Browsing by Subject "Preoperative Period"
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Item Does Delay to Surgery in Type III Supracondylar Humerus Fractures Lead to Longer Surgical Times and More Difficult Reductions?(2017-01-17) Prabhakar, Pooja; Elliott, Marilyn; Ho, ChristineBACKGROUND: As numerous studies have shown that delay in reduction of pediatric supracondylar humerus fractures (SCHFx) does not affect clinical outcomes, and as many hospitals adopt dedicated daytime trauma operative time, more type III SCHFx are being pinned non-emergently after hospital admission. We sought to determine if delay in surgical treatment of type III SCHFx would affect the length of operative time. METHODS: This is an IRB-approved, retrospective review of a series of 317 modified Gartland type III supracondylar fractures treated operatively at a tertiary referral center from 2011 to 2013. Mean patient age was 5.4 years (range, 2-10y). To balance the study design, 15 hours was selected as the cut-off between early and delayed treatment. A total of 53.6% (170/317) fractures were treated early, and 46.4% (147/317) were delayed. Surgical time was defined as "incision start" to "incision close". Fluoroscopy time was use as a surrogate for difficulty of reduction. RESULTS: Time from injury to OR was shorter for high-energy fractures (fractures with soft tissue or neurovascular injury) versus low energy fractures (12.9 vs. 15.2 hours, p < 0.0001); however, surgical time (37.3 vs. 31.9 minutes, p = 0.005) and fluoroscopy time (54.4 vs. 48.4 sec, p = 0.032) were longer in high-energy fractures vs. low-energy fractures. Among low energy fractures, no significant difference was detected in surgical time between the early and delayed treatment groups (32.0 vs. 31.9 minutes, p = 0.284) or in the fluoroscopy time (50.6 vs. 46.5 seconds, p = 0.778). Additionally, there was no statistically significant difference found in surgical or fluoroscopy time with the presence of a surgical assistant. Mean surgical time when the attending surgeon was alone was 29.3 minutes, compared to 38.6 min with a fellow, 33.5 min with a resident, 34.8 min with a mid-level practitioner, and 40.9 min with both a fellow and resident (p=0.065). Mean fluoroscopy time when the surgeon was alone was 42 seconds, compared to 58.3 sec with a fellow, 51 sec with a resident, 47.6 sec with a mid-level practitioner, and 53.4 sec with multiple trainees (p=0.102). CONCLUSIONS: Delay in surgery did not result in a longer surgical time or more difficult reduction for type III SCHFx. Patients with low energy fractures still underwent a shorter operative time even with delay from injury to surgery. When excluding high-energy injuries, surgical treatment of Gartland type III SCHFxs may be delayed without increasing surgical time or difficulty of reduction.Item Pre-Surgical Behavioral Medicine Evaluation (PBME) for Implantable Devices for Pain Management : a One-Year Prospective Study(2006-08-11) Heckler, David Robert; Stowell, Anna W.Chronic pain affects millions of individuals around the world financially, physically, psychologically, and socially. When nonoperative care does not provide adequate pain relief, surgically invasive procedures are often considered. However, poor surgical outcome affect the patient, the physician, the employer, and the insurance company. In order to reduce negative surgical outcomes, pre-surgical psychological evaluations are used in order to better predict prognosis. The current study looked at the utility of the Presurgical Behavioral Medicine Evaluation (PBME) and revised algorithm that was described in Shocket's (2005) investigation that determines a patient's prognosis for invasive pain procedures. Patients were placed in a Green, Yellow I, Yellow II, or Red prognosis group, with Green having the best prognosis for surgery and Red having the worst prognosis. A total of 95 patients completed the PBME evaluation, with most patients being evaluated for a spinal cord stimulator or intrathecal pump. Variables, including gender, disability payment status, and involvement in pending litigation, were found to be significantly different among the groups. Analysis of data at the initial evaluation indicated that patients within the Red group endorsed significantly more physical/functional limitations, depressive symptomatology, and reported more psychological distress than the Green group. Patients were followed-up 6- and 12-months post-evaluation with both physical/functional and psychosocial measures. Analysis of the 12-month follow-up data indicated that there were significant differences among the four groups in terms of the VAS, BDI, MCS, OSW scores, and the catastrophizing scale on the CSQ. In addition, the Tukey HSD and Mann Whitney tests revealed specific significant differences among the groups. A repeated measures analysis of the initial evaluation, 6-month, and 12-month follow-up data revealed the Green and Red group was significantly different in terms of the VAS, OSW, BDI, and MCS. In addition, nonparametric analysis indicated that there were significant differences among the groups on total risk factor scores as determined by the PBME algorithm.