Post-operative Care for Cryosurgery

The standard-of-care for postoperative care following elective craniotomy has historically been ICU admission. However, recent literature interrogating complications and interventions during this postoperative ICU stay suggests that all patients may not require this level of care. Thus, hospitals began implementing non-ICU postoperative care pathways for elective craniotomy. This systematic review aims to summarize and evaluate the existing literature regarding outcomes and costs for patients receiving non-ICU care after elective craniotomy. A systematic review of the PubMed database was performed following PRISMA guidelines from database inception to August 2021. Included studies were published in peer-reviewed journals, in English, and described outcomes for patients undergoing elective craniotomies without postoperative ICU care. Data regarding study design, patient characteristics, and postoperative care pathways were extracted independently by two authors. Quality and risk of bias were evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence tool and Risk Of Bias In Non-Randomized Studies-of Interventions tool, respectively. In total, 1,131 unique articles were identified through the database search, with 27 meeting inclusion criteria. Included articles were published from 2001 to 2021 and included non-ICU inpatient care and same-day discharge pathways. Overall, the studies demonstrated that postoperative non-ICU care for elective craniotomies led to length of stay reduction ranging from 6 hours to 4 days and notable cost reductions. Across 13 studies, 53 of the 2,469 patients (2.1%) intended for postoperative management in a non-ICU setting required subsequent care escalation. Overall, these studies suggest that non-ICU care pathways for appropriately selected postcraniotomy patients may represent a meaningful opportunity to improve care value. However, included studies varied greatly in patient selection, postoperative care protocol, and outcomes reporting. Standardization and multi-institutional collaboration are needed to draw definitive conclusions regarding non-ICU postoperative care for elective craniotomy.

Background: Present study focuses on effectiveness of standard post-operative care on post-operative evaluation among women undergone lower segment cesarean section in selected hospitals. Standard post operative care basically stands for list of non-pharmacological or pharmacological measures, procedures and methods adopted by the investigator/care giver during post-operative period of women undergone lower segment cesarean section for the reduction of negative post-operative outcomes or complications and to fasten recovery. Present study encompasses articles on post-operative care in terms of one, two or more than two or three measures or interventions as post-operative care measures adapted to reduce post-operative complications like use of music therapy, foot-hand massage therapy, planned early ambulation, planned ambulation techniques etc. for post-operative complications and pain relief.
 Objective: To identify various post-operative measures or care which can be included in standard post-operative care list and its effectiveness on post-operative outcome evaluation among women undergone Lower segment cesarean section in selected hospitals.
 Methods: Articles were searched in Google scholar, Pub-med, Medline and research gate by using keywords post-operative care of cesarean section, post-operative outcomes of cesarean section and Cesarean mother.
 Result: Review includes seven articles showing different non-pharmacological or pharmacological measures or techniques to overcome post-operative complications for early recovery and better outcomes. These measures can be included in standard post-operative care list for positive post-operative maternal and fetal outcomes. These measures include early planned ambulation, planned ambulation techniques, music therapy, Foot and hand massage therapy and use of certain analgesia for pain management in post cesarean women if needed, as per the patient’s condition.
 Conclusion: Conclusion of the review revealed that there are various measures which can be standardized in post-operative outcome evaluation among women undergone lower segment cesarean section.

Background: Wound dehiscence is a significant postoperative complication following caesarean sections, leadingto increased morbidity, prolonged hospital stays, and higher healthcare costs. Various maternal, surgical, andpostnatal factors contribute to wound dehiscence, making early identification of high-risk cases crucial forimproving surgical outcomes. Factors such as obesity, diabetes, hypertension, anemia, prolonged labor,chorioamnionitis, surgical technique, and improper postoperative wound care have been implicated in woundhealing complications. This study aims to evaluate the risk factors associated with wound dehiscence followingcaesarean sections at a tertiary care hospital in Bihar.Objectives: This study aims to assess the prevalence and risk factors of wound dehiscence in post-caesareanpatients, evaluate the impact of maternal comorbidities and surgical factors, and analyze the relationship betweenintraoperative and postoperative complications and wound healing.Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology,Patna Medical College and Hospital, Patna, Bihar, India, over twelve months. A total of 120 post-caesareanpatients who developed wound dehiscence were included in the study and compared with 120 matched controlswho had uneventful wound healing. Data on patient demographics, maternal comorbidities (diabetes,hypertension, anemia), BMI, nutritional status, duration of labor, presence of chorioamnionitis, intraoperativefactors (type of incision, duration of surgery, blood loss), and postoperative care were collected and analyzed. Thewound was assessed using standard criteria, including signs of infection, gaping, and serous or purulent discharge.Statistical analysis was performed to determine significant risk factors.Results: The incidence of wound dehiscence was 8.5% among post-caesarean patients. Obesity (BMI > 30 kg/m²)was observed in 32% of cases, while diabetes mellitus (24%) and anemia (36%) were also significantly associatedwith wound dehiscence. Prolonged labor (>12 hours) and emergency caesarean sections (60%) were identified asindependent risk factors (p < 0.01). Chorioamnionitis was present in 18% of cases, contributing to infection-related wound breakdown. The use of vertical midline incisions (22%) and increased intraoperative blood losswere significantly associated with dehiscence. Patients with inadequate postoperative wound care and earlymobilization had a higher risk of wound complications.Conclusion: Wound dehiscence following caesarean section is influenced by multiple risk factors, includingobesity, diabetes, anemia, prolonged labor, emergency surgeries, and surgical technique. Optimizing maternalhealth, improving intraoperative hemostasis, and ensuring adequate postoperative wound care can significantlyreduce the incidence of wound complications. Preventive strategies, including better glycemic control, nutritionalsupport, and the use of standardized surgical techniques, are essential in improving maternal surgical outcomes incaesarean deliveries

Impact of Shortage of Postoperative Intensive Care Management on Morbidity after Major Elective Abdominal Oncologic Surgery during COVID Pandemic

BackgroundHip fractures mainly affect older people. It is associated with high morbidity and mortality, and in particular a high frequency of delirium. Incident delirium following hip fracture is associated with an increased risk of dementia in the following months, but it is still not firmly established whether this is an association or a causal relationship. Orthogeriatric units vary with respect to content and timing of the intervention. One main effect of orthogeriatric care may be the prevention of delirium, especially if preoperative and postoperative care are provided. Thus, the aim of Oslo Orthogeriatric Trial, is to assess whether combined preoperative and postoperative orthogeriatric care can reduce the incidence of delirium and improve cognition following hip fracture.Methods/designInclusion and randomisation will take place in the Emergency Department, as soon as possible after admission. All patients with proximal femur fractures are eligible, irrespective of age, pre-fracture function and accommodation, except if the fracture is caused by a high energy trauma or the patient is terminally ill. The intervention is pre-and post-operative orthogeriatric care delivered on a dedicated acute geriatric ward. The primary outcome measure is a composite endpoint combining the Clinical Dementia Rating Scale (CDR) and the 10 word memory task at four months after surgery. Secondary outcomes comprise incident delirium, length of stay, cognition, mobility, place of residence, activities of daily living and mortality, measured at 4 and 12 months after surgery. We have included 332 patients in the period 17th September 2009 to 5th January 2012.DiscussionOur choice of outcome measures and our emphasis of orthogeriatric care in the preoperative as well as the postoperative phase will enable us to provide new knowledge on the impact of orthogeriatric care on cognition.Trials registrationClinicalTrials.gov NCT01009268

To retrospectively analyze the postoperative management and care needs of patients undergoing spontaneous ventilation supraglottoplasty (SVS). Retrospective chart review. Charts of children undergoing (SVS) for severe laryngomalacia from 2007 to 2011 at a single institution were reviewed. Intraoperative and postoperative management data were collected to review the airway management, postoperative care needs, and potential complications associated with this surgery. A total of 65 patients were included in the study. Only three patients (4.5%) required more than an overnight stay in the hospital, and no patients left the operating room intubated. One patient required temporary intensive care unit observation, and the majority (78.1%) demonstrated adequate oral intake within 4 hours of surgery. Comorbidities did not portend a longer hospital stay or slower return to oral intake. SVS with cold-steel instruments is a safe and effective surgical intervention with low complication rates. This study suggests that postoperative intubation or intensive care unit monitoring may not be necessary when using these techniques.

Understanding best practices in perioperative care is critical for quality of care for our urology patients. We compiled a single, concise resource that provides recommendations for optimizing postoperative outcomes in patients undergoing urological surgery. Optimal postoperative care includes minimizing complications, optimizing recovery and improving patient outcomes. The assembled White Paper multidisciplinary writing team included experts in a number of different areas (urologists, nurses, anesthesiologists) to address a comprehensive set of topics that urological providers face when caring for postoperative patients. This article provides a summary of key elements to optimize postoperative care in adult urological surgery, including in-hospital considerations, transition/discharge, and followup and surveillance. In-hospital postoperative considerations include checklists, handoffs for safe transitions from the anesthesia to surgical team, level of care planning and enhanced recovery after surgery (ERAS®). Embedded in ERAS are postoperative nutrition, mobilization, wound care, judicious use of catheters and drains, and postoperative medications and transfusions. As the patient transitions to the outpatient setting, the urologist must provide clear and readable postoperative education, which includes medication management and coordinated followup with primary care providers and home health as needed. Finally, followup visits should be carefully considered using innovative methods such as telehealth and patient reported outcomes to elevate postoperative and long-term care. This article summarizes postoperative factors that may impact surgical outcomes in urology. By understanding and applying best practices for postoperative care, urologists can optimize the quality of care for their patients.

Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery

Personality patterns of 84 adolescent scoliosis patients were assessed and an evaluation made of certain psychological effects of corrective surgery. Results indicate the following: Scoliosis has fewer psychologically debilitating effects on younger adolescents (those under 16) than it does on older adolescents; scoliotic boys show comparatively better general personality integration than girls; scoliotic girls are less disturbed in psychosexual development than are boys. Postoperatively, boys can be expected to show less overt incapacitation than girls; psychologically, boys will require a longer period of recuperation than will girls; boys can be expected to present fewer immediate management problems than girls; the internalization of a sense of "difference" from the normal in adolescent scoliotics increases in direct relation to age. Consequently, the eariler surgical correction can be undertaken the better. Important differences exist between the psychological "set" of male and female adolescent patients. For boys, self-acceptance is at the core. Postoperative surgical care should thus focus on reinforcing characteristics of personal adequacy, namely, the ability to compete, and fulfill reasonable goals. For girls, acceptance by others is paramount. Postoperative care is best directed toward strengthening feelings of attractiveness (of any personal characteristic), worth, and, above all, future interpersonal possibilities.

Background Diseases of the biliary system and gallbladder pose a significant global public health burden, affecting millions annually. Conditions such as gallstone formation, cholecystitis, and biliary dysfunction contribute to gastrointestinal morbidity, often necessitating surgical intervention. Gallstone prevalence ranges between 10% and 15%, with post-surgical recovery in open cholecystectomy patients being hindered by limited mobility, leading to prolonged hospital stays. This study investigates the impact of implementing an early mobility protocol on postoperative recovery in patients who have undergone open cholecystectomy. Methods This study included a total of 24 patients who underwent open cholecystectomy, who were randomly assigned to two groups, with 12 participants in each. Baseline demographic and clinical characteristics, including age, gender, education level, religion, body mass index (BMI), and preoperative pain scores, were systematically documented to ensure comparability between the groups. The experimental group followed a structured early mobility protocol, consisting of supervised mobility exercises such as sitting, standing, breathing exercises, abdominal exercises, and short-distance ambulation, conducted twice daily from the first postoperative day until the fourth day. In contrast, the control group received standard postoperative nursing care without additional mobility interventions. Recovery outcomes, including mobility levels, functional independence, and patient satisfaction, were evaluated using validated assessment scales. Statistical analyses were performed using SPSS version 28.0(IBM Corp., Armonk, NY, USA). Results Prior to the intervention, all patients exhibited complete dependence on mobility. Following the intervention, 83.3% of patients in the experimental group attained moderate mobility, with 58.3% achieving partial functional independence by the fourth postoperative day (p < 0.001). The experimental group demonstrated a mean improvement in mobility scores of 4.67, significantly higher than the 0.24 mean improvement in the control group (p < 0.001). Functional independence scores in the experimental group increased by a mean difference of 19.08 (p < 0.001). A strong positive correlation was observed between mobility and functional independence (r = 0.744, p < 0.01), reinforcing the efficacy of early mobilization. Conclusion The implementation of an early mobility protocol significantly improved mobility, functional independence, and patient satisfaction in open cholecystectomy patients, demonstrating its importance in postoperative care. The protocol's effectiveness was consistent across different demographic variables, suggesting broad applicability. Larger studies are recommended to further validate these findings.

The Recovery Period

Intraocular gnathostomiasis is an exceptionally rare manifestation of Gnathostoma spinigerum infection. Ingested larvae from undercooked meat[1] can migrate to various body parts, causing significant morbidity. Intralenticular localization-where the larva is embedded within the crystalline lens-is extremely unique, with this video documenting the first reported global case. To present the clinical, diagnostic, and surgical aspects of a unique case of intralenticular gnathostomiasis, providing educational value to ophthalmologists, parasitologists, and primary care physicians. This case emphasizes the importance of considering parasitic infections in differential diagnoses, particularly in patients with relevant dietary or travel histories. A foreign national presented with ocular irritation and gastrointestinal symptoms following the consumption of undercooked meat. Clinical findings included anterior chamber reaction, mild vitritis, optic disc edema, retinal hemorrhages, and curvilinear retinal scars. Endogenous endophthalmitis was initially suspected. On Day 18, a live worm was visualized within the lens on slit-lamp examination and anterior segment-optical coherence tomography (AS-OCT). The video illustrates the diagnostic journey and meticulous surgical extraction of the worm in toto. An animated segment demonstrates the presumed migratory path of the larva. Histopathology confirmed the species as Gnathostoma spinigerum. • Diagnosis: Emphasizes the importance of detailed history-taking, including dietary habits and travel exposure. • Documentation: High-quality images of the motile worm within the lens aid future recognition and diagnosis. • Surgery: Demonstrates the technique to safely extract the worm, providing insights into managing such rare and delicate cases. • Postoperative Care: Discusses the importance of postoperative monitoring and care for full visual and systemic recovery. https://youtu.be/VAdj17UZVA0.

ObjectiveThe postoperative care regimes of ankle fractures are studied for over 30 years and recommendations have shifted only slightly in the last decades. However, study methodology might have evolved. The aim of this study was to evaluate the changes in time in the design, quality and outcome measures of studies investigating the postoperative care of ankle fractures.MethodsThe MEDLINE and EMBASE database were searched for both RCTs and cohort studies. The original studies were divided into decades of publication over the last 30 years. The methodological quality of the studies was assessed using the ‘traditional’ risk of bias assessment tool provided by The Cochrane Collaboration and the ‘newer’ MINORS criteria.ResultsThe percentage of RCTs on this subject declined from 67 to 38 % in the last decades. According to the Cochrane tool, the reported quality of RCTs has improved in the last three decades whereas the reported quality of observational studies has remained unchanged. However, when quality was evaluated with the MINORS criteria, equal improvement was observed for both RCTs and observational studies. In the 80s, 67 % of all studies used the range of motion as the primary outcome measure, which decreased to 45 % in the 90s. In the 00s, none of the studies used the range of motion as the primary outcome.ConclusionFor postoperative care of ankle fractures, results of this study showed a relative decrease in the published number of RCTs. The overall quality of the published articles did not decline. In addition, a gradual shift from physician measured to patient-reported outcome variables was observed. However, it should be borne in mind that the findings are based on a small sample (n = 25).

INTRODUCTION: Antimicrobial agents were considered as magic bullets and effective tools to combat infection in various therapeutic settings. In conventional antibiotic use, antimicrobials are used for a predetermined period after therapeutic procedure to combat the infection because most often in public hospitals due to lack of maintainance of environmental hygiene & overload of surgical patients fear of SSI (surgical site infection) are more. AIMS AND OBJECTIVES: To study the wound infection rate and recognition and prevention of exogenous and endogenous sources of SSI in laproscopic cholecystectomy, whether long term antibiotics should be given or antibiotics given at the maximum time of concentration are sufficient. MATERIALS AND METHODS: Study size and period: 50 cases, June 2017 to December 2018. Study conducted at: V.S.G.H, Ahmedabad. Single dose of antibiotic, 1 gm ceftriaxone was administered one hour before surgery by IV route & 5 days course, 2 days IV and 3 days oral (cefixime). Study on patients with age group of 18-60 years both males & females with no co-morbid condition posted for laproscopic cholecystectomy for gall bladder stones. Wound inspection done on 3rd, 5th, and 7th day. RESULTS: 1 day pre-operative antibiotic is almost as effective as to multiple dose antibiotics.Hence a single-day prophylaxis is recommended to reduce the financial burdens, the emergence of resistant strains and avoid the side effects of the drugs.However , it is of utmost importance that complete asepsis be maintained during the surgery and post-operative care, irrespective of the antibiotic prophylaxis, to achieve the most desired goal of elimination of post-operative infections, thus reducing the morbidity and mortality. CONCLUSION: Single dose antibiotic is sufficient in preventing wound infection and also some other factors like proper preoperative skin preparation, sterile surgical practice & operative theatre & good postoperative nursing care to be taken care of. Prolonged administration of antibiotics is unnecessary and costlier. Prolonged use of antibiotics is associated with emergence of resistant strains and super-infections, which can be prevented by cost effective short term antibiotic prophylaxis.

Postoperative complications (PCs) are a major cause of mortality following elective major abdominal surgery (EMAS). The increasing complexity of abdominal procedures, particularly in oncology, may significantly affect patient outcomes. However, this has also introduced a higher variability in postoperative management, and the use of tailored approaches to address critical issues such as hemodynamic stabilization, infection management, and respiratory failure. While elective admission to intensive care units (ICU) is a standard practice to manage high-risk surgical patients, ICU resource allocation is often influenced by local practices and bed availability.This document presents a framework for preoperative ICU admission planning after EMAS. It focuses on the identification of patient and surgical risk factors—using established scoring systems—and provides statements to determine ICU admission. The aim is to optimize resource allocation, reduce PCs, and prevent unplanned ICU admissions. This good clinical practice statement was developed through a multidisciplinary panel formed by selected members coming from SIAARTI (Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care), SIC (Italian Society of Surgery) and ANIARTI (National Association of Critical Area Nurses).The designed scientific board developed, through a systematic literature review and a consensus methodology, a roadmap for defining the priorities of perioperative care based on the complexity of the patient and the surgical procedure. Eventually, the panel worked out statements about six voted queries that could have supported the preoperative indication to postoperative ICU admission.Evaluation of patients’ characteristics, comorbidities, and surgical factors are all essential to plan ICU admission for immediate postoperative patient care after EMAS.The presence and severity of comorbidities, assessed through various severity scores, play a crucial role in predicting PCs and guiding ICU admission decisions. Tools such as the American Society of Anesthesiologists physical status, Charlson Comorbidity Index, and Rockwood Frailty Index, along with surgical risk scores and intraoperative events, help define the need for intensive care. Preoperative frailty assessment—achieved using the Clinical Frailty Scale—is essential to anticipate postoperative care needs. Finally, during the postoperative phase, continuous monitoring and reassessment in the post-anesthesia care unit are key to determine whether ICU admission is required. Establishing high-dependency units and tailored care pathways based on individual patient needs and available resources will enhance patient outcomes and optimize postoperative care.