Patient Satisfaction Undergoing Surgery for Lumbar Disc Herniation

Objective: To assess patient’s satisfaction, who are undergoing surgery for lumbar disc herniation.Materials and Methods: This observational study was conducted in Neurosurgery Department of Rehman Medical Institute, Peshawar from February 2014 to July 2014. A total of 58 patients who underwent surgery with lumbar disc herniation were studied. Clinical outcomes were measured using the visual analog scale (VAS) score for leg and/or back pain pre-operatively and 2 weeks post-operatively. Patient was considered satisfied from surgery (Lumbar Microdiscectomy), if there is improvement in VAS, 2 weeks post-operatively of ≥ 3 score. All the patients were followed up for a minimum period of four weeks.Results: The mean age of the patients was 40.21 ± 12.51 years with majority (62.1%) of the male patients. The main bulk of the patients (75.8%) having lumbar disc herniation were in between 20 – 50 yearsof age. Regarding level of the prolapsed intervertebral disc, most of the patients were harboring lumbar disc herniation at L4-L5 level (41.4%). About 5.2% (n = 3) of the patients were lost to follow-up. Major bulk of the patient (89.1%) was satisfied from the surgery. There was statistically significant difference between pre-op and post-op VAS (p value = <0.01).Conclusion: Majority of the patients of lumbar prolapsed intervertebral disc was male with L4 – L5 level most commonly involved.Almost 90% of the patients were satisfied from the surgery, Lumbar microdiscectomy, with statistically significant p value

Outcome of Topical Epidural Methylprednisolone Versus Control in Lumbar Disc Surgery Patients

Objective:  The use of topical intraoperative methylprednisolone in lumbar disc surgery leads to significant improvement in pain relief and early resumption of daily life activities. The study determined the outcome of topical epidural methylprednisolone. Materials & Methods:  60 patients included with diagnosed cases of the herniated lumbar disc with ASA Grade 2 and below. Group A was for patients who had to receive topical methylprednisolone while group B was the control group where no topical methylprednisolone had been used. The outcome was measured from OLBI and VAS scores. Results:  In Group A, the mean hospital stay was 2 days, mean OLBI score was 35%, mean VAS score was 3, mean time to resumption of ADL was 7 days, mean dose of paracetamol (per day) was 3 mg, mean dose of Ketorolac (per day) was 90 mg. Whereas Group B, mean hospital stay was 3 days, mean OLBI score was 45%, mean VAS score was 5, mean time to resumption of ADL was 10 days, mean dose of paracetamol (per day) was 4 mg, mean dose of Ketorolac (per day) was 100 mg. In Group A, 91% of patients had a favorable outcome and 9% of patients had an unfavorable outcome. Whereas in Group B, 83% of patients had a favorable outcome and 15%of patients had an unfavorable outcome. There existed insignificant results in outcomes concerning diabetic/non-diabetic, and hypertension/non-hypertension. Conclusion:  The use of topical intraoperative methylprednisolone in lumbar disc surgery leads to significant improvement in pain relief and early resumption of daily life activities as compared to without the use of topical methylprednisolone. Keywords:  Outcome, Epidural Methylprednisolone, Lumbar Disc Surgery, OLBI (Oldenburg Burnout Inventory), ADL (Activities Of Daily Life)

The Efficacy of Surgery for Supra-Tentorial Gliomas in Preventing Seizures

Objectives:  The study examined the surgical outcome of supratentorial gliomas in terms of improvement in seizures in patients who presented to a tertiary care institution. Material and Methods:  A descriptive case series was conducted in Neurosurgery Department at Northwest General Hospital & Research, Peshawar. Patients (n = 95) with supratentorial gliomas with seizures between 18 – 70 years were included. Supratentorial gliomas were diagnosed by neuroimaging as MRI brain with contrast, diffusion-weighted, Fluid-attenuated inversion recovery, and magnetic resonance spectroscopy. The patient was observed for seizures postoperatively. Data was stratified for age and gender. Results:  The majority of patients (36.8%) were in 41 – 50 years. 55.78% of patients were males whereas 44.21% of patients were females. 42 (44.21%) involved the frontal lobe, 16 (16.84%) involved the parietal lobe, 26 (27.36%) involved the temporal lobe, and 11 (11.57%) patients involved the occipital lobe. According to Engel’s classification, 53 patients were in class I, 16 in class II, 10 in class III, and 5 in class IV. 84 (88.42%) experienced post-op seizure reduction. An insignificant association was found with the seizure improvement (yes/no) with different age groups and gender. Conclusion:  The frontal lobe was the most prevalent location for supratentorial gliomas. After surgery, a large proportion of patients improved in terms of seizure management. Keywords:  Seizures, Supratentorial gliomas

Outcome of patients operated for depressed skull fracture with dural tear

Objective:  The objective of this study was to determine the outcome of patients operated for depressed skull fracture with a dural tear. Material and Methods:  A descriptive case series (n = 155) was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months. Results:  The mean arrival GCS was 10.64 ± 2.33. About 21.9% (n = 32) patients presented with a GCS of ? 8, while the remaining 78.1% (n = 123) presented with a GCS of ? 8. About 8.4% (n = 13) patients died due to the complications of the brain injury. The most common postoperative complication was found to be progressive neurologic deficit (PND) occurred in 21 (13.5%) patients. Penetrating injury to the head was also associated with unfavorable outcomes after surgery (p = 0.046), which shows that penetrating injury is associated with increased brain damage and hence consequently poor outcomes. Conclusions:  The neurologic status as denoted by the Glasgow coma scale is one of the most important factors which predicts the outcome. Surgical management of depressed skull fractures with dural tear has favorable outcomes in about two-thirds of patients. The remaining one-third patient remains in the severely disabled group. Every effort should be made to reduce the occurrence of complications as they are directly related to postoperative functional outcomes

Outcome of the Traumatic Extradural Hematoma on the Basis of Size of Extradural Hematoma

Objective:  This study aimed to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma. Materials & Methods:  A descriptive case series was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months and included 188 patients. The detailed history and clinical examinations were noted through a pre-designed proforma. Patients were followed post-operatively till the time of discharge and for either favorable outcome or unfavorable outcome according to the GOS. Results:  73% of patients had extradural hematoma volume between 25 – 50 mL, while 27% patients had extradural hematoma >50 mL. 12% of patients had Glasgow Outcome Score (GOS) scores 1 – 3, while 88% of patients had GOS scores: 4 – 5. The mean GOS was 3. Patients with favorable outcomes were 88% while 12% had an unfavorable outcome. Conclusion:  The size of the extradural hematoma has a strong correlation with outcome. The greater the size of the hematoma, the poorer the outcome

Safety of Nonsteroidal Anti-inflammatory Drugs in Major Gastrointestinal Surgery: A Prospective, Multicenter Cohort Study

Background Significant safety concerns remain surrounding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) following gastrointestinal surgery, leading to wide variation in their use. This study aimed to determine the safety profile of NSAIDs after major gastrointestinal surgery. Methods Consecutive patients undergoing elective or emergency abdominal surgery with a minimum one-night stay during a 3-month study period were eligible for inclusion. The administration of any NSAID within 3 days following surgery was the main independent variable. The primary outcome measure was the 30-day postoperative major complication rate, as defined by the Clavien–Dindo classification (Clavien–Dindo III–V). Propensity matching with multivariable logistic regression was used to produce odds ratios (OR) and 95 % confidence intervals. Results From 9264 patients, 23.9 % (n = 2212) received postoperative NSAIDs. The overall major complication rate was 11.5 % (n = 1067). Following propensity matching and adjustment, use of NSAIDs were not significantly associated with any increase in major complications (OR 0.90, 0.60–1.34, p = 0.560). Conclusions Early use of postoperative NSAIDs was not associated with an increase in major complications following gastrointestinal surgery

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Background Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies