Browsing by Subject "Abdomen"
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Item The abdominal examination: an evidence-based medicine approach(1995-02-16) Wagner, James M.Item Ice-POP: Ice Application for Post-Operative Pain: A Randomized Controlled Trial(2021-05-01T05:00:00.000Z) Kenyon, Laura Elizabeth; Kho, Kimberly A.; Shields, Jessica; Weix, PatrickBACKGROUND: The Opioid Crisis is directly linked to over-prescription of opioids by physicians. Non-opioid and non-pharmacologic forms of post-operative pain management need to be explored. Cryotherapy, accomplished with the use of ice, is a non-pharmacologic form of pain relief. There is limited data regarding cryotherapy and its application in abdominal surgery. OBJECTIVE: To investigate the effectiveness of cryotherapy as an additional form of pain control in women undergoing total laparoscopic hysterectomy (TLH) for benign gynecologic conditions through a randomized trial. METHODS: 52 patients were randomized evenly to receive standardized post-operative pain management with or without cryotherapy (abdominal ice packs applied directly following surgery). VAS pain scores and narcotic usage were collected at the patient's pre-op appointment, before surgery, at discharge, during a 1-day post-op phone interview, and at a 2-week post-op appointment. Questions about the patient's perception of pain were asked during the postoperative day 1 phone call. Quality of recovery scales were collected at enrollment and the 2-week post-op appointment. Demographic data, VAS pain scores, and narcotic usage were analyzed for significance via the student's t-test. RESULTS: There was no statistically significant difference (p < 0.05) between the patient group receiving ice and no ice based on demographics, VAS pain score, narcotic usage, quality of recovery, and perception of pain control. However, for patients using ice, VAS pain scores were lower on postoperative day 1 and narcotic usage was lower in the post-anesthesia care unit (PACU). Patient perception of ice was largely positive with 87% of patients reporting they would use ice again while 83% would recommend ice to family/friends. Of note, less than half (38%) of opioids prescribed were used within 2 weeks post-op. CONCLUSION: Based on the minimal risks of ice, low cost, and perceived benefit by patients including the opportunity for patient autonomy, we would recommend using ice immediately following surgery. Ice is a reasonable alternative to decrease the number of opiates prescribed.Item A Simplified Risk Score for Predicting the Incidence of Major Complications after Complex Abdominal-Pelvic Resections(2016-04-01) Bennett, Adam Jacob; Mansour, John; Brancaccio, Anne; Abraham, ReeniBACKGROUND: The POSSUM system is used to predict risk of complications following general surgical procedures. This 18-factor instrument has been challenging to apply to most surgical oncology patient populations. Our aim is to develop a simplified scoring system that is highly correlated with the incidence of major complications. OBJECTIVE: To develop a simplified scoring system that is highly correlated with the incidence of major complications. METHODS: We queried a single-institution IRB-approved prospective database from a surgical oncology population from January 2008 to December 2012. We identified patients undergoing complex abdominal or pelvic resections and factors associated with the development of major (Clavien-Dindo ≥ III) complications. Factors not included in the POSSUM system were incorporated into a new scoring system based on univariate correlation with complication rates (Chi-square). Optimal binning generated an ideal cut-off value associated with major complications. A composite scoring system (SOPI) was compared to standard POSSUM predictions using ROC analysis. RESULTS: We identified 831 patients undergoing pancreatic (23%), hepatic (23%), colorectal (22%), esophagogastric (16%), retroperitoneal (4%), combined (3%), or other type (10%) of resection. Major complications occurred in 17% of patients. Two original POSSUM factors were included in the new SOPI model (cardiac history and EBL). Four factors improved correlation with complication rate: gender (female/male-1/3 points); operation type (retroperitoneal/ pancreatic or rectal/others-4/2/1 points); curative intent (curative/non-curative-1/2 points); and cancer (no cancer/cancer-1/2 points). ROC analysis generated a greater AUC for the simplified 6-factor system than standard 18-factor POSSUM (AUC: 0.676 vs 0.631). Increasing SOPI quartiles higher risk of major complications (5%, 15%, 20%, 29%; p-value < 0.001). CONCLUSION: The efficacy of POSSUM or P-POSSUM for complex abdominal and pelvic resections remains unclear. The SOPI system, which is comprised of only 6 factors, was equivalent to P-POSSUM for predicting major complication rates (Clavien-Dindo score of at least III) for surgical oncology patients. Validation in a large, independent dataset is necessary before the system can be widely applied.Item [UT Southwestern Medical Center News](2008-12-08) Shear, Kristen Holland