Surgical Procedures, Operative Commons^™

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Opioid Free Anesthesia To Prevent Post Operative Nausea/Vomiting, Aleksander Acred, Milena Devineni, Lindsey Blake, Cindi Dabney Dnp, Crna

Doctor of Nursing Practice Projects

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice.

Methods In this scoping …

Microfracture For Cartilage Defects In Today’S Orthopaedics: Pearls And Pitfalls, Himanshu Yn, Sufyan Ibrahim

Manipal Journal of Medical Sciences

Microfracture technique has vacillating clinical outcomes, limited demographic applicability, high failure rate, and variable patient satisfaction. Although it does not deserve to be a gold standard technique, there has not been a technique that could overcome all possible disadvantages associated with the technique and at the same time give a favourable result/be suitable for widespread use/not have its own disadvantages. Microfracture, integrated with biomaterial/stem cell transfer has shown promise over the past decade but studies evaluating the long-term efficacy of the tests and standardization are lacking. Besides, cost and operative difficulties limit widespread use. Twenty-five years into the field, microfracture …

Management Of Pararenal Aortic Aneurysms : A Literature Review, Hilman Ibrahim, Akhmadu Muradi, Ihza Fachriza

The New Ropanasuri Journal of Surgery

Abdominal aortic aneurysms (AAA) are the most common group of aortic aneurysms. Pararenal aortic aneurysm (PAA) is a classification of AAA where there is no normal aortic segment between the renal artery and the proximal border of the aneurysm. This group has a prevalence of around 20% of all AAA cases. In open repair (open surgery), PAA requires suprarenal clamps or even supraceliac which causes high morbidity. In endovascular procedures, PAA presents difficulties due to the absence of a landing zone to place the graft and the possibility of reintervention after action. A literature review is needed to discuss the …

Iatrogenic Electrocautery Damage And Cellular-Based Corrosion Of Total Joint Arthroplasty Biomaterials, Kirsten Carol Miller

Theses and Dissertations (ETD)

Introduction. The number of patients undergoing a Primary Total Knee Arthroplasty (PTKA) has been increasing steadily each year. Of those PTKA patients, 20% report long-term pain and/or some functional deficit. Cobalt-Chromium-Molybdenum (CoCrMo) alloy is one of the most used materials in Total Joint Arthroplasty (TJA) implants due the material’s high strength, high corrosion resistance, and biocompatibility. The release of metal ions and potential occurrence of metallosis in TJA has been shown to be detrimental to the longevity of the implant. The mechanisms leading to this increase in metal ion concentrations have been up for debate, with some believing it is …

Infliximab As Rescue Therapy In Pediatric Severe Colitis, Kayla B. Briggs

Research Days

Background: Infliximab has been shown to be effective in achieving clinical remission in patients with ulcerative colitis (UC) refractory to conventional therapy. However, there is conflicting data in the literature regarding its effectiveness as rescue therapy in acute severe colitis. Furthermore, most studies were conducted in adults, and pediatric onset of inflammatory bowel disease (IBD) is associated with more severe disease that may be less amenable to rescue therapy.

Objectives/Goal: We reviewed our experience with pediatric severe colitis and report outcomes following attempted rescue therapy with infliximab.

Methods/Design: A retrospective review was conducted of patients with UC or indeterminate colitis …

Outcomes Of Infants With Severe Rop At Risk Of Treatment With Avastin Compared To Laser Surgery, Stephen Doxey

Research Days

Background: Retinopathy of prematurity (ROP) is a well-known complication occurring in the most premature infants leading to visual impairment and in the most severe cases associated with retinal detachment and childhood blindness. Factors contributing the development of ROP include chronic hypoxia and disordered vascular genesis primarily through the vascular endothelial growth factor (VEGF) signaling pathway. Infants at risk of developing ROP are screened with serial eye exam and treated with either laser surgery or intraocular injects of bevacizumab (Avastin) to prevent progression of ROP and preserve vision. Bevacizumab, an inhibitor of VEGF signaling, may have positive effects on preventing ROP …

Reconsidering Perioperative Antibiotic Use In Elective Laparoscopic Cholecystectomy, Kayla B. Briggs

Research Days

Background: As rates of antimicrobial resistance increase, the use of prophylactic perioperative antibiotics (PPA) has been questioned in cases with a low risk of surgical site infection (SSI). In laparoscopic cholecystectomy performed for biliary dyskinesia, hyperkinetic gallbladder, and gallbladder polyps, the use of PPA varies with no widely accepted practice pattern.

Objectives/Goal: We examined institutional PPA usage and SSI rates for elective laparoscopic cholecystectomy to determine if PPAs are indicated.

Methods/Design: Following IRB approval, children/2010 and 8/2020 for symptomatic cholelithiasis, biliary dyskinesia, hyperkinetic gallbladder, and/or gallbladder polyps were included. Several surgeons changed practice to selective PPA use in 2016, decreasing …

Bar Removal Following Minimally Invasive Pectus Excavatum Repair – Does Removal At 2 Years Affect Recurrence Or Satisfaction Rates?, Wendy Jo Svetanoff

Research Days

Background: Some patients with pectus excavatum require bar removal despite having the bar in for less than three years after minimally invasive placement (MIRPE). It is unknown whether early removal is associated with a higher recurrence rate or lower cosmetic satisfaction.

Objectives/Goal: The aim of this study was to review post-operative outcomes, specifically recurrence rate, and patient satisfaction in patients who underwent bar removal prior to three years.

Methods/Design: A retrospective review was performed of patients who underwent MIRPE between October 2006 and June 2017 and had bar removal less than 3 years after repair. Demographics, reason for bar removal, …

Refining The Optimal First Treatment For Pediatric Breast Abscesses, Kayla B. Briggs

Research Days

Background: We previously reported treatment and outcomes of children with untreated, not spontaneously draining (UTND) breast abscesses. What has not been well defined however are those with previously treated, not spontaneously draining (PTND) pediatric breast abscesses. In general, a more conservative approach is favored in children with breast abscesses to avoid damage to the developing breast bud.

Objectives/Goal: We sought to determine if care at a pediatric tertiary referral center impacts disease persistence rate.

Methods/Design: Following IRB approval, patientstherapy.

Results: In all, 114 patients met inclusion criteria, 96 in the UTND group and 18 in the PTND group (Figure 1). …

Biomedical Porcine Models For The Study Of Surgical Hemostasis, Hindlimb Ischemia, And Pancreatic Cancer, Shruthishree Aravind

Theses & Dissertations

Murine models have dominated the world of biomedical research and comparative medicine since their development in the early 1900s. [1] While they may be suitable models to study proteomics and genomics, they may not serve as effective translational models. [2-4] Murine models do not accurately model the pathophysiology of human disease and are limited by their size, application of medical imaging and intervention, which reduces their overall preclinical predictive value. [2-4]

Porcine models on the other hand, are slowly and steadily bridging the gap between murine models and human patients. [5] Pigs …

Meralgia Paresthetica As A Complication Of Laparoscopic Cholecystectomy In A Post Partum Teenager, Puthenmadam Radhakrishnan, Wajihah Memon, Prasanna Tati

Rowan-Virtua Research Day

An 18 year old G1P1 female, 3 months postpartum presented to the emergency department with abdominal pain that was diagnosed as cholelithiasis and choledocholithiasis. Following a cholecystectomy surgery, the patient developed weakness and gait abnormality that was diagnosed as neuralgia.

Meralgia paresthetica is such an understudied diagnosis that its incidence is unknown. Patients who are 30-85 years old, obese, diabetic, and/or pregnant are at an increased risk for the condition. This case calls attention to the underdiagnosis of meralgia paresthetica in pediatric patients with comorbidities. As aforementioned risk factors increase in the pediatric population due to societal and environmental factors, …

Minimally Invasive Surgery For Septic Arthritis Of The First Metatarsophalangeal Joint: An Uncommon Approach Utilizing Small Joint Arthroscopy, Michael Thomas, Hinal Patel, Jeffrey Belancio

Rowan-Virtua Research Day

Small joint arthroscopy can be utilized for septic arthritis, synovitis, osteochondral lesions, arthritis, and various other pathologies. However, information regarding arthroscopy of the first metatarsophalangeal joint (MTPJ) is limited in the literature. This case report discusses the use of arthroscopy for septic arthritis of the 1st MTPJ.

Perioperative Family Updates Reduce Anxiety And Improve Satisfaction: A Randomized Controlled Trial, Lindsay S. Howe, Daniel Wigmore, Nathaniel Nelms, Patrick Schottel, Craig Bartlett, David Halsey, Martin Krag, David Lunardini, Robert Monsey, Bruce Beynnon, Michael Blankstein

Journal of Patient-Centered Research and Reviews

Purpose: This study aimed to determine if standardized updates at specific perioperative events affect anxiety and satisfaction of the family members and if the length of surgical procedure affects the satisfaction with updates.

Methods: This study was a randomized control trial. In the control group, surgeons communicated with the family only once near the completion of the procedure. In the intervention group, families received electronic updates at 3 significant perioperative events during the procedure. A postoperative survey rating family member satisfaction and anxiety levels, using a Likert scale of 0–5, was administered.

Results: Mean level of overall satisfaction did not …

Pheochromocytoma Presenting As Testicular Pain: An Unusual Case Report, Jinal K. Patel, Varun Reddy, Gauthier L. Stepman, Debra Angelo, Johnathan Frunzi

Endocrinology

Pheochromocytoma (PCC) is a rare catecholamine-secreting tumor that arises from chromaffin cells of the adrenal medulla which are derived from the neural crest. This report illustrates a 51-year-old Caucasian male with a history of hypertension diagnosed two years ago who presented to the hospital due to acute onset of right testicular pain of 3-day duration. Laboratory results and imaging revealed a presumptive diagnosis of PCC. The patient had undergone robot-assisted laparoscopic right adrenalectomy 14 days after being diagnosed with PCC due to perioperative management with phenoxybenzamine. The final pathology report revealed a PCC. At follow-up two weeks after discharge, the …

Serious Adverse Events And 30-Day Hospital Readmission Rate Following Elective Total Knee Arthroplasty: A Systematic Review And Meta-Analysis., Costas Papakostidis, Peter V Giannoudis, J. Tracy Watson, Robert Zura, R. Grant Steen

School of Medicine Faculty Publications

Background: Elective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved. Methods: To obtain a pooled estimate of SAE rate and 30-dRR following TKA, we searched Medline, Web of Science, Cochrane Library, and Google Scholar databases. Data were extracted by two authors following PRISMA guidelines. Eligibility criteria were defined prior to a comprehensive search. Studies were eligible if they were published in 2007 or later, described sequelae of TKA …

Smartphone-Based Prediction Model For Postoperative Cardiac Surgery Outcomes Using Preoperative Gait And Posture Measures, Rahul Soangra, Thurmon Lockhart

Physical Therapy Faculty Articles and Research

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were …

Predicting Dissatisfaction With Total Knee Arthroplasty, Joseph S. Munn

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a common and effective treatment for end-stage osteoarthritis. However, approximately 20% of patients are consistently found to be dissatisfied or unsure of their satisfaction with their TKA at 1-year post-surgery. Two strategies for reducing dissatisfaction have appeared in the literature. The first aims to reduce the number of dissatisfied patients who will undergo surgery by identifying patients likely to be dissatisfied pre-surgery. The second aims to implement interventions that improve patient satisfaction by generating realistic expectations for outcomes and by association improving met expectations scores. It may be possible to improve the performance of these …

Post-Operative Day 1 Versus Day 0 Follow-Up For Uncomplicated Cataract Surgeries: A Comparison Of Post-Operative Outcomes And Managements, Harsh Parekh Bs, Shibandri Das Md, Vaama Patel Md, Ryan Freedman Md, Sabba Mansoor Bs, Amanda Ismail Md, Faisal Ridha Al-Timimi Md

Medical Student Research Symposium

Purpose: To compare the postoperative outcomes and management of uncomplicated cataract surgery (CEIOL) patients seen on post-operative day zero (POD 0) versus post-operative day one (POD 1).

Methods: A retrospective chart review of 533 patients who had CEIOL at the Kresge Eye Institute from December 2017 to September 2019 was performed. Visual acuity (VA) and intraocular pressure (IOP) were collected from the pre-operative visit, and the first and second post-operative day visits. In addition, changes in management were recorded from the first post-operative day visit. Patients were excluded if they had a complex cataract procedure, had combined glaucoma filtering surgery, …