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Aim To explore the risk factors associated with postoperative cognitive dysfunction in older patients within the first 7 days after non‐neurosurgical surgery and anaesthesia. Design A systematic review. Methods Following, PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta‐analyses). Checklist, a systematic review of studies published from January 2018 to January 2024. The literature search was conducted across six electronic online databases, including PubMed, EMBASE, Scopus, Ovid, MEDLINE and Science Direct, and the Johns Hopkins Nursing Evidence‐Based Practice Evidence Rating Scale was used for study appraisal. Results The initial search yielded 1750 studies. The review included 19 studies which comprised prospective observational, case–control and retrospective studies. The prevalence of postoperative cognitive dysfunction ranged from 19% to 64% among older adults undergoing non‐neurosurgery. The identified risk factors were classified into three phases including preoperative, intraoperative and postoperative. Preoperative risk factors were found in age, educational attainment, malnutrition, preoperative biomarkers and co‐morbidities. Intraoperative risk factors were the duration of the operation, blood loss during the operation and anaesthesia used. Postoperative risk factors consisted of postoperative biomarkers and postoperative pain. Patient or Public Contribution The result from this review may assist researchers and healthcare providers in assessing the underlying causes and risk factors of postoperative cognitive dysfunction, and in formulating suitable preventative and therapeutic strategies for older adults with non‐neurosurgery during the short‐term postoperative period.

The association of frailty with postoperative delirium has not been fully investigated in patients undergoing cardiovascular surgery. Therefore, this study aimed to investigate whether preoperative hand grip strength is associated with postoperative delirium. This retrospective study included patients aged >65 years who had undergone elective cardiovascular surgery using cardiopulmonary bypass at a Japanese university hospital between April 2020 and February 2022. We defined low hand grip strength as hand grip values of <275 n and <177 n for men and women, respectively. Postoperative delirium was assessed using the confusion assessment method during patients’ intensive care unit stay. The odds ratio of low hand grip strength for postoperative delirium was estimated using multiple logistic analysis, which was adjusted for prominent clinical factors. Ninety-five patients with a median age of 74 years were included in the final analysis, and 31.5% of them had low hand grip strength. Postoperative delirium occurred in 37% of patients, and the odds ratio of low preoperative hand grip strength for postoperative delirium was 4.58 (95% confidence interval: 1.57–13.2). Thirty-seven patients experienced postoperative delirium after cardiovascular surgery using cardiopulmonary bypass, and low preoperative hand grip strength was positively associated with its occurrence.

Objectives Verify whether the previously planned correction with osteotomy was achieved and, in cases with hinge fracture, whether the accuracy of the correction was affected. In addition, identify the fracture characteristics responsible for inaccurate repair, including the type of fracture and the location of the hinge Methods Retrospective evaluation of patients who underwent tibial osteotomy with medial opening wedge and fixation with locking plate. The sample size was based on other similar studies available in the literature. After applying the exclusion and inclusion criteria, data from 47 participants were used. The research participants underwent the same surgical procedure, divided into two groups: patients without lateral cortical fracture and patients with fractures. Patients with fractures were compared to patients without fractures in terms of the statistical difference in the axis of correction of lower limb alignment. Results In the preoperative period, the following measurements were evaluated: Tibiofemoral Angle, Tibial Slope, mPtA (Medial Proximal Tibial Angle), Joint Obliquity (JLCA). In the immediate postoperative period: Tibiofemoral angle, tibial slope, mPtA, joint obliquity. In the late postoperative period: Tibiofemoral Angle, Tibial Slope, mPtA, Joint Obliquity, MAD (Mechanical Axis Deviation) and correction achieved between groups. There was no statistical difference between the groups in the preoperative, immediate postoperative and late postoperative periods. Conclusion No statistical differences were found between the group with and without lateral cortical fracture. We conclude that lateral cortical fracture does not cause loss of alignment correction as long as a rigid fixation method is used.

Purpose To compare the improvements in all-distance visual acuity (VA) and contrast sensitivity early after cataract surgery among eyes implanted with multifocal and monofocal intraocular lenses (IOLs). Study design Nonrandomized comparative study. Methods Forty-two eyes with a trifocal IOL (Alcon, PanOptix ® ), 42 eyes with a combined bifocal and extended-depth-of-focus (EDF) IOL (Johnson & Johnson, Synergy ® ), and 84 eyes with a monofocal IOL were recruited. Uncorrected or corrected VA at various distances, and photopia and mesopic contrast VA were examined at 1 day and 3 months postoperatively. Improvements in these VAs were compared between time points and among groups. Results Mean uncorrected as well as corrected VA improved significantly between 1 day and 3 months postoperatively at almost all distances in the trifocal and combined bifocal + EDF groups ( P  ≤ 0.018), and at the intermediate distance of 1.0 m and far distances in the monofocal group ( P  ≤ 0.031). Mean improvements in near uncorrected VA at 0.3 m, intermediate VA at 0.5 m, and far VA at 2.0, 3.0, and 5.0 m were significantly greater in the multifocal groups than in the monofocal group ( P  ≤ 0.032). Improvements in photopic and mesopic contrast VA at most contrasts were significantly better in the multifocal groups ( P  ≤ 0.021). Conclusion Mean uncorrected or corrected VA at almost all distances and contrast sensitivity at most contrasts improved significantly early after surgery in eyes implanted with multifocal IOLs, and the improvements in VA at most distances and in contrast sensitivity were better with multifocal IOLs than with monofocal IOLs.

Opioid-free anaesthesia may enhance postoperative recovery by reducing opioid-related side effects such as nausea, hyperalgesia or tolerance. The objective was to investigate the impact of multimodal opioid-free general anaesthesia on postoperative nausea, vomiting, pain and morphine consumption compared to the traditional opioid-based approach. This study was conducted as a prospective parallel-group randomised controlled trial. Perioperative Care. 152 adult women undergoing elective inpatient gynaecological laparoscopy. Patients were randomly assigned for opioid-free anaesthesia (Group OF) with dexmedetomidine, esketamine and sevoflurane or to have opioid-based anaesthesia (Group C) with sufentanil and sevoflurane. Primary outcome was the occurrence of nausea within 24 h after surgery. Patients were assessed for the incidence and severity of PONV, postoperative pain and morphine consumption and recovery characteristics. Patients in both groups had comparable clinical and surgical data. 69.7% of patients in the control group and 68.4% of patients in the opioid-free group met the primary endpoint (OR 1.06, 95% Confidence Interval (CI) (0.53; 2.12) p = 0.86). The incidence of clinically important PONV defined by the PONV impact scale was 8.1% (Group C) vs 10.5% (OF); p = 0.57). Antiemetic requirements, pain scores and morphine consumption were equivalent in both groups. Postoperative sedation was significantly increased in group OF (p < 0.001), and the median length of stay at the post-anaesthesia care unit was 69.0 min (46.5–113.0) vs 50.0 (35.3–77.0) minutes in the control group (p < 0.001). Opioid-free multimodal general anaesthesia is feasible but did not decrease the incidence of PONV, or reduce pain scores and morphine consumption compared to an opioid-containing anaesthetic regimen. •This trial assessed opioid-free anaesthesia in comparison to opioid-based anaesthesia for gynaecological laparoscopy.•Both study groups did not differ with respect to postoperative nausea and vomiting, pain or morphine consumption.•Multimodal general anaesthesia was associated with an increased time to discharge from the post-anaesthesia care unit.

Cytokines and chemokines in the tumor microenvironment drive metastatic development and their serum levels might mirror the ongoing inflammatory reaction at the tumor site. Novel highly sensitive tools are needed to identify colorectal cancer patients at high risk of recurrence that should be more closely monitored during post-surgical follow up. Here we study whether circulating inflammatory markers might be used to predict recurrence in CRC patients. Circulating levels of the inflammatory cytokines IL-1, IL-6, IL-10, TNFalpha, CCL2, CXCL8, VEGF and the acute phase protein Pentraxin-3 were measured by ELISA in preoperative serum samples prospectively collected from a cohort of sixty-nine patients undergoing surgical resection for stage 0-IV CRC and associated with post-operative disease recurrence. Cox multivariate analysis showed that combined high levels (≥ROC cut off-value) of CXCL8, VEGF and Pentraxin3 were associated with increased risk of disease recurrence [HR: 14.28; 95%CI: (3.13-65.1)] independently of TNM staging. Kaplan-Meier analysis showed that CXCL8, VEGF and Pentraxin3 levels were significantly associated with worse survival (P<0.001). Circulating inflammatory mediators efficiently predicted postoperative recurrence after CRC surgery. Therefore, this study suggest that their validation in large-scale clinical trials may help in tailoring CRC post-surgical management.

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionApplication for ESRA Abstract Prizes: I don’t wish to apply for the ESRA PrizesBackground and Aims The main barrier preventing optimal pain management is the inability to identify and manage patients at elevated risk of significant pain in a timely manner, thereby compounding pain-related morbidity. Our aim was to develop a predictive model for pain score at postoperative 13-36th hours by analysing data from our centralized enterprise analytic platform (eHIntS).MethodsWe analysed postoperative data retrieved from eHIntS in 667 patients between January to July 2020, comprising demographic, type of admission, method of surgery (minimally invasive/open), duration of surgery, procedure code, pain scores at PACU, postoperative pain scores at 0-12th hours (at rest, on movement), number of analgesia attempts at postoperative 12th hour, and delivered analgesia at postoperative 12th hour.ResultsA total of 102 (15.3%) patients had at least one pain score of >3 at postoperative 13-36th hours, with average and maximum pain score of 2.4 (SD 0.9) and 5.0 (SD 1.4), as compared with those having pain scores 0-3 at postoperative 13-36th hours (average: 1.3 (SD 0.6); maximum: 2.4 (SD 0.9)). The multivariable model showed that Malay race as compared with Chinese, having ovarian surgery, increased PCA morphine dose at 12th hour, and having higher maximum pain score at movement at postoperative 0-12th hours were independently associated with maximum pain score on movement at postoperative 13-36th hours >3 (significant pain), with an AUC of 0.731.ConclusionsThis model needs to be verified and validated in a larger and more diverse dataset to increase the predictive power of the model.Attachment2022-2505 20220922 NR.pdf

Background and AimsThe evaluation of the postoperative acute pain (PAP) is sometimes difficult in children more-than-six-years- old, such as the visual analogue scale (VAS). The objective of this study is to assess the existence or not of a difference in the scores obtained by two evaluation scales at the same time.MethodsThis is a prospective study which includes children who had limbs surgery. In order to identify patients ‘difficult to be evaluated’ during the first 24 hours of the post-operative phase at: H0, H4, H8, H12, H18, H24. self-assessment of pain combined with the behavioral pain assessment scale were proposed at the same time to patients (VAS and FLACC ¬[Face Legs Activity Cry Consolability]). The data was analyzed by the SPSS ‘20’ software program. The threshold of significance was 5% (P < 0,05). An intra-category correlation test was realized between the two above-mentioned scales.Results355 patients were included in this study. The average age was 9,29 ± 4,13 years. The average of the postoperative pain scores were 1,03 ± 1,61 for the VAS and 0,48 ± 1,23 for the FLACC. We also found that the intra-category coefficients were stated between r = 0,79 and 0,81 with a very good reproducibility of the two scales.ConclusionsThese results sustain the possibility of using the FLACC scale as reliable instrument in case of doubt regarding the VAS obtained score in more- than-6-years-old children.

Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child's pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting. The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents' satisfaction. Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child's pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user's adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app's ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round. Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30% (interquartile range [IQR] 22%-33%) of alerts within 1 hour in round 1, and subsequently to median 60% (IQR 44%-64%) in round 2 and median 64% (IQR 56%-72%) in round 3 (P=.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 (P=.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts. It is feasible for parents or guardians to use Panda at home to manage their child's medication schedule and track their pain. Simple modifications to the app's alert sounds and user interface improved response times.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is a triplanar deformity of the first metatarsal, which may extend beyond the first ray. Compared with normal feet, previous studies have found that HV patients have an increase in hypermobility of the joints along the medial column and at the medial – middle (MM) intercuneiform joint. Despite increased instability at the MM intercuneiform joint, no study has investigated its clinical significance. The primary purpose of this study was to determine if postoperative widening of the MM intercuneiform joint was associated with recurrence in HV patients who undergo a first tarsometatarsal fusion (modified Lapidus procedure). A secondary purpose was to investigate whether other HV imaging parameters were associated with a widening of the MM intercuneiform joint. Methods: This study included 52 consecutive HV patients who underwent a modified Lapidus procedure and had preoperative and at least 5-month postoperative weightbearing CT (WBCT) scans. Preoperative and postoperative measurements of HV deformity, including the intermetatarsal angle and hallux valgus angle (HVA) on plain radiographs and triplanar pronation angle and sesamoid station from WBCTs, were performed as previously described. MM intercuneiform distance was measured on the coronal multiplanar reconstructed WBCT scans after reorienting the axial and sagittal planes such that the coronal cuts were orthogonal to the intercuneiform joint (Figure 1A). Recurrence of the HV deformity was defined as a postoperative HVA ≥ 20°. Paired t-tests were used to compare preoperative and postoperative imaging parameters, and Mann-Whitney U tests were used to compare measurements between patients with and without HV recurrence. Pearson correlation coefficients were used to explore associations between preoperative and postoperative measurements and the change in MM intercuneiform distance. Results: Nine of 52 patients (17.3%) had recurrence of their HV deformity. For the entire cohort, the mean preoperative and postoperative MM intercuneiform distances were 0.73 mm (standard deviation (SD) 0.3) and 1.08 mm (SD 0.5), respectively. In patients with and without HV recurrence, the mean widening at the MM intercuneiform joint was 0.69 mm (95% confidence interval (CI) 0.52-0.86) and 0.27 mm (95% CI 0.17-0.38, P< 0.001), respectively. Patients with recurrence had significantly greater widening of the MM intercuneiform joint than patients without recurrence (P=0.001, Figure 1B and Table 1). While no preoperative imaging parameters were associated with a change in the MM intercuneiform distance, increasing postoperative sesamoid position (r=0.32, P=0.022) and HVA (r=0.28, P=0.046) were correlated with a greater change MM intercuneiform joint gapping. Conclusion: In patients undergoing a modified Lapidus procedure for correction of their HV deformity, postoperative widening of the MM intercuneiform joint was associated with recurrence of the HV deformity. As understanding of the HV deformity continues to evolve, our study suggests that there is a complex interplay between deformity at the hallux metatarsophalangeal (MP) joint, reduction of the metatarsosesamoid joint complex, and the instability at the tarsometatarsal and intercuneiform joints. This may guide surgical correction as surgeons may need to address both intercuneiform instability and correction at the hallux MP joint in order to decrease HV recurrence rates.