage or choose against it when it is not designated. The current article reviews the roles of orthopedic and plastic surgery and how this team can deal with the existing techniques to improve outcomes in hand salvage surgery.
文摘Background:Venous thromboembolism(VTE)is a common postoperative complication in orthopedic surgery and warrants the use of pharmacologic thromboprophylaxis.The purpose of this study was to analyze current prescribing practices at our institution and to assess outcomes of pharmacologic strategies used for VTE prophylaxis following major orthopedic surgery.Methods:This was a single center,retrospective analysis at a tertiary academic medical center.Patients were included if they were admitted for total hip or knee arthroplasties and received pharmacologic thromboprophylaxis(warfarin INR goal 1.8-2.3,aspirin at variable doses,low molecular weight heparin(LMWH),DOAC)post-operatively from January 2017 to June 2017.Patients were excluded if they had a history of VTE or were on long-term anticoagulation.Major endpoints included incidence of thrombotic and bleeding events within 30 days post-surgery.Results:A total of 476 patients were screened;89 were excluded and 387 were included(warfarin=183,aspirin=201,LMWH=2,apixaban=1).Two patients in the warfarin group experienced a deep vein thrombosis compared with one patient in the aspirin group(p=0.51).Major bleeding occurred in one patient in the warfarin group and none in the aspirin group.Total bleeding rates occurred in 2.7%and 1.0%in the warfarin and aspirin groups,respectively.Conclusion:There has been an increase in the use of aspirin at our facility in postoperative orthopedic surgery patients without an increase in DOAC use.No difference was detected in safety and efficacy endpoints in our warfarin versus aspirin patients.
文摘Objective:To study the effect of parecoxib sodium intervention before induction on incision pain and inflammatory stress response after orthopedic surgery.Methods: Patients who underwent orthopedic surgery under lumbar anesthesia combined with epidural block anesthesia in Mianyang Central Hospital between March 2015 and June 2017 were selected and divided into two groups by random number table method, Par group received parecoxib sodium intervention before induction combined with routine postoperative patient-controlled intravenous analgesia, and control group only accepted routine postoperative patient-controlled intravenous analgesia. The pain neurotransmitters, inflammatory molecules and stress molecules in serum and peripheral blood were measured before surgery as well as 1 day and 3 days after surgery.Results: Compared with pain neurotransmitters of same group before surgery, serum PGE2, 5-HT, SP, NPY levels of both groups were significantly lower whereas serum COR and GH levels and peripheral blood JAK2, STAT3, IL-1, IL-6, IFIT1, Nrf2 and HO-1 mRNA expression were significantly higher 1 day and 3 days after surgery, and serum PGE2, 5-HT, SP, NPY, COR and GH levels as well as peripheral blood JAK2, STAT3, IL-1, IL-6, IFIT1, Nrf2 and HO-1 mRNA expression of Par group 1 day and 3 days after surgery were lower than those of control group.Conclusions: Parecoxib sodium intervention before induction can reduce the incision pain and inflammatory stress response after orthopedic surgery.
文摘Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009. Results Totally, 208 surgeons (71.0%) responded, successfully completing the questionnaire. Of them, 57.6% respondents selected combined basic, mechanical, and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients' special conditions and needs upon discharge. "Safety" was the most repeated and emphasized factor during VTE prophylaxis. Conclusions Multimodal thromboprophylaxis is frequently used after major orthopedic surgery. Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery. Thromboprophylaxis regimen varies for discharged patients.
文摘Objective:To study the effect of flurbiprofen axetil intervention before induction on incision pain and inflammatory stress response after orthopedic surgery.Methods: A total of 86 cases of elderly patients who underwent operative treatment of femoral neck fracture in Guangyuan Hospital of Traditional Chinese Medicine between March 2014 and December 2017 were selected as the research subjects. All patients were randomly divided into the experimental group who accepted flurbiprofen axetil intervention before induction + routine anesthesia induction and maintenance, and the control group who accepted routine anesthesia induction and maintenance, and each group included 43 cases. The pain levels of the two groups were assessed 24 h after surgery;the levels of pain mediators and inflammatory stress molecules in serum as well as the expression intensity of inflammatory stress molecules in peripheral blood were determined before surgery and 24 h after surgery.Results:24 h after surgery, serum SP, NPY, PGE2, TNF-α, IL-1β, IL-18, ACTH, COR and NE levels as well as peripheral blood NF-κB, NLRP3, Caspase-1, GLUT4 and FOXP3 expression intensity of both groups were significantly higher than those before surgery, and NRS pain score, serum SP, NPY, PGE2, TNF- , IL-1β, IL-18, ACTH, COR and NE levels as well as peripheral blood NF-κB, NLRP3, Caspase-1, GLUT4 and FOXP3 expression intensity of experimental group 24 h after surgery were significantly lower than those of control group.Conclusions:Flurbiprofen axetil intervention before induction can improve and inhibit the incision pain and inflammatory stress response after orthopedic surgery.
