Conectar
by Zhi-Hua Huang, Jun Zhang, Xiao-ying Xu, Ying Wang, Xiao-jian Lu, Yan Luo
BackgroundPostoperative delirium is a common complication after various types of major surgery. The aim of this study was to identify risk factors associated with delirium following pancreatic surgery.
MethodsData from the patients who had pancreatic surgery between July 2020 and March 2021 in Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine were retrospectively analysed. The postoperative risk factors related to delirium were analyzed by univariate and multivariate Logistic regression analysis.
Results59 of 385 patients (15.3%) developed postoperative delirium after pancreatic surgery. The ROC curve revealed the optimal cutoff of intraoperative fluid balance was 2863ml. Furthermore, the multivariate analysis demonstrated that age ≥ 65 years old [Odds ratio (OR) 2.01; 95% Confidence interval (CI) 1.12-3.63; p = 0.019], hypnotic drug use (OR 4.17; 95% CI 1.50-11.10; p = 0.005), and intraoperative fluid balance (OR 2.57; 95% CI 1.37-4.84; p = 0.003) were the independent risk factors of postoperative delirium.
ConclusionThis study identified that intraoperative fluid balance and hypnotic drug use were independent risk factors associated with postoperative delirium development after pancreatic surgery.
To investigate the status and influencing factors of caring readiness among parents of children undergoing liver transplantation transitioning from the intensive care unit, and to explore the associations between caring readiness and other variables.
A cross-sectional study.
A total of 126 parents of children who underwent liver transplantation at a tertiary hospital in China took a questionnaire survey via convenience sampling. Independent t-test, ANOVA and correlation analysis were conducted to analyse the data. Multivariable stepwise linear regression was used to analyse the influencing factors of caring readiness. The PROCESS macro (Model 4) was used to verify the mediating effect of caregiver burden between social support and caring readiness.
The STROBE checklist was used as a guideline in this study.
The mean score of caring readiness among parents of children who had undergone liver transplantation and were transitioning from the intensive care unit was 23.62 ± 5.34. Multivariable stepwise linear regression analysis indicated that experience with caregiving, intensive care unit length of stay, social support and caregiver burden were the factors associated with caring readiness, explaining 18.6% of the variance in caring readiness among parents. Caregiver burden partially moderated the relationship between social support and caring readiness (20.93%).
The study shows caring readiness was moderate among parents of children who have undergone liver transplantation and are transitioning from the intensive care unit. It reveals that lack of caregiving experience and children's short intensive care unit length of stay should be emphasised, preventing inadequate readiness of parents. Furthermore, enhancing social support interventions and burden-reduction strategies are important for improving parents' caring readiness.
The findings demonstrate that health care professionals should provide timely and appropriate intervention strategies to enhance parents' caring readiness, which could potentially be achieved by increasing social support and reducing caregiver burden.
Parents of children who underwent liver transplantation participated in this study via a questionnaire survey.
Post-operative diarrhoea is a common adverse event after pancreatic surgery. While the risk factors for this condition have been identified, the increasing trend of administering chemotherapy before surgery might change these factors. This study aimed to identify the risk factors of post-operative diarrhoea in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy.
A retrospective cohort study.
Patients who underwent neoadjuvant chemotherapy and pancreatectomy because of PDAC between 2021 and 2023 were included. The preoperative characteristics of, operative details of and post-operative outcomes in patients with and without post-operative diarrhoea were collected and compared. The independent risk factors of post-operative diarrhoea were identified using logistic regression analysis. STROBE checklist was used.
Post-operative diarrhoea occurred in 65 out of 145 (44.8%) patients during hospitalization. Elevated white blood cell count, advanced tumour stage, and late abdominal drain removal were independent risk factors for post-operative diarrhoea (p < .001, p = .006 and p = .009, respectively).
Some perioperative factors influence post-operative diarrhoea in patients who undergo neoadjuvant chemotherapy. More attention should be paid to patients at a higher risk of post-operative diarrhoea, with an emphasis on high-quality management for these patients.
Management of postoperative pain is of vital importance for patients undergoing Video-Assisted Thoracoscopic Surgery (VATS) for Pulmonary Carcinoma Resection. The study evaluates the impact of Paravertebral Nerve Blockade (PNB) in conjunction with general anaesthesia on postoperative pain relief, as compared with general anaesthesia alone. A retrospective analysis was carried out from May 2020 to May 2023, involving 100 patients with pathologically confirmed pulmonary carcinoma. The patients were divided into two groups: a control group that received general anaesthesia and an observation group that received a combination of general anaesthesia and PNB. The intensity of postoperative pain was assessed at various time intervals using the visual analogue scale (VAS), while the effectiveness of patient-controlled analgesia was also evaluated. Additionally, the study examined the incidence rates of chronic pain in the postoperative period. Statistical analysis was performed using IBM SPSS version 27.0. Significant reductions in VAS scores for both resting and cough-induced pain were observed in the observation group at 2 and 6 h post-operation (p < 0.01). However, the difference diminished over time. The observation group had fewer patient-controlled analgesia activations and required lower dosages of hydromorphone at both 24- and 48-h post-operation. The incidence of chronic pain was also significantly lower in the observation group (24.00%) compared with the control group (54.00%) (p < 0.01). PNB, when administered in combination with general anaesthesia, significantly reduces immediate postoperative pain and the requirement for additional analgesics in patients undergoing VATS for pulmonary carcinoma resection. The effect diminishes over time but has a lasting impact on reducing the incidence of chronic postoperative pain.
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