Physiotherapy outcomes and staffing resources in open abdominal surgery patients

The measurement of physiotherapy outcomes after abdominal surgery has rarely been undertaken in Australia. Under the financial pressures of the current health care environment, physiotherapists urgently need to develop clinical outcomes and accurate measures of resource utilization. This study investigated clinical outcomes and physiotherapy staffing resources in open abdominal surgery patients at two hospitals. The Abdominal Surgery Physiotherapy Outcomes Data Sheet (APODS), designed for this study, demonstrated good content validity and high intrarater and interrater reliability. The 30 subjects at each of the two hospitals were comparable in all preoperative and perioperative variables. Wide variations in the amount of physiotherapy resources were found between the two hospitals. Number of physiotherapy treatments was found to be correlated with preoperative ASA score ( r = 0.35, p = 0.006), days of mechanical ventilation ( r = 0.60, p < 0.001), and postoperative length of stay ( r = 0.53, p < 0.001). Rates of restoration of mobility varied significantly, with hospital B subjects sitting out of bed earlier ( p = 0.004) and able to mobilise independently earlier after surgery ( p = 0.045) compared to hospital A. Overall rate of postoperative pulmonary complication rates was 43.3%. Development of clinical outcome measures in this area of physiotherapy is urgently needed in order to guide physiotherapy staffing, review clinical practices, and inform priorities for future research direction.     

Video-endoscopic interventions in thoracic surgery]

Between October and December 1991 we performed videoendoscopic procedures, including resection of lung tissue, on 9 patients in our thoracic surgery unit. A lung measuring 15 x 18 was extirpated in 1 patient and parietal pleurectomy was performed after complicated pneumothorax in 4 patients. In one of these cases it was necessary to close a parenchymal leak and in 3 cases bullae had to be removed. Resection was undertaken in 4 patients for peripheral lung nodules, in one of them for metastases. Two patients proceeded to conventional lobectomy immediately after the frozen section results came through. Closure of lung parenchyma was carried out by means of the new ENDO-GIA stapler. Duration of the procedure was less than one hour except in the case of one patient. In one case it was necessary to use three cannulae. In the other cases two cannulae (one for videoendoscopy and fixating instrument, one for preparation instrument and stapler) sufficed for the operation to be undertaken without difficulty. This new technique brings all the known advantages of minimal invasive intervention to patients requiring thoracic surgery.     

电视胸腔镜手术78例体会

目的 :总结电视胸腔镜手术的经验教训。方法 :对电视胸腔镜手术 78例进行回顾性临床分析。结果 :电视胸腔镜手术 78例中 ,肺部疾病 5 1例 ,食管良性病 18例 ,纵隔肿瘤 4例 ,其他 5例。电视胸腔镜下完成手术 75例 ,中转开胸 3例 ,手术成功率 96%。手术时间 10～ 12 0min ,手术后并发症发生率 6%。术后住院时间 3～ 10d ,平均 8d。结论 :电视胸腔镜手术是胸外科的微创手术 ,在胸部一些疾病的手术中 ,充分体现了创伤小、痛苦小、恢复快的优越性。     

Surgical endoscopy in thoracic surgery.

From November 1990 to April 1992, 32 patients were operated on by video thoracoscopic surgery (VTS). Included were 22 males and 10 females, mean age 47.6 years. VTS has been used therapeutically on 25 occasions: 20 spontaneous pneumothoraxes; two recurrent pleuritis; two cysts; one mediastinal; one pulmonary; and one thoracic sympathectomy. VTS was also used diagnostically seven times: five lung biopsies and two mediastinal lymph node biopsies. It was necessary to perform a mini-thoracotomy in one patient and proceed to immediate thoracotomy in three patients. There were no deaths in this series, the morbidity was two patients with collapsed lungs, one of which required drainage. VTS must be performed under standard thoracic surgical conditions: selective intubation, and fully equipped to make an immediate thoracotomy. The advantages of VTS are aesthetic and functional, the post-operative pain is reduced in intensity and duration. At present, VTS is indicated for the treatment of spontaneous pneumothorax, the assessment and biopsy of mediastinal lymph node and the excision of some lung lesions. Improvements in the apparatus should lead to a broadening of these indications in the future.     

Recurrent pericarditis after thoracic surgery

Acute pericarditis is a frequent complication after cardiac and/or thoracic surgery. Recurrent acute pericarditis with multiple episodes is an uncommon phenomenon, however. Patients typically have chest pain and/or pericardial inflammation as shown by electrocardiography and echocardiography. Treatment presents a clinical challenge due to the condition's rarity and lack of multicenter comparative treatment studies. Numerous therapeutic modalities, including nonsteroidal anti-inflammatory agents (NSAIDs), corticosteroids, immunosuppressants, and pericardiectomy, have been used without overwhelming evidence of a standard protocol. We report a case in which 32 episodes of recurrent acute pericarditis occurred, emphasizing the need for multicenter trials comparing therapeutic modalities in the future.     

The role of video-thoracoscopy in thoracic surgery

The widespread acceptance of minimal invasive techniques has revolutionized the practice of surgery including, thoracic surgery. Within a short period of time, video-assisted thoracic surgery (VATS) has become an acceptable approach to a wide range of thoracic procedures. The use of VATS as a diagnostic modality is now well established. For therapeutic procedures, VATS has also been generally accepted as the treatment for spontaneous pneumothorax, thoracic sympathectomy, treatment of loculated effusions and resection of simple mediastinal cysts and benign tumors. Its role in major procedures, e.g. anatomic lung resections and thymectomy, however, remain poorly defined at present although some of the existing intermediate results are encouraging. The technique continues to evolve, with further miniaturization to reduce access-induced trauma. No matter how attractive the new techniques may appear, carefully conducted clinical trials should precede the general acceptance and widespread use.