Surgery 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 …

Impact Of Duration Of Antibiotic Prophylaxis On Rates Of Surgical Site Infection (Ssi) In Patients Undergoing Mastectomy Without Immediate Reconstruction, Comparing A Single Prophylactic Dose Versus Continued Antibiotic Prophylaxis Postoperatively: A Multicentre, Double-Blinded Randomised Control Trial Protocol, Abida K. Sattar, Nida Zahid, Hania Shahzad, Rufina Soomro, Omema Saleem, Syed Faisal Mahmood

Department of Surgery Docs

Introduction: In breast surgeries, prophylactic antibiotics given before the surgical incision as per Joint Commission Surgical Care Improvement Project guidelines have been shown to decrease the rate of postoperative infections. There is, however, no clear consensus on postoperative antibiotic prophylaxis in patients undergoing mastectomy with indwelling drains. This trial protocol proposes to study the difference in rates of surgical site infection (SSI) with or without continuation of postoperative antibiotics in patients undergoing mastectomy without immediate reconstruction and with indwelling drains.
Methods and analysis: In this multicentre, double-blinded clinical trial, all patients undergoing mastectomy (without immediate reconstruction) will receive a single …

Rapidly Progressive Acth-Dependent Cushing’S Disease Masquerading As Ectopic Acth-Producing Cushing’S Syndrome: Illustrative Case, Siyuan Yu, Michael Karsy, Jeffery Miller, Stephanie R. Beldick, Mark T. Curtis, Marc Rosen, James J. Evans

Department of Neurosurgery Faculty Papers

BACKGROUND Cushing’s disease (CD) remains a challenging condition to diagnose and treat. This case study highlights the challenges of diagnosing CDwhen faced with discrepant clinical, biochemical, and radiologicalfindings.

OBSERVATIONS A 62-year-old man presented with rapid evolution of symptoms, including depression, fatigue, and extreme muscle atrophy, whichresulted in the patient being a wheelchair user over the course of a few months. His rapid clinical course in conjunction with hypercortisolemia in thesetting of a pituitary macroadenoma involving the cavernous sinus, two large pulmonary nodules, and urine-free cortisol levels in the thousandssuggested an aggressive ectopic adrenocorticotropic hormone (ACTH) source. After extensive testing ruled …

Online Assessment In Undergraduate Medical Education: Challenges And Solutions From A Lmic University, Syeda Sadia Fatima, Romana Idrees, Kauser Jabeen, Saniya Sabzwari, Sadaf Khan

Department of Biological & Biomedical Sciences

Background and objectives: The Covid-19 pandemic has caused large-scale disruption in almost all educational programs across the world. Planning and rapid implementation of assessment through an online format presents the next set of novel challenges that must be addressed by academic administrations across the globe.
Methods: This cross-sectional study was conducted between March to August 2020 at the Aga Khan University Medical College. Two hundred medical students of year 1 and 2 participated in the study. We describe the planning, processes, and outcomes of online assessments using video communication platforms conducted at a private university in Pakistan. Standardized protocols were …

Improving Patient Outcomes With Post-Op Education For Nurses Caring For Patients Undergoing Total Joint Replacement, Amanda Collier

Doctor of Nursing Practice Projects

Background: Surgical site infections (SSI) are the third most reported nosocomial infection causing an increased length of stay, increased healthcare cost, and a substantial increase in morbidity. A SSI is an infection developing within 30 days of surgery without using an implant and within one year of surgery utilizing any form of implant. Typically SSI occurs at the time of incision. However, poor postoperative wound care can lead to an SSI.

Purpose: This project aims to educate nursing staff on care of the total joint replacement (TJR) patient to reduce readmission rates for postoperative SSI.

Design Methods: This …

A Machine Learning Approach To First Pass Reperfusion In Mechanical Thrombectomy: Prediction And Feature Analysis., Lohit Velagapudi, Nikolaos Mouchtouris, Richard F Schmidt, David Vuong, Omaditya Khanna, Ahmad Sweid, Bryan Sadler, Fadi Al-Saiegh, M Reid Gooch, Pascal Jabbour, Robert H Rosenwasser, Stavropoula Tjoumakaris

Department of Neurosurgery Faculty Papers

INTRODUCTION: Novel machine learning (ML) methods are being investigated across medicine for their predictive capabilities while boasting increased adaptability and generalizability. In our study, we compare logistic regression with machine learning for feature importance analysis and prediction in first-pass reperfusion.

METHODS: We retrospectively identified cases of ischemic stroke treated with mechanical thrombectomy (MT) at our institution from 2012-2018. Significant variables used in predictive modeling were demographic characteristics, medical history, admission NIHSS, and stroke characteristics. Outcome was binarized TICI on first pass (0-2a vs 2b-3). Shapley feature importance plots were used to identify variables that strongly affected outcomes.

RESULTS: Accuracy for …

Discrepancies In Stroke Distribution And Dataset Origin In Machine Learning For Stroke., Lohit Velagapudi, Nikolaos Mouchtouris, Michael P Baldassari, David Nauheim, Omaditya Khanna, Fadi Al Saiegh, Nabeel Herial, M Reid Gooch, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour

Department of Neurosurgery Faculty Papers

BACKGROUND: Machine learning algorithms depend on accurate and representative datasets for training in order to become valuable clinical tools that are widely generalizable to a varied population. We aim to conduct a review of machine learning uses in stroke literature to assess the geographic distribution of datasets and patient cohorts used to train these models and compare them to stroke distribution to evaluate for disparities.

AIMS: 582 studies were identified on initial searching of the PubMed database. Of these studies, 106 full texts were assessed after title and abstract screening which resulted in 489 papers excluded. Of these 106 studies, …

Competency-Based Medical Education And Breast Disease, David Scott Lind, Bharti Jasra

HCA Healthcare Journal of Medicine

The future delivery of high quality, patient-centered breast care is fundamentally dependent on how we train the next generation of breast care providers. As medical educators, we have a tremendous opportunity to transform how clinical skills related to breast care are taught and assessed and thereby, improve breast patient outcomes. This article reviews the current state of education and ideas for implementing a learner-specific, competency-based curriculum to teach breast care skills.

Anorectal Malformations In Monozygotic Twins: An Illustration Of Management Of Anorectal Malformations In A Tertiary Hospital In Indonesia, Hardian Gunardi, Asri D. Rachmawati, Nanok E. Susilo

The New Ropanasuri Journal of Surgery

A case of monozygotic twin boys with anorectal malformation with delayed presentation of bowel perforation. Both are managed surgically with a colostomy; after a definite diagnosis of anorectal malformation with a urethral fistula based on distal colostography, both boys underwent anoplasty with a posterior sagittal approach. Stoma closure was performed, and we found no complication during eight months of follow-up. Delay in the management of the twins was due to a lack of anal screening of the newborn. The unavailability of the neonatal intensive care unit became a significant concern. Distal colostography was performed for the definitive procedure. Despite that …

Outcomes Of Percutaneous Transluminal Angioplasty For Central Vein Stenosis In Hemodialysis: A Literature Review, Hilman Ibrahim, Akhmadu Muradi, Eka A. Limianto

The New Ropanasuri Journal of Surgery

Percutaneous transluminal angioplasty (PTA) is the mainstay treatment for central vein stenosis. However, the recurrent rate of the stenotic lesion after PTA remains high. Thus, we ran a review found on some databases. Out of thirteen articles, five articles were eligible and reviewed. Drug-coated balloon angioplasty, plain old balloon angioplasty, percutaneous transluminal angioplasty, and stenting angioplasty were discussed regarding the outcomes with a focus on interest to prevent the stenosis.

Management Of Internal Hernia In Neonates With Multiple Heart Diseases: A Case Report, Riana P. Tamba, Andi Wiradeni

The New Ropanasuri Journal of Surgery

Internal hernia is a rare clinical entity. In all cases, less than 1% found as the cause of intestinal obstruction. However, delayed treatment of internal hernia may lead to necrosis of the intestines. Neonates with congenital heart disease may be at increased risk of morbidity and mortality than another concurrent disease.

A male infant was delivered with a Cesarean section due to a congenital disorder of umbilical hernia, ventricular septal defect, and aortic transposition. The infant was born full-term with a 2,515 g birth weight and 3, 5, 7 APGAR score, positive ventilation, and intubation proceeded. Prostaglandin E1 10 mcg/kg/minute, …

Prediction Of Liver Volume From Liver Transplant Donor Using Biometric Formula Compared With Computed Topography Volumetry, Agi S. Putranto, Adinda B. Syafina, Damayanti Sekarsari, Yarman Mazni, Yefta Moenadjat

The New Ropanasuri Journal of Surgery

Introduction. Liver volume calculation is critical in assessing the compatibility and resectability of the graft in living donor liver transplants (LDLT). An accurate estimation of liver volume is a predictor for successful LDLT. The gold standard of liver volume estimation is CT Volumetry. Despite several limitations in the availability of software, facility, and time consumed, there is still disagreement of biometric formula to predict liver volume in Indonesia.

Methods: A cross-sectional design study was carried out in Dr. Cipto Mangunkusumo General Hospital, enrolling those who underwent liver transplantation from 1^st January 2010 – 3^rd October 2019. Bodyweight, body …

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 …

Co2 Contrast As Alternative Media Contrast For Renal Insufficiency Patient In Angiography: An Evidence Based Case Report, Frengky Bermana, Dedy Pratama

The New Ropanasuri Journal of Surgery

The use of iodine contrast, which is more commonly used, is associated with systemic effects in nephrogenic systemic fibrosis, contrast-induced nephropathy (CIN) in patients with kidney function disorders, geriatric, hypertension, and patients with comorbid diabetes mellitus and hypersensitivity reactions. An evidence-based case report was carried out in the Medical Department of Surgery, FKUI-RSCM. The study indicated that the safety of CO₂ angiography did not cause CIN to manifest and showing CO₂ contrast proved to be safe for patients who have impaired renal function

Preoperative Ca 19-9 Level As Additional Predictor Of Pancreatic Head Adenocarcinoma Resectability, Pasihulizan Pasihulizan, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. Determining eligibility criteria for resection is the basis of pancreatic head adenocarcinoma treatment planning, yet the currently used CT scan only has 80% accuracy as its primary modality. This study aimed to investigate preoperative CA 19-9 level use to help predict resectability of pancreatic head adenocarcinoma.

Method. Determining eligibility criteria for resection is the basis of pancreatic head adenocarcinoma treatment planning, yet the currently used CT scan only has 80% accuracy as its primary modality. This study aimed to investigate preoperative CA 19-9 level use to help predict resectability of pancreatic head adenocarcinoma.

Results. There were …

Quality Of Life Of Post-Gastrectomy Patients: A Study In Indonesia's National Central Hospital, Herlan Napitupulu, Agi S. Putranto

The New Ropanasuri Journal of Surgery

Introduction. Several studies suggest gastrectomy is associated with deterioration in a patient's quality of life (QOL). This study is conducted to assess the impact of distal (DG), proximal (PG), or total (TG) gastrectomy and the cause of disease on a patient's QOL.

Method. This retrospective study was conducted in dr. Cipto Mangunkusumo Hospital with collected data from the medical records throughout July-September 2020. Inclusion criteria were patients after proximal, distal, or total gastrectomy for a tumor or any non-tumor indications. They were assessed using the World Health Organization Quality of Life Questionnaire Abbreviated Version (WHOQOL-BREF). Collected data were …

The Development Of Lived Experience-Centered Word Clouds To Support Research Uncertainty Gathering In Degenerative Cervical Myelopathy: Results From An Engagement Process And Protocol For Their Evaluation, Via A Nested Randomized Controlled Trial, Benjamin M Davies, Oliver D Mowforth, Danyal Z Khan, Xiaoyu Yang, Sybil R L Stacpoole, Olesja Hazenbiller, Toto Gronlund, Lindsay Tetreault, Sukhvinder Kalsi-Ryan, Michelle L Starkey, Iwan Sadler, Ellen Sarewitz, Delphine Houlton, Julia Carter, Evangeline Howard, Vafa Rahimi-Movaghar, James D Guest, Bizhan Aarabi, Brian K Kwon, Shekar N Kurpad, James Harrop, Jefferson R Wilson, Robert Grossman, Emma K Smith, Angus G K Mcnair, Michael G Fehlings, Mark R N Kotter

Department of Neurosurgery Faculty Papers

OBJECTIVES: AO Spine REsearch objectives and Common Data Elements for Degenerative Cervical Myelopathy [RECODE-DCM] is a multi-stakeholder consensus process aiming to promote research efficiency in DCM. It aims to establish the top 10 research uncertainties, through a James Lind Alliance Priority Setting Partnership [PSP]. Through a consensus process, research questions are generated and ranked. The inclusion of people with cervical myelopathy [PwCM] is central to the process. We hypothesized that presenting PwCM experience through word cloud generation would stimulate other key stakeholders to generate research questions better aligned with PwCM needs. This protocol outlines our plans to evaluate this as …

The Utility Of Continuous Passive Motion After Anterior Cruciate Ligament Reconstruction: A Systematic Review Of Comparative Studies, Taylor D'Amore, Somnath Rao, John Corvi, Robert Jack Ii, Fotios Tjoumakaris, Michael G. Ciccotti, Kevin Freedman

Department of Orthopaedic Surgery Faculty Papers

Background: The application of continuous passive motion (CPM) after anterior cruciate ligament reconstruction (ACLR) was popularized in the 1990s, but advancements in the understanding of ACLR rehabilitation have made the application of CPM controversial. Many sports medicine fellowship–trained surgeons report using CPM machines postoperatively. Purpose: To determine the efficacy of CPM use for recovery after ACLR with respect to knee range of motion (ROM), knee swelling, postoperative pain, and postoperative complications. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed (MEDLINE), EMBASE, Cochrane, Cumulative Index of Nursing, and Allied Health Literature databases were searched from inception to January …