Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Factors affecting mortality and morbidity in acute pancreatitis

We aimed to reveal the parameters that may be early predictors of mortality and morbidity by examining the data of patients with acute pancreatitis. In this study, demographic, clinical and biochemical parameters of 273 patients treated with the diagnosis of acute pancreatitis between 2010 and 2016 were scanned. Age, sex, comorbidity, history of operation, application method, clinical information about the etiology of pancreatitis, hemogram and biochemical parameters, Ranson values, morbidity and mortality findings were recorded. Of the 273 patients, whose mean age ranged from 18 to 98 (mean±sd: 56.94±19.21), 105 were male and 168 were female. Mortality developed in 3% of the patients (n=8), and a statistically significant difference was found between patients with and without mortality concerning age, the time between symptom and admission, presence of comorbidity, operation, Ranson scores, hypocalcemia and CRP values. Morbidity developed in 49.1% (n=134) of the patients, and when the patients with and without morbidity were compared, statistically significant difference was found concerning the female sex, presence of comorbidity, hyperglycemia, neutrophil to lymphocyte ratio (NLR), BUN, ALT, GGT, CRP, BUN, Ca values and Ranson scores. According to the Logistic Regression Analysis of the parameters that give significant results, Ranson 48th-hour measurements, admission time and age can predict mortality best, respectively, while 48th-hour Ranson value, CRP and NLR can best predict morbidity, respectively. [Med-Science 2022; 11(2.000): 566-73

Appendico-Ileal Fistula: A Rare Image

We present a rare image where an acutely inflammed appendix entered and perforated the terminal ileum. This became a presentable rare image after we converted a laparoscopic attempt to do appendisectomy in this patient in an open surgery. The patient was managed by simple appendisectomy without burying the stump and closing the ileal perforation after freshening the margins in two layers using 3-0 Polyglactin

Evaluation of the findings affecting the treatment decision in cases of adhesive intestinal obstruction

To establish a standard approach in patient management by determining the parameters that affect the decision of surgical or conservative treatment in adhesive small bowel obstructions. 94 patients who were admitted to the emergency department with symptoms of ileus and were diagnosed with adhesive intestinal obstruction according to clinical, examination and imaging findings were grouped as patients who were followed up with conservative methods (Group 1) and patients who underwent surgery (Group 2). All patients' laboratory values (hemoglobin, white blood cell (WBC), C- reactive protein (CRP), Blodd urea nitrogen (BUN)/creatinin, sodium, potassium, Lactate dehydrogenase (LDH), lactate and amylase) and imaging findings (air-fluid level in direct abdominal X-ray, increase in small intestine diameter (≥3.95 cm) in computerized tomography), wall thickness increase (>3mm), transition zone, fecal sign, and presence of contrast in the colon) were evaluated, and criteria for early surgery and non-operative follow-up-treatment criteria were determined. 72% (n:68) of the patients were classified as Group 1 and 28% (n:26) as Group 2, and no significant difference was found between the groups according to age and gender. Surgical treatment with increased lactate (r:0.326, p=0.001), diameter increase in the small intestine (r:0.299, p=0.003) and wall thickness increase (r:0.540, p [Med-Science 2023; 12(1.000): 217-23

Evaluation of the Appearance Characteristics of Suspicious Microcalcifications Detected by Ultrasonography

Objective: To investigate the imaging properties of mammographically suspicious microcalcifications (MC) that can be detected by ultrasonography (USG)

Comparison of Olfactory Cleft Width and Volumes in Patients with COVID-19 Anosmia and COVID-19 Cases Without Anosmia

Introduction: The aim of this study was to assess the relationship between olfactory cleft width/volume and COVID-19-related anosmia. Methods: This study consisted of PCR-proven COVID-19 patients. Cases with COVID-19-related anosmia constituted Group 1 and cases without any olfactory dysfunction (OD) throughout COVID-19 infection or after recovery constituted Group 2. A total of 50 patients were included in the study, comprising 24 cases in Group 1 and 26 cases in Group 2. Group 1 patients underwent a 4-item-odor identification test during active symptoms and a Sniffin' Sticks test after reconversion of PCR results to negative. All patients in Group 2 also underwent the Sniffin' Stick test to document normosmia. All cases had paranasal sinus CT performed. Olfactory cleft widths and olfactory volumes were measured. The differences in width and volume between groups and the correlation with odor test scores (threshold-discrimination-identification [TDI]) were calculated. In addition, regression analyzes analysis was performed for cleft widths, volumes, and TDI scores according to age. Results: Olfactory cleft widths and olfactory volumes were significantly higher in Group 1 than those in Group 2 (p = 0.001; p < 0.01). There was a significant negative correlation between total TDI scores and olfactory cleft widths and total olfactory volumes (r = -0.665; r = -0.731, respectively). Patients younger than 40 years of age had significantly higher right olfactory cleft width, left olfactory cleft width, and olfactory cleft volume than those in patients older than 40 years of age (p = 0.004, p = 0.005, p = 0.003; p < 0,01, respectively). However, patients younger than 40 years of age had a significantly lower total TDI score and in all other values individually (t-d-i) than those in patients older than 40 years of age (p = 0.004; p < 0.01). Conclusion: Patients with COVID-19-related OD had larger olfactory cleft width and volumes than those without OD in this study. Total TDI score was found to be inversely correlated with cleft width and volume

Evaluation of Multiparametric Shear Wave Elastography Indices in Malignant and Benign Breast Lesions

Rationale and Objectives: To evaluate the shear wave elastography indices (multiparametric SWE) of breast lesions based on patient and lesion dependent features and assess the contribution of different elastographic parameters to radiological diagnosis

Acute Enteric Eosinophilic Myenteric Ganglionitis: A challenging and uncommon case of lung adenocarcinoma

Chronic intestinal pseudo-obstruction (CIPO) is caused by metabolic and endocrine factors, but it can also be caused by the cancer's paraneoplastic effect. The cancers most associated with paraneoplastic syndromes are lung cancers and are generally associated with small cell lung cancers. Lung adenocarcinomas may rarely cause paraneoplastic syndromes, however, they mostly cause general effects such as cachexia and leukocytosis. The goal of this case report was to provide a case of non-mechanical obstruction due to lung adenocarcinoma as a very unusual cause of intestinal pseudo-obstruction, together with clinical, laboratory, and imaging results. [Med-Science 2022; 11(1.000): 410-2

Splenic artery aneurysm: Management of a rare entity in a series of patients

Splenic artery aneurysm (SAA) is a rare clinical condition; however, it can lead to life-threatening hemorrhages. Endoscopic and endovascular treatments or laparoscopic and open surgical approaches can be used for the treatment. On the grounds of its rarity, there are few series in the literature. We aimed to present our centers experience of splenic artery aneurysm management. Patients' data who were treated in our hospital between 2008 and 2019 due to splenic artery aneurysm was retrieved from the hospitals registry software. Patients demographic data (age, gender); type, localization and the diameter of aneurysms and treatment methods applied were examined. There were 13 (10 females, 3 males) consecutive patients (mean age was 51.7±16.9 years) in the study. Aneurysms were located proximally in six patients, distally in six patients, and one patient had aneurysm both proximally and distally. Nine of the aneurysms were saccular and four were fusiform. Coil embolization was successful in one patient, splenic artery ligation was applied to six patients and splenectomy was performed in four patients. Two patients, in whom coil embolization failed, were included in the follow-up program since they were asymptomatic. Morbidity and/or mortality due to aneurysms were not seen in treated patients. Nowadays, endovascular interventions are the primary treatment option for SAAs. However, they do not apply to every patient and surgery may be necessary. While choosing the appropriate surgery, the primary goal should be minimally invasive procedures that require good laparoscopic experience. Isolated ligation of the splenic artery and protection of the spleen should be performed if possible. [Med-Science 2021; 10(2.000): 386-90