12-Month generic health status and psychological distress outcomes following an Australian natural disaster experience: 2009 Black Saturday Wildfires

Objective

To describe the generic health status, health-related quality of life and psychological distress over a 12-month period of burns patients affected by the 2009 Black Saturday Wildfires.

Design setting and participants

Cohort study with retrospective assessment of pre-injury status and prospective assessment of physical and psychosocial functioning in the Black Saturday Wildfires burns patients across time. Generic health status and burn specific quality of life using the 36-item Short Form Health Survey (SF-36) and Burn Specific Health Scale (BSHS) were collected at three, six and twelve months post-burn injury. In addition, similar time points were used to measure level of psychological distress and the presence of pain using the Kessler-10 questionnaire (K-10) and the McGill Pain Questionnaire.

Results

At 12 months post-injury, patients reported a mean 16.4 (standard error, SE: 3.2) reduction in physical health and a 5.3 (SE 2.5) reduction in mental health scores of the SF-36 as compared to their pre-injury scores, with significant decreases observed in the “bodily pain”, “physical functioning”, “role physical” and “vitality” subscales. High levels of psychological distress and persistent pain were experienced, with no significant changes during the study period to the overall burns specific quality of life.

Conclusions

Even 12 months post-burn injury, patients affected by the 2009 Victorian Wildfires still experienced a significant reduction in generic health, increased psychological distress and persistent pain. The need for early and ongoing identification of physical and psychosocial impairments during hospital admission and upon discharge could be helpful to establish systematic interdisciplinary goals for long-term rehabilitation after severe burn injury.     

Markedly elevated thyroglobulin levels in the preoperative thyroidectomy patient correlates with metastatic burden

Background

Thyroglobulin (Tg) is a marker of tumor recurrence during thyroid cancer follow-up. While helpful in the postoperative setting, the clinical significance of preoperative Tg measurements remains unclear. The aim of the study was to determine if preoperative Tg levels are indicative of underlying malignancy or burden of metastatic disease.

Methods

A retrospective review of a prospectively collected database at an academic medical center of all thyroidectomy patients with a measured preoperative Tg level was conducted. Patients were grouped by Tg level into quartiles for initial univariate analysis, followed by multivariable analysis of variance.

Results

Between 2007 and 2012, 611 patients met criteria. Quartile breakdown was as follows: ≤19 ng/mL, 19.1–54 ng/mL, 54.1–151 ng/mL, and >151 ng/mL. Patients' age and gender were equivalent. Hashimoto's thyroiditis was most common in the lowest Tg group (24% versus 11%–12%, P < 0.01). While cancer was more common in the low Tg, metastatic disease was most common in the high Tg group. Specimen weight increased with increasing Tg levels (P < 0.01). Body mass index, gland weight, cancer, and Hashimoto's and metastatic disease were entered into a multivariable analysis. Only gland weight and metastatic disease correlated with Tg levels (both P < 0.001). All patients with Tg > 5000 ng/mL had metastatic disease (n = 6).

Conclusions

Although preoperative Tg levels are not associated with a diagnosis of cancer, they are associated with the presence of metastatic disease. All patients with a Tg > 5000 ng/mL had significant disease burden. In patients with concern for metastatic disease, preoperative serum Tg may be a useful marker to aid decision making.     

The influence of advancing age on quality of life and rate of recovery after treatment for burn

Background

With an ageing population the prevalence of burns in the elderly is increasing. The influence of increasing age on post-burn quality of life (QoL) is unquantified.

Aim

To examine the effect of ageing on QoL recovery after burn.

Methods

The Burn Specific Health Scale-Brief (BSHS-B) and Short Form Health Outcomes (SF-36), collected up to 24 months post-injury, for patients treated by the Royal Perth Hospital Burn Service were analysed. Multivariable analysis was adjusted for demographic and injury factors. The impact of ageing on rate of recovery was examined using BSHS-B normative data.

Results

The cohort (n = 1051) was 79.6% male with mean TBSA of 8% and age of 37.3 years. The SF-36 showed advancing age predicted poorer outcomes in physical function, role physical, vitality and role emotional domains but reduced bodily pain. The BSHS-B was affected by injury factors, not ageing. The standardised rate of recovery after burn improved with advancing age. The provision of surgery positively affected most outcomes assessed.

Conclusion

This study quantified the impact of ageing on post-burn QoL recovery and confirmed that physical function suffered to the greatest degree. The results emphasise the importance of pro-active burn surgery and physical rehabilitation strategies with older patients.     

Surgical resident involvement differentially affects patient outcomes in laparoscopic and open colectomy for malignancy

Background

We evaluated effect of resident involvement on outcomes after laparoscopic and open colon resection for malignancy.

Methods

Patients undergoing colectomy were queried using the American College of Surgeons' National Surgical Quality Improvement Program. “Attending alone” and “Resident” cohorts were compared with primary end point of overall morbidity.

Results

Of 37,330 patients, residents were involved in 26,190 (70.2%) cases. Attending alone patients were older with higher vascular, cardiac, and pulmonary comorbidity. Univariate analysis demonstrated increased operative time (181.0 ± 98.4 vs 138.7 ± 77.0, P < .001), reoperation (5.7% vs 5.2%, P = .041), and readmission rates (11.9% vs 9.6%, P = .037) with resident involvement. Serious (16.0% vs 13.9%, P < .001), minor (17.5% vs 14.1%, P < .001), and overall morbidity (26.4% vs 22.5%, P < .001) were higher with resident participation. Mortality (2.0% vs 2.8%, P < .001) and failure to rescue (.8% vs 1.2%, P < .029) were lower with resident involvement. Resident involvement showed independent association with overall morbidity in both laparoscopic (odds ratio, 1.2; 95% confidence interval, 1.13 to 1.38, P < .001) and open cases (odds ratio 1.3, 95% confidence interval, 1.18 to 1.35, P < .001).

Conclusions

Resident participation in colectomy for malignancy is associated with lower mortality at the expense of higher overall morbidity.     

Risk factors contributing to the difference in prognosis for papillary versus micropapillary thyroid carcinoma

Background

The aggressiveness of papillary thyroid carcinoma (PTC) was evaluated by comparing conventional PTC with papillary thyroid microcarcinoma (PTMC). Risk factors associated with differences in clinical and pathologic features were analyzed to provide appropriate surgical management.

Methods

A total of 539 patients with papillary carcinoma who underwent total thyroidectomy were retrospectively reviewed. The median follow-up period was 32 months.

Results

Of 539 patients, 311 (57.7%) had PTMC, and 228 (42.3%) had conventional PTC. No differences between patients with PTMC and those with PTC were observed in age, gender, and multifocality. PTMC was associated with less frequent bilaterality (P = .002), lymph node metastasis (P < .001), thyroid capsule invasion (P < .001), and disease recurrence (P < .001), and a higher rate of incidental diagnosis (P = .001). There was no statistically significant difference between the prevalence of lymph node metastasis at diagnosis and disease recurrence rate between nonincidental PTMC and conventional PTC (P > .05).

Conclusions

Incidental PTMC had significantly fewer aggressive tumor features. Nonincidental PTMC presented with aggressive characteristics similar to those of conventional PTC and should be treated likewise. The authors suggest routine total thyroidectomy followed by an adequate exploration of the central neck compartment as a safe treatment.     

Valuing postoperative recovery: validation of the SF-6D health-state utility

Background

Many surgical innovations are costly but may result in faster patient recovery. Economic analyses of these innovations require utility measures that reflect the construct of “postoperative recovery.” We investigated the validity of Short Form 6D (SF-6D) utility value as a measure of postoperative recovery in patients undergoing elective colorectal resection.

Materials and methods

Patients undergoing elective colorectal resection completed the Short Form 36 and the 6-min walk test at baseline (before surgery) and at 4 and 8 wk postoperatively. SF-6D utilities were derived from the Short Form 36. Longitudinal validity (responsiveness) was assessed using standardized response means (SRM). Construct validity was assessed by comparing the difference in mean SF-6D between patients with and without complications (discriminant) and by correlating the SF-6D with other measures of recovery (convergent).

Results

A total of 191 patients were included (58% male; mean age 63.0 (SD 14.2) y, 81% malignancy, and 54% laparoscopic). SF-6D values dropped significantly from baseline to 4 wk after surgery (SRM −0.54, P < 0.001) and returned to baseline by 8 wk (SRM −0.12, P = 0.111). At 4 wk after surgery, the SF-6D was lower in patients with complications than in those without (mean difference −0.047, 95% CI −0.088, −0.006). At all time points, the SF-6D correlated significantly with the physical and mental component scales of the SF-36 (Pearson r 0.67–0.80, all P < 0.001) and the 6-min walk test (r 0.21–0.29, all P < 0.05).

Conclusions

The SF-6D is a valid measure of postoperative recovery following elective colorectal resection and may be used to measure quality-adjusted life years for cost-effectiveness analyses of surgical technologies and interventions hypothesized to impact recovery.     

Douleurs chroniques postchirurgicales

Objectives

Update reviewing of chronic postsurgical pain.

Data sources

The following review is based on the English and French literature published in PubMed database between January 1998 and 2013. The research articles were made with following keywords alone or in combination: “chronic pain”, “surgery”, “postsurgical pain”. These keywords were combined with “epidemiology”, “incidence”, “predictive factors” and “prevention”.Study selection Publications were deemed relevant if they contained information about CPSP after 8 weeks post surgery. Animal publications were not included. Only randomized controlled studies were taken into consideration for the pharmacological prevention.

Data extraction

Data extracted were related to epidemiology, impact, predictive factors and prevention of CPSP.

Data synthesis

Epidemiology of CPSP is more recognized as it is experienced by 10–50% of individuals after classical operations. CPSP can be severe in about 5 to 10% of these patients. CPSP is a major public health problem still rarely diagnosed and treated. Twenty percent of patients consulting in a pain clinic have a CPSP. The frequency of neuropathic pain is important but the difference in the proportion to CPSP falls between 6–68% and depend on the type of surgery. Clinical risk factors and physiopathology of CPSP are subject of wide development. Human studies allowed better understanding of the neurophysiological as well psychological aspect of the development of CPSP. Finally, the possibility of pharmacological prevention of CPSP seems to have increased in the past years. Nevertheless, there are still many questions that need to be answers about the problem. We should clearly define the optimal characteristics of clinical and experimental studies as this will allow the better understanding of the prevention of CPSP. Anesthesiologists play a crucial role in this development. They are involved in all of the stages of the operative care of patients and play a decisive role in the evaluation of the risk, the development of a preventive strategy, and in the early detection and treatment of CPSP.     

Radioactive iodine scanning is not beneficial but its use persists for euthyroid patients

Background

Radioactive iodine (RAI) scanning is a method of determining the functional status of thyroid nodules. Historically, practitioners thought “cold” or inactive nodules were more likely malignant. However, surgeons no longer find these scans helpful for preoperative management of euthyroid patients. The purpose of this study was to evaluate the utility of RAI scans.

Methods

We retrospectively reviewed cases of euthyroid patients (thyroid-stimulating hormone > 1.0 mIU/L) who underwent RAI scans before thyroid surgery at our institution between 1994 and 2011. We correlated the RAI scan results with final pathology. We considered RAI scans concordant with pathology when we found a malignancy on the same lobe as a cold nodule. We also tabulated the specialty and affiliation of the ordering physicians.

Results

A total of 109 euthyroid patients underwent RAI scanning as part of their preoperative workup. Of these, 88 patients (81%) had a cold nodule. A malignancy concordant with the RAI scan findings occurred in only 15 of these patients (17%). Non-surgical specialties ordered 90 scans (95%). Only 11 of these scans (10%) were performed in the past 5 y, and physicians outside the academic institution ordered all 11 (100%) of these. A linear regression of RAI scanning per year yielded a slightly negative slope (m–0.32 per year).

Conclusions

Radioactive iodine scanning is not useful for the surgical management of thyroid disease in euthyroid patients because it poorly predicts malignancy. The overall use of RAI scans is trending downward, but they are still ordered by non-surgical referring physicians.     

Improvement in Gastrointestinal and Health-related Quality of Life Outcomes After Conversion From Mycophenolate Mofetil to Enteric-coated Mycophenolate Sodium in Liver Transplant Recipients

Objective

To evaluate improvement in gastrointestinal (GI) symptoms and health-related quality of life (HRQoL) in liver transplant recipients switched from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS).

Methods

A multicenter, open-label, single-arm study was undertaken in maintenance liver transplant recipients who reported GI complications with MMF therapy. The patients were switched to equimolar doses of EC-MPS at baseline. The primary end point was the change in the Gastrointestinal Symptom Rating Scale (GSRS) total score after 6 to 8 weeks of treatment with EC-MPS. Other key assessments for GI symptoms and HRQoL included the GSRS subscores, the Gastrointestinal Quality of Life Index (GIQLI), the Psychological General Well-Being Index, and the Overall Treatment Effect (OTE). Paired t-test was used to assess the difference in the mean score changes over time.

Results

A total of 34 patients were enrolled and switched to equimolar doses of EC-MPS. After 6 to 8 weeks of EC-MPS treatment, mean GSRS total score improved significantly from 2.88 ± 0.66 to 2.10 ± 0.78. Mean improvement in GSRS total score (−0.77 score points; P = .001) exceeded the minimal clinically important difference. Significant improvements were observed in all GSRS subscales (P < .05), GIQLI total scores (P = .001), and GIQLI subscales “GI symptoms” (P < .001) and “physical function” (0.013). Patients who continued EC-MPS reported sustained benefits compared with patients who switched back to MMF after 6 to 8 weeks of treatment with EC-MPS. On the OTE scale, improvement in symptoms was reported in 76.5% and 61.8% of the patients as perceived by the physicians and the patients. Improvement in HRQoL was reported by 41.2% of the patients. No deaths, biopsy proven acute rejections, or graft losses were reported during the study.

Conclusion

Conversion from MMF to EC-MPS was associated with a significant improvement in GI symptoms and HRQoL in liver transplant recipients.     

Evaluation of Functional Status,Pulmonary Capacity,Body Composition,and Quality of Life of End-Stage Liver Disease Patients Who are Candidates for Liver Surgery

Introduction

Muscular weakness in combination with malnutrition can induce a global motor impairment and physical inactivity, adversely impairing the daily living activities and quality of life of end-stage liver disease patients who are candidates for liver transplantation.

Objectives

To evaluate functional status, pulmonary capacity, body composition and quality of life in end-stage liver disease patients who are candidates for liver transplantation; to verify if there is a correlation between the functional variables of the individuals tested through the 6-minute walk test (6MWT) and covariables: pulmonary function test (PFP), quality of life and body composition.

Methods

This study was carried out at the Liver Transplantation Unit of the State University of Campinas (UNICAMP). We included 46 patients with end-stage liver disease who underwent the following evaluations: medical history, quality of life questionnaire “Short Form 36” (SF-36), surface electromyography (sEMG) of the diaphragm and rectus abdominis muscles, body composition assessment by electrical vioimpedance (BIA), 6MWT and PFP.

Results

Univariate analysis and Pearson's correlation found correlations between distance walked on 6MWT and QOL (P = .006 and P = .02) and TBW (P = .5 and P = .02). Pearson's correlation were found between respiratory variables of 6MWT, QOL, and PFP.

Conclusion

The functional status may be correlated to body composition, quality of life and pulmonary capacity of patients with liver disease, candidates for transplantation.     

Pilonidal disease in a military population: how far have we really come?

Background

Pilonidal disease (PD) has a long connection with military personnel, even nicknamed “jeep disease” during World War II. The aim of this study was to identify factors associated with recurrence and complications after surgery in a military population.

Methods

A retrospective cohort analysis of operative therapy for PD at a single institution from 2005 to 2011 was conducted. Patient demographics, disease characteristics, and surgical methods were assessed for the primary outcomes of recurrence and morbidity.

Results

A total of 151 patients with PD were identified, who underwent excision (45.7%), excision with primary closure (29.8%), and incision and drainage (9.9%). Overall recurrence and morbidity rates were 27.2% and 34.4%, respectively. Black race, chronic disease, wound infection, and infection and drainage were associated with recurrence (P < .05), and excision with primary closure was associated with increased complications (P < .001).

Conclusions

PD remains a significant source of morbidity and recurrence among military personnel. Certain patient-related and disease-related factors portend a worse prognosis, with black race and operative method the strongest predictors of outcomes.     

Gender and Age Differences in the Perception of Bother and Health Care Seeking for Lower Urinary Tract Symptoms: Results from the Hospitalised and Outpatients’ Profile and Expectations Study

Background

Few comparisons have been made of health care seeking behaviour for lower urinary tract symptoms (LUTS) between men and women, as well as trends across age groups.

Objective

To investigate the bother from LUTS and effect on health care seeking in both men and women of different age groups and in comparison between the two genders.

Design, setting, and participants

A representative cross section of each of 13 clinics of a general academic hospital, with equal numbers of subjects recruited in each of six design cells that were defined by age (18–40, 41–60, 61–80 yr) and gender.

Intervention

A 2-h in-person interview, conducted by a trained psychologist/interviewer in a clinic office.

Measurements

Severity of LUTS was measured by the International Prostate Symptom Score (IPSS). Treatment seeking was measured by a single item. A bother question was modified to assess overall bother. Impact on quality of life (QoL) was measured by the IPSS QoL question.

Results and limitations

The final study sample comprised 415 patients. More women than men reported the presence of LUTS (85.5% vs 75.2%; p = 0.01). LUTS were more bothersome in women (25.4% of women vs 17.6% of men with bother “some” or “a lot”; p = 0.02). Severity of LUTS increased with age in both genders (men: p < 0.001; women: p = 0.03). Bother from LUTS increased as severity of symptoms increased in both genders (p < 0.001) but was associated with age only in men (p < 0.001). QoL showed similar results as bother. Although men and women had equal prevalence of treatment seeking (27.9% vs 23.7%; p = 0.40), men, but not women, were more likely to seek treatment as age (p < 0.01) and severity of LUTS (p < 0.001) increased. In multivariate logistic regressions, only bother from LUTS was associated with treatment seeking in women, compared with bother, age, and the presence of voiding symptoms in men.

Conclusions

In our hospital-based sample, differences in LUTS frequency, bother, and health care seeking profiles between men and women suggest a different perception and response to LUTS between the two genders.     

Surgery improves quality of life in patients with “mild” hyperparathyroidism

Background

Surgical treatment of patients with “classic” hyperparathyroidism improves quality of life, but these benefits to patients with “mild” disease remain unclear.

Methods

The SF-36 Health Survey was administered to 174 patients 1 week before, 1 week after, and 1 year after undergoing parathyroidectomy.

Results

One hundred fifty-one patients completed at least 2 surveys. There were 18 and 133 cases of “mild” and “classic” hyperparathyroidism, respectively. Preoperatively, the groups did not differ significantly in the 10 scales. One year after surgery, patients with “classic” and “mild” disease improved significantly in 9/10 and 10/10 scales, respectively (P < 0.05). Those with “mild” disease had a statistically larger improvement than those with “classic” disease in 4 scales.

Conclusions

Quality of life significantly improved in surgically treated patients with both “mild” and “classic” hyperparathyroidism, supporting surgical treatment of “mild” hyperparathyroidism. Moreover, quality of life may improve more in patients with “mild” rather than “classic” disease.     

Thyroglobulin antibodies as a potential predictive marker of papillary thyroid carcinoma in patients with indeterminate cytology

Backround

We investigated the efficacy of thyroglobulin antibodies (TgAb) in detecting malignancy in indeterminate thyroid nodules and evaluated the possible association between TgAb and autoimmunity in papillary thyroid carcinoma (PTC).

Methods

This retrospective, nonrandomized study included 1,646 patients who had undergone preoperative fine-needle aspiration biopsy to evaluate their thyroid nodules, and then standard total thyroidectomy. Of 194 patients (11.8%) with indeterminate nodules, 61 (31.4%) had PTC and 133 (68.6%) had benign nodules at the final histologic examination.

Results

Univariate analysis showed that multifocality (P = .002), bilaterality (P = .003), lymph-node metastasis (P = .030), and capsule penetration (P = .003) were significantly associated with positive TgAb in patients with indeterminate cytology and histopathologic diagnosis of PTC. The multivariate analysis showed that TgAb positivity (P < .001) and preoperative thyroid-stimulating hormone levels (P = .022) were independent predictive factor for PTC diagnosis in patients with indeterminate cytology.

Conclusions

Preoperative TgAb could be a marker for PTC in patients with indeterminate thyroid nodules, increasing diagnostic accuracy. TgAb positivity could also influence the clinical assessment and subsequent selection of total thyroidectomy.     

Demonstration of the validity of the SF-36 for measurement of the temporal recovery of quality of life outcomes in burns survivors

Objective

Outcome assessment after burn is complex. Determination of quality of life is often measured using the Burns Specific Health Scale (BSHS), a validated tool in the burn population. The SF-36 is a generic quality of life questionnaire that is validated for numerous populations, but not in burns. The aim of the study was to examine the validity of SF-36, using the BSHS as a reference.

Methods

280 burn patients were recruited at Royal Perth Hospital. Each completed SF-36 and BSHS-B at regular intervals to 2 years after burn. Regression modelling was used to assess the temporal validity and the relative sensitivity of the measures.

Results

SF-36 domains and BSHS-B demonstrated significant associations at all time points (r = 0.37–0.76, p < 0.002). In the months after burn, SF-36 domains: role physical; bodily pain; social function and role emotional outperformed BSHS-B total score and domain scores. Greater measurement sensitivity was demonstrated in all SF-36 summary and subscales measures (except General Health) when compared to BSHS-B and sub-domains.

Conclusion

This study demonstrated SF-36 as a valid measure of recovery of quality of life in the burn patient population. The data suggests that SF-36 components were more sensitive to change than the BSHS-B from ∼1 month after injury.     

Influence of relatives' anxious symptomatology on the quality of life of pretransplant hepatic patients

Objectives

We sought to analyze the influence of anxiety symptoms of relatives of patients undergoing a pretransplant study on the quality of life of the hepatic patients body pain, physical role, mental health, general health, vitality, social functioning, emotional role, and physical functioning.

Materials and Methods

We assessed 2 groups: 51 patients with hepatic cirrhosis and 51 of their closest relatives who were studied while the patients were hospitalized to undergo the pretransplant study. We used a “Psychosocial Survey” (in both groups), the “Hospital Anxiety and Depression Scale” (HADS) in the relatives, and the “SF-36 Health Survey” (in the patients).

Results

The results showed that the patients whose relatives presented clinical levels of anxiety showed the worst quality of life, specifically for the dimensions “mental health” (P = .016) and “emotional role” (P = .041).     

Real-time instrument detection in minimally invasive surgery using radiofrequency identification technology

Background

A key part of surgical workflow recording is recognition of the instrument in use. We present a radiofrequency identification (RFID)-based approach for real-time tracking of laparoscopic instruments.

Methods

The system consists of RFID-tagged instruments and an antenna unit positioned on the Mayo stand. For reliability analysis, RFID tracking data were compared with the assessment of the perioperative video data of instrument changes (the reference standard for instrument application detection) in 10 laparoscopic cholecystectomies. When the tagged instrument was on the Mayo stand, it was referred to as “not in use.” Once it was handed to the surgeon, it was considered to be “in use.” Temporal miscounts (incorrect number of instruments “in use”) were analyzed. The surgeons and scrub nurses completed a questionnaire after each operation for individual system evaluation.

Results

A total of 110 distinct instrument applications (“in use” versus “not in use”) were eligible for analysis. No RFID tag failure occurred. The RFID detection rates were consistent with the period of effective instrument application. The delay in instrument detection was 4.2 ± 1.7 s. The highest percentage of temporal miscounts occurred during phases with continuous application of coagulation current. Surgeons generally rated the system better than the scrub nurses (P = 0.54).

Conclusions

The feasibility of RFID-based real-time instrument detection was successfully proved in our study, with reliable detection results during laparoscopic cholecystectomy. Thus, RFID technology has the potential to be a valuable additional tool for surgical workflow recognition that could enable a situation dependent assistance of the surgeon in the future.     

Resident involvement in postoperative conversations: an underused opportunity

Background

Because of established attending-patient and family relationships and time constraints, residents are often excluded from the immediate postoperative conversation with family. Interpersonal and communication skills are a core competency, and the postoperative conversation is an opportunity to develop these skills. Our objective is to assess attitudes, experience, and comfort regarding resident participation during postoperative conversations with families.

Materials and methods

Residents and attending surgeons in an academic surgery center were surveyed regarding resident involvement in the postoperative conversation with families. Paper surveys were administered anonymously. Nonparametric statistics compared responses.

Results

There were 45 survey respondents (23 residents, 22 attendings). All residents rated postoperative conversations with families, as “important” or “very important”. Residents reported being “comfortable” or “very comfortable” with postoperative conversations. However, on average, residents reported fewer than 10 postoperative conversation experiences per year. Feedback was received by <30% on postoperative communication skills, but 88% wanted feedback. Most attendings reported it is “important” or “very important” for residents to communicate well with families during postoperative conversations, but rated residents' performance as significantly lower than the residents' self-assessments (P < 0.001). Attendings on average were only “somewhat comfortable” or “moderately comfortable” with residents conducting postoperative conversations with families, and only 68% reported allowing residents to do so. When bad news was involved, only 27% allowed resident participation. Most attendings (86%) believed residents need more opportunities with postoperative conversations.

Conclusions

Although most residents reported being comfortable with postoperative conversations, these survey results indicate that they have few opportunities. Developing a workshop on communication skills focused on the postoperative conversations with families may be beneficial.     

Identifying predictors of a difficult thyroidectomy

Background

A Thyroidectomy Difficulty Scale (TDS) was previously developed that identified more difficult operations, which correlated with longer operative times and higher complication rates. The purpose of this study was to identify preoperative variables predictive of a more difficult thyroidectomy using the TDS.

Methods

A four item, 20-point TDS, was used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult thyroidectomy and non-difficult thyroidectomy (NDT) patients were compared. A final multivariate logistic regression model was constructed with significant (P < 0.05) variables from a univariate analysis.

Results

A total of 189 patients were scored using TDS. Of them, 69 (36.5%) suffered from hyperthyroidism, 42 (22.2%) from Hashimotos, 34 (18.0%) from thyroid cancer, and 36 (19.0%) from multinodular goiter. Among hyperthyroid patients, the DT group had a greater number preoperatively treated with Lugols potassium iodide (81.6% DT versus 58.1% NDT, P = 0.032), presence of ophthalmopathy (31.6% DT versus 9.7% NDT, P = 0.028), and presence of (>4 IU/mL) antithyroglobulin antibodies (34.2% DT versus 12.9% NDT, P = 0.05). Using multivariate analysis, hyperthyroidism (odds ratio [OR], 4.35, 95% confidence interval [CI], 1.23–15.36, P = 0.02), presence of antithyroglobulin antibody (OR, 3.51, 95% CI, 1.28–9.66, P = 0.015), and high (>150 ng/mL) thyroglobulin (OR, 2.61, 95% CI, 1.06–6.42, P = 0.037) were independently associated with DT.

Conclusions

Using TDS, we demonstrated that a diagnosis of hyperthyroidism, preoperative elevation of serum thyroglobulin, and antithyroglobulin antibodies are associated with DT. This tool can assist surgeons in counseling patients regarding personalized operative risk and improve OR scheduling.     

Relationship Between Inflammation and Sex Hormone Profile in Female Patients Receiving Different Types of Renal Replacement Therapy

Background

Patients with end-stage renal disease (ESRD) experience female sexual dysfunction (FSD). The purpose of this study was to compare FSD in different types of renal replacement therapy and control patients.

Methods

The study was consisted of 47 renal transplantation (RT), 46 hemodialysis (HD), and 28 continuous ambulatory peritoneal dialysis (CAPD) patients and 36 healthy control subjects. All groups were evaluated with the following scales: Female Sexual Function Index (FSFI) questionnaire, Short Form (SF)–36 questionnaires, and Beck Depression Inventory (BDI). Demographic data, laboratory values, and hormone levels were obtained. The patients with FSFI score <26.55 were accepted as experiencing sexual dysfunction.

Results

Overall, total FSFI scores in RT, HD, CAPD, and control were 22 (range, 2–35), 22.4 (4–34), 18.35 (2–34), and 29.6 (2–35), respectively. The mean total FSFI score was not different in patients receiving different kinds of renal replacement therapy (P > .05) although they were significantly worse then the control group (P < .001). On regression analysis, age was significantly associated with FSD (β = −0.14; P = .001). In addition, the physiologic health domain of SF-36 was significantly better in control groups (P < .001). The difference in terms of mean of BDI score did not reach statistical significance among patient groups (P > .05). Female sexual dysfunction score was negatively correlated with BDI (r = −0.371; P < .001) and positively correlated with the mental-physical components score of SF-36 (r = 0.423 [P < .001] and r = 0.494 [P < .001], respectively) in all patients groups. Regarding the hormones of the patients, there was a significant difference between RT and the HD and CAPD groups in dihydroepiandrosterone sulfate (DHEAS; P < .001), RT and HD in prolactin (P < .001), and RT and CAPD in free testesterone (P < .001).

Conclusions

Renal transplantation, hemodialysis, and peritoneal dialysis patients were at more risk of developing sexual dysfunction and lower quality of life scores than healthy subjects. Notably, the mode of renal replacement therapy had no impact on female sexual function.