OBJECTIVE: To evaluate the perioperative outcome of posterior spinal fusion in adolescent idiopathic scoliosis (AIS) patients comparing a single attending surgeon strategy (G1) versus a dual attending surgeon strategy (G2).
SUMMARY OF BACKGROUND DATA: The complication rate for surgical correction in AIS is significant. There are no prospective studies that investigate dual attending surgeon strategy for posterior spinal fusion in AIS.
METHODS: A total of 60 patients (30 patients in each arm) were recruited. The patients were comparable for age, gender, Lenke classification, major Cobb angle magnitude, and number of fusion levels. The anesthetic, surgical, and postoperative protocol was standardized. The outcome measures included the operative duration, blood loss, postoperative hemoglobin, need for transfusion, morphine usage, duration of hospital stay, intraoperative lactate levels, and pH. The timing of the operation at six critical stages of the operation was recorded.
RESULTS: The mean operative time for G2 was 173.6 ± 27.0 minutes versus 248.0 ± 49.9 minutes in G1 (P controlled analgesia morphine requirement and led to faster patient recovery during the perioperative period.
LEVEL OF EVIDENCE: 2.
METHODS: A 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia-Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance.
RESULTS: In total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p
METHODS: Patients with mild to moderate ABP were prospectively randomized to either an early cholecystectomy versus a delayed cholecystectomy group. Recurrent biliary events, peri-operative complications, conversion rate, length of surgery and total hospital length of stay between the two groups were evaluated.
RESULTS: A total of 72 patients were enrolled at a single public hospital. Of them, 38 were randomized to the early group and 34 patients to the delayed group. There were no differences regarding peri-operative complications (7.78% vs 11.76%; p = 0.700), conversion rate to open surgery (10.53% vs 11.76%; p = 1.000) and duration of surgery performed (80 vs 85 minutes, p = 0.752). Nevertheless, a greater rate of recurrent biliary events was found in the delayed group (44.12% vs 0%; p ≤ 0.0001) and the hospital length of stay was longer in the delayed group (9 vs 8 days, p = 0.002).
CONCLUSION: In mild to moderate ABP, early laparoscopic cholecystectomy reduces the risk of recurrent biliary events without an increase in operative difficulty or perioperative morbidity.