Educational outcomes in school age children with a history of isolated Hirschsprung disease are equivalent to their peers

PurposeThe aim of this study was to assess real-world educational outcomes and developmental disorders in patients with a history of Hirschsprung disease compared to an age-matched control group.MethodsWith ethics approval (H2016:014) a retrospective cohort study of all children diagnosed with Hirschsprung disease at a single centre from 1992 to 2017 was performed. A 10:1 date-of-birth matched control cohort was constructed from a population-based directory. The educational outcomes were compared using the following measures: Early Developmental Instrument, Grades 3, 7, and 8 assessments, Grade 9 completion, Grade 9 performance, and high school graduation. Fisher's exact tests were used to compare the odds of failure between cases to controls. Only children who reached 4 years of age were included.ResultsA total of 75 cases with Hirschsprung disease patients were identified. Patients with Hirschsprung disease were at increased risk of failing to meet expectations on the Early Development Instrument. After entering elementary school, Hirschsprung patients were at no greater risk than their peers of failing to meet expectations on standardized testing or failing to graduate from high school.ConclusionUsing real-world measures of academic success as a surrogate for neurodevelopmental status, our study demonstrates that patients with a history of Hirschsprung disease demonstrated poor neurodevelopmental performance in pre-school, but the educational achievements of patients did not differ from controls once they started school. These promising data can be used to mitigate preconceived notions that patients with Hirschsprung disease require special education, which may be isolating and psychosocially damaging.     

"Pulling the plug"--management of meconium plug syndrome in neonates

BackgroundThe significance of meconium plug syndrome (MPS) is unclear but has been associated with Hirschsprung’s disease and magnesium tocolysis. We reviewed our experience to attempt to identify any potential association with these conditions and to review our outcomes.MethodsUsing the International Classification of Diseases, Ninth revision, code for meconium obstruction, patient charts were identified during the 1998–2008 period. A total of 61 cases of MPS were found, after excluding 7 of meconium ileus. Data regarding the hospital course and outcomes were collected and analyzed.ResultsApproximately 30% of patients had spontaneous resolution of the meconium plug without any treatment. Of those patients requiring treatment, contrast barium enema was used, with 97% success. Only 2 patients required surgical intervention owing to worsening distension and subsequent peritonitis. When we stratified the patients according to gestational age of >36 and <36 wk, contrast barium enemas were performed 2.2 ± 1.8 versus 8.6 ± 7.8 d after birth (P = 0.003), respectively, and the lower gestational age patients had a longer length of stay. Contrast barium enema was still successful in 94% of patients with a gestational age of <36 wk. Magnesium tocolysis was noted in 16% of the cases, and Hirschsprung’s disease was only found in 3.2% of patients.ConclusionsPatients with MPS have excellent outcomes, independent of gestational age. Contrast barium enema remains the initial diagnostic and treatment of choice for patients with MPS. Also, although previous reports have shown a link between magnesium tocolysis and Hirschsprung’s disease with MPS, our experience suggests otherwise.     

The Chest Wall Injury Society Recommendations for Reporting Studies of Surgical Stabilization of Rib Fractures

Background: Publications investigating the efficacy of surgical stabilization of rib fractures (SSRF) have increased exponentially. However, there is currently no standardized reporting structure for these studies, rendering both comparisons and extrapolation problematic.Methods: A subject matter expert group was formed by the Chest Wall Injury Society. This group conducted a review of the SSRF investigational literature and identified variable reporting within several general categories of relevant parameters. A compliment of guidelines was then generated.Results: The reporting guidelines consist of 26 recommendations in the categories of: (1) study type, (2) patient and injury characteristics, (3) patient treatments, (4) outcomes, and (5) statistical considerations.Conclusion: Our review identified inconsistencies in reporting within the investigational SSRF literature. In response to these inconsistencies, we propose a set of recommendations to standardize reporting of original investigations into the efficacy of SSRF.     

Is daily dilatation by parents necessary after surgery for Hirschsprung disease and anorectal malformations?

Background/PurposeMost surgeons recommend daily dilatation after surgery for Hirschsprung disease and anorectal malformations. Our goal was to critically evaluate the potential risks and benefits of this practice.MethodsA retrospective chart review was carried out of all children undergoing repair of Hirschsprung disease or anorectal malformation over 5 years. Patients with long segment Hirschsprung disease or anal stenosis were excluded.ResultsThere were 95 patients, of which 34 had Hirschsprung disease and 61 had an anorectal malformation. Postoperatively, 65 underwent routine dilatation by parents; and 30 underwent weekly calibration by the surgeon, with daily dilatation by the parents only if the anastomosis was felt to be narrow. Of the 30 children undergoing weekly calibration, only 5 (17%) developed late narrowing that required conversion to the daily parental dilatation approach. There were no significant differences between the 2 approaches with respect to stricture development, anastomotic disruption, perineal excoriation, or enterocolitis.ConclusionWeekly calibration by the surgeon is associated with similar outcomes to daily dilatation by the parents. Because this approach is kinder to the parents and the child, it should be seriously considered for the postoperative management of children with Hirschsprung disease or anorectal malformations.     

Improving Estimates of Perioperative Morbidity After Radical Cystectomy Using the European Association of Urology Quality Criteria for Standardized Reporting and Introducing the Comprehensive Complication Index

BackgroundNo procedure-specific definitions in complication reporting have been universally accepted in urological surgery, and conventional classification systems do not reflect cumulative morbidity.ObjectiveTo conduct a rigorous assessment of 30-d complications after radical cystectomy and improve morbidity estimates by introducing the novel Comprehensive Complication Index (CCI).Design, setting, and participantsA retrospective proof-of-concept study of 506 patients with bladder cancer between 2009 and 2017.InterventionRadical cystectomy with pelvic lymph node dissection.Outcome measurements and statistical analysesThirty-day complications were extracted from digital charts based on a procedure-specific catalog. Each complication was graded by the Clavien-Dindo classification (CDC), and each individual CCI was calculated. We evaluated traditional morbidity endpoints and tested the ability of both classification tools to mirror cumulative morbidity. Multivariable regression analyses were employed for risk modeling using conventional and novel endpoints. The study fulfilled all the European Association of Urology (EAU) criteria of standardized reporting. Limitations include restricted follow-up of 30 d.Results and limitationsOf 506 patients, 503 (99%) experienced a total of 2485 complications, of which the majority was classified as “minor” (CDC grade ≤ IIIa; 89%). Overall, 29 (5.7%), 20 (4.0%), and 12 (2.4%) patients were reoperated, readmitted, and died within 30 d, respectively. When using the CCI to capture cumulative morbidity, the proportion of patients with most severe complication burden (CDC grade ≥ IIIb or corresponding CCI > 33.7) increased to 31% as compared with 11% when considering only the highest-grade complication according to the CDC. Age-adjusted comorbidity and delta hemoglobin were the main drivers of perioperative complications for all outcomes in multivariable models.ConclusionsThe assessment of short-term morbidity after radical cystectomy may be refined and optimized by employing the EAU criteria of standardized reporting and using the CCI to capture cumulative morbidity. These are the cornerstones of urgently needed procedure-tailored benchmarking to improve comparability and quality control.Patient summaryCharacterization of short-term morbidity after radical cystectomy was improved by using several validated assessment tools and adhering to existing guidelines for reporting surgical complications.     

Clinical characteristics and validation of diagnosis in individuals with Hirschsprung disease and inflammatory bowel disease

Background/purposeHirschsprung disease has previously been reported to be associated with inflammatory bowel disease (IBD). The aim was to clinically confirm the diagnosis and to describe characteristics among individuals with both conditions in a national populationbased cohort.MethodsNationwide, population-based cohort study, including all individuals with a Hirschsprung disease diagnosis and an IBD diagnosis registered between 1964 and 2016, in which clinical data were collected from the medical records of 18 validated cases with both Hirschsprung disease and IBD. The medical record of each individual in the study cohort was reviewed for age at IBD diagnosis, type of aganglionosis, type of surgical treatment, subtype of IBD, and treatment for IBD.ResultsMedian age at follow up was 34 years (range 19–66), and 3 of 18 indivduals (17%) were females. Median age at first diagnosis of IBD was 21 years (range 10–46). Six patients had ulcerative colitis, ten had Crohn's disease and two had unclassified IBD. Most of the patients had pharmacological treatment for IBD and 5 (28%) individuals had surgical treatment.ConclusionHirschsprung disease and IBD was clinically confirmed in 18 cases. Age at IBD onset and subtype of IBD is similar to IBD patients without Hirschsprung disease. Five individuals had undergone surgical treatment for IBD.     

Surgical Management of Hidradenitis Suppurativa: A Narrative Review

ObjectiveHidradenitis suppurativa (HS) is a debilitating, chronic, dermatological inflammatory skin disease that affects apocrine gland bearing skin in the axillae, groin, and inframammary regions. It is underdiagnosed and its pathogenesis incompletely understood. This paper provides a comprehensive review of the existing literature on the surgical management of HS, focusing upon outcomes of definitive surgery. MethodsA literature search was conducted according to PRISMA guidelines. PubMed and EMBASE databases were searched for original studies pertaining to the surgical management of HS published from January 1970 to July 2020. A total of 33 papers were included for analysis.ResultsManagement options include risk factor modification, pharmacological agents, and surgical intervention. Many surgical management techniques exist, including incision and drainage, CO₂ laser therapy, deroofing, wide local excision, and reconstructive surgery. Incision and drainage is commonly utilized for symptom relief of sepsis. While data on curative surgical management are lacking, studies on surgical approaches have shown favorable outcomes in highly selected cases.Wide excision with flap reconstruction results in high patient satisfaction rates, good cosmesis, and reduced disease recurrence.Limitations A small number of suitable papers met our specific focus and inclusion and exclusion criteria. Novel techniques described in case studies were missed. Additionally, this study examined HS management as a whole, but region-specific management was not reviewed closely.ConclusionThe success of surgical management is dependent on multiple factors. Thus far, the precise role of surgery in elective treatment of refractory HS requires further analysis and reporting of outcomes.     

Nonoperative management of lisfranc injuries – A systematic review of outcomes

BackgroundHistorically, most Lisfranc injuries have been considered to be unstable and treated with surgical intervention. However, with better access to cross-sectional imaging, stable injury patterns are starting to be recognised. The aims of the current study were to perform a systematic review of outcomes of Lisfranc injuries treated non-operatively.MethodsA literature review was performed of studies reporting nonoperative management of Lisfranc injuries (PROSPERO registered and following PRISMA guidelines). Following exclusions, 8 papers were identified: 1 prospective and 7 retrospective studies. A total of 220 patients were studied with a mean age of 39.8 years and a mean follow-up of 4.3 years. Outcomes included function, displacement, and rates of surgery.ResultsHigh heterogeneity was observed with variable outcomes. Four papers reported good outcomes, with adjusted functional scores ranging from 82.6 to 100 (out of 100). However, one study reported late displacement in 54 % of patients. Rates of secondary osteoarthritis ranged from 5 % to 38 %. Rates of surgical intervention were as high as 56 %. Several studies compared operative to non-operative treatment, reporting superior outcomes with surgery. Those injuries with no displacement on CT, measured at the medial cuneiform-second metatarsal had the best outcomes.ConclusionReported outcomes following nonoperative treatment of Lisfranc injuries vary widely, including high rates of conversion to surgery. In contrast, some studies have reported excellent functional outcomes. CT seems to be an important diagnostic tool in defining a stable injury. Due to limited data and lack of a clear definition of a stable injury or treatment protocol, prospective research is needed to determine which Lisfranc injuries can be safely treated nonoperatively.     

Notificación y clasificación de complicaciones después de procedimientos quirúrgicos urológicos: una evaluación y recomendaciones del panel de guías clínicas de la EAU

ContextThe incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology.ObjectiveTo review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes.Evidence acquisitionStandardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999–2000 and 2009–2010. Data identification for the systematic assessment of the Clavien-Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms.Evidence synthesisThe systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien-Dindo system. The latter system was not properly used in 72 papers (35.3%).ConclusionsUniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria.     

A systematic review of the impact of preoperative exercise for patients with abdominal aortic aneurysm

BackgroundAbdominal aortic aneurysm (AAA) surgery carries significant risk of morbidity and mortality. Preoperative exercise may improve the physical fitness capacity of patients with AAA as well as postoperative outcomes.MethodsA systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was performed on MEDLINE, Embase, and Cochrane Library for relevant studies. A methodologic assessment of included studies was conducted using the Physiotherapy Evidence Database (PEDro) scale.ResultsSeven studies (six randomized controlled trials and one retrospective cohort study) were included. The overall quality of studies was assessed to range from fair to good. Three studies included AAA patients without indication for surgery, whereas four other studies included AAA patients awaiting surgical repair. One study implemented an inspiratory muscle training program; five studies implemented a continuous moderate-intensity exercise regimen; one study implemented a high-intensity interval training program. Overall compliance with the exercise regimen was high (94% in those not waiting for surgery; 75.8% to 82.3% in those waiting for surgery). In patients not awaiting surgery, preoperative exercise may improve physical fitness parameters including ventilatory threshold (P = .016 at 12 weeks; P = .09 at 12 months) and anaerobic threshold (10% increase; P = .007) but not peak oxygen consumption (P = .183 at 12 weeks; P = .29 at 12 months). In patients awaiting surgery, one study demonstrated a statistically significant improvement in peak oxygen consumption (difference, 1.6 mL/kg/min; P = .004) and anaerobic threshold (difference, 1.9 mL/kg/min; P = .012) for patients who exercised. In terms of postoperative outcomes, exercise may reduce the risk of cardiac, renal, and respiratory complications, although only in those who undergo open surgery. Only patients who underwent endovascular repair had a shorter length of hospital stay when preoperative exercise was conducted.ConclusionsDespite the encouraging evidence of preoperative exercise for AAA patients, it remains premature to recommend it as a preoperative intervention. Given the heterogeneity of reported outcomes, future studies should consider conducting well-designed randomized controlled trials with standardized reporting outcomes and definitions.     

Prognostic factors for isolated medial patellofemoral ligament reconstruction: A systematic review

BackgroundEvidence concerning the influence gender, age, and the time elapsed from the first dislocation to surgery in the outcomes of Medial Patella Femoral Ligament (MPFL) reconstruction are lacking. This systematic review was conducted to investigate whether patient characteristics have an influence in the clinical outcomes of MPFL reconstruction for patients with patellofemoral instability.Material and methodsThis study followed the PRISMA guidelines. The main databases were accessed in February 2021. All the studies reporting outcomes of primary MPFL reconstruction in patients with recurrent patellofemoral instability were considered for inclusion. A multivariate analysis diagnostic tool was used to analyse the association between age, gender and time from injury to surgery and the surgical outcomes at last follow-up.ResultsA total of 50 articles (2037 procedures) were included. The mean follow-up was 40.90 ± 24.8 months. The mean age was 23.6 ± 3.9 years. 64.3% (1309 of 2037 patients) were female. The mean time from injury to surgery was 64.5 ± 48.9 months. Women showed no statistically significant association with the Kujala score or complications. Older patients had a reduced risk to incur re-dislocations (P = 0.01) and revisions (P = 0.01). Longer time from injury to surgery was associated with greater risk to incur re-dislocations (P = 0.01), and with lower Kujala score (P < 0.0001). No other statistically significant association was evidenced.ConclusionThe time span from the first patellar dislocation to the surgical reconstruction was a negative prognostic factor, while sex had no influence on surgical outcomes. The role of patients age on surgical outcomes remains unclear.     

Transmetatarsal amputation: A 12 year retrospective case review of outcomes

BackgroundDiabetic foot pathology has rapidly increased, presenting a vast economic burden with severe implications for patients. Establishing effective limb salvage techniques such as transmetatarsal amputation is essential to offer viable alternatives to major limb amputation in severe foot infection, where outcomes are variable and mortality rates high.MethodsA retrospective review of outcomes was performed on patients who underwent TMA at a single United Kingdom hospital between 2005–2017. Healing rate and time to healing, mortality, duration of hospital admission and incidence of revision surgery was evaluated.Forty-seven patients had 54 TMA’s by the Podiatric Surgery team. Data was assessed for Mean (SD) and Median. The impact of co-morbidities was considered and the perioperative and surgical management reviewed to identify techniques which may improve outcomes.ResultsA 78% healing rate was achieved. Six patients (11%) died before healing. The aremaining 11% did not heal and resulted in major limb amputation. No further surgery to the same foot was required after the TMA healed.A Median healing time of 83 days was identified and the Median duration of hospital admission was 24 days. Adjunctive wound care products may to have a positive impact on these factors.Five-year mortality was 43%, and demonstrated an association with renal and/or vascular pathology. All patients had diabetes, with many also having Peripheral Vascular Disease (PVD). Almost all TMA’s failing to heal had PVD. The presence and severity of renal disease also seemed to have a negative impact on wound healing.ConclusionPositive healing and mortality rates with low need for revision surgery support TMA to be an effective alternative to major limb amputation. Adjunctive agents may have a positive impact on wound healing and length of hospital admission. Skilled surgical technique and Multidisciplinary work is essential for positive long-term outcomes and cost-effective care.     

Application of Da Vinci robotic surgery system in cervical cancer: A single institution experience of 557 cases

ObjectiveConflicting data have been published regarding the oncologic appropriateness of minimally invasive surgery (MIS) in the treatment of cervical cancer. The purpose of the present study was to investigate whether our experience in the treatment of early cervical cancer using a robotic surgical approach was safe and oncologically effective.MethodsThe data of 557 patients with cervical cancer treated by robotic surgery were retrospectively collected, including the perioperative and survival outcomes. Tumor stage was based on the International Federation of Gynecology and Obstetrics (FIGO 2009). The disease-free survival (DFS) and overall survival (OS) were calculated by the Kaplan–Meier method.ResultsOf the 557 patients, 196 (35.2%) patients were stage IA1 to IB1, and 304 (54.6%) patients were stage IB2 to I1A2. Also included were 57 (10.2%) patients with either recurrent or persistent disease following concurrent chemoradiotherapy. Two patients (0.4%) experienced severe intraoperative complications and 11 patients (2.0%) developed postoperative complications. A stratified analysis of survival was conducted in 91 patients who met a follow-up time of 3-year or more. The median follow-up time was 49 (range, 6–57) months. Both the 3-year DFS and OS of early-stage (stage IA1 to IB1) cervical cancer were 97.6%. For patients with locally advanced (stage IB2 to IIA2) disease, DFS and OS were 88.1% and 90.5%, respectively. The patients with recurrent or persistent disease had DFS and OS of 62.5%.ConclusionOur study results demonstrated that the robotic surgical approach could achieve satisfying therapeutic outcomes in patients with early-stage cervical cancer, with a low complication rate. For advanced cervical cancer patients with recurrent or persistent disease following concurrent chemoradiotherapy, robotic surgery undertaken as supplementary therapy may improve prognosis. However, there remains a need for additional prospective data reporting long-term survival of cervical cancer patients treated with a robotic surgical approach.     

The Israel National Bariatric Surgery Registry: the inception process

BackgroundObesity rates in Israel are increasing, and so is the popularity of bariatric surgeries, which reached in 2017 a prevalence rate of 1428.7 surgeries per million citizens. However, data regarding patient characteristics and surgery outcomes, including complications, are limited and the procedure requires monitoring.ObjectivesTo establish a national bariatric surgery registry with high reliability and validity.SettingAll private and public medical centers performing bariatric surgeries in the state of Israel.MethodsThe Israeli Bariatric Surgery Registry (IBSR) was established in June 2013 by the Israel Center for Disease Control in the Ministry of Health, in collaboration with the Israel Bariatric Surgery Society. An official directive of the Director General of the Ministry of Health as of 2013 made reporting of all bariatric surgeries carried out in Israel mandatory. The bariatric surgery centers relay clinical and surgical information to the IBSR. Presurgery and follow-up outcome information was retrieved from all 4 health maintenance organizations.ResultsAll 32 certified bariatric units report to the national IBSR. National reporting rates increased from 46.3% in 2013 to 98.7% in 2017. Adherence to bariatric surgery guidelines also increased from 72.8% in 2013 to 98.7% in 2017, and fewer patients not fulfilling the guidelines underwent bariatric surgeries in 2017. Importantly, the considerable annual preregistry increase in surgical procedures has been halted. Registry data regarding obesity-related co-morbidities were validated against hospital files with high Cohen's kappa coefficients for hypertension (r = .8), diabetes (r = .8), and sleep apnea (r = .7).ConclusionsThe national IBSR is an identified, validated, mandatory database with access to other national databases, which enables quality assurance of bariatric surgeries in Israel and short- and long-term postoperative follow-up.     

Long-term outcomes of children with transanal endorectal pull-through and a review of the literature

Introduction: The transanal endorectal pull-through (TERPT) procedure, the latest advancement in the surgical treatment of Hirschsprung’s disease, has replaced most other surgical techniques in the last decade.

Patients and methods: Between October 2002 and March 2014, a total of 22 patients diagnosed with Hirschsprung’s disease underwent a one-stage TERPT operation.

Results: Resected segments included the rectosigmoid (seven patients), the descending colon (10 patients), and the transverse colon (five patients). The minimum length of the resected segments was 15?cm and the maximum length was 65?cm. The mean length was 39.18?±?12.05?cm. Following surgery, the start of oral ingestion was 1–8 days (mean 3?±?1.69 days) and the hospital stay after the operation lasted 4–11 days (mean 7.04?±?2.05 days). The mean follow-up period was 48?±?6 months (range of 24–166 months). Out of 22 patients, three patients had an anal stricture, which responded to anal dilatations; three patients had an enterocolitis episode that required hospitalization; two patients experienced constipation; and two patients had incontinence/soiling.

Conclusion: Our data suggest that the TERPT operation can be safely performed in terms of long-term complications.     

Correlation between radiographic transition zone and level of aganglionosis in Hirschsprung's disease: Implications for surgical approach

Background/Purpose: The anticipated level of aganglionosis can influence the surgical approach to Hirschsprung[apos ]s disease. The aim of this study was to determine the accuracy of the contrast enema in predicting this level. Methods: Over a 6-year period (1995 through 2000), 88 patients with Hirschsprung[apos ]s disease underwent surgical correction. Preoperative contrast enema findings were available for 75 of these patients and were compared with operative and pathology reports. Data were analyzed by [chi ]². Results: The contrast enema showed a transition zone suggestive of Hirschsprung[apos ]s disease in 67 of 75 patients (89%). In 59 of 67 (88%), the pathologic and radiographic transition zones were concordant. Seven of the 8 patients with discordant studies had total colonic (n [equals] 5) or long-segment (n [equals] 2) disease. Contrast enema correctly predicted the level of aganglionosis in 55 of 62 (89%) patients with rectosigmoid disease but only 4 of 13 (31%) of those with long-segment or total colonic disease (P [lt ] .01). Of the patients with a radiographic transition zone in the rectosigmoid, 54 of 60 (90%) had a matching level of aganglionosis. Conclusions: In rectosigmoid Hirschsprung[apos ]s disease, the location of the radiographic transition zone correlates accurately with the level of aganglionosis in 90% of cases. However, the small incidence of discordance between anticipated level of aganglionosis and operative findings should be recognized, particularly when planning a one-stage transanal pull-through. J Pediatr Surg 38:775-778. [copy ] 2003 Elsevier Inc. All rights reserved.     

Osteopathic manipulative treatment in cardiac surgery patients: A systematic review

ObjectiveOsteopathic manipulative treatment (OMT) in surgical patients aims at reducing postoperative pain and enhancing recovery. The effects of OMT have not been extensively studied in cardiac surgery patients, mostly owing to the fact that a limited number of osteopathic physicians are trained in thoracic surgery.MethodsA systematic review of the literature was performed to identify all currently available data on postoperative OMT in cardiac surgery patients. Case reports and case series were excluded. Risk of bias of the eligible studies was assessed individually using specific protocols. Among the outcomes of interest were postoperative pain, hospital length of stay, changes in respiratory capacity, and changes in cardiac index and mixed oxygen venous saturation (SvO₂) measurements.ResultsWe identified four eligible studies which were included in the quantitative analysis of the present review. There were three randomized controlled trials (RCTs) and one non-randomized controlled cohort study which investigated on outcomes of OMT in cardiac surgery patients. The most common cardiac operations performed were coronary artery bypass grafting, valve procedures, combined procedures, and aortic operations. Numerous OMT modalities were used on postoperative patients. The OMT group of patients showed improvement in pain management and respiratory capacity, and shorter hospital length of stay.ConclusionsOsteopathic treatment might be helpful as an adjunct to current medical therapies in mitigating postoperative pain and improving the overall patient's functional status.     

Patient perspectives on surgeon-specific outcome reports in bariatric surgery

BackgroundSurgeon specific outcome reports (SSOR) in the UK can be accessed freely by the general public to promote transparency and informed decision-making. However, the views amongst bariatric patients concerning these data are unknown.ObjectivesThe aims of this study were to determine patient awareness, views and priorities for outcome reporting in bariatric surgery, and to provide recommendations for future surgeon-specific outcome reporting through the United Kingdom National Bariatric Surgery Registry.SettingBariatric surgical unit in a UK university teaching hospital.MethodsWe adapted a previously validated questionnaire and surveyed the views of 150 patients in a single bariatric surgical unit. We collected data concerning awareness, views, and future priorities for outcome reporting.ResultsA full 73% of participants were unaware they could access SSOR. Of the participants that were unaware, 75% stated that they would have accessed SSOR had they been aware they could. Of the participants that had previously accessed SSOR, 86% stated they understood the data, although 61% indicated it did not influence their choice of surgeon. The majority of participants favored public release of outcome reports at the surgeon-level (75%) and hospital-level (83%). The 3 main priorities indicated by participants for future outcome reporting were complication rates (91%), patient reported outcome measures (90%), and reoperation rate (89%), all at the surgeon level.ConclusionPatient awareness of outcome reporting is poor. Efforts must be made to increase awareness of SSOR. Patients should be incorporated as key stakeholders in determining future outcome reporting in bariatric surgery.