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PubMed1976

The application of a semiautomated postoperative care program in a community hospital: early results.

The clinical involvement of computer technology in medical center environment has been successfully utilized in the postoperative care of patients following open intracardiac operations. This report describes the initial experience in a community hospital with the adaptation and evaluation of such a system in the postoperative care of critically ill patients. The early experience with this noncomputerized system suggests the clinical usefulness of the approach, the potential increase in manpower utilization, and the greater utilization of the nursing staff in true patient care. The early results of the study do not indicate that this approach to patient care is necessarily economically feasible or technically applicable in all community hospitals.

Aged↗
PubMed2006

The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic.

OBJECTIVE: To describe the implementation of a nurse-led preoperative cataract assessment and postoperative care clinic and to assess the safety, efficacy and outcomes. DESIGN, SETTING AND PARTICIPANTS: A prospective study involving 185 public patients (221 eyes) referred to the Department of Ophthalmology at Flinders Medical Centre for cataract surgery. The study was conducted between February 2003 and August 2004. INTERVENTIONS: Patients were assessed in the nurse-led preoperative assessment clinic. Those deemed suitable for cataract surgery were also assessed by an ophthalmologist and underwent cataract surgery if appropriate. The nurse managed postoperative care. MAIN OUTCOME MEASURES: Concordance between nurse practitioner and ophthalmologist assessments; waiting times for first clinic appointment and surgery; visual acuity and degree of visual disability; patient satisfaction. RESULTS: 114 patients (61.6%) were assigned to see the ophthalmologist for cataract surgery. Median waiting times fell from 115 days (range, 23-268 days) to 21 days (range, 9-43 days) for initial clinic appointment, and from 44 days (range, 5-148 days) to 29 days (range, 14-154 days) for surgery. All 114 patients were listed for cataract surgery, and surgery had been performed on 121 eyes by the end of the study. After surgery, visual acuity improved by a mean of 0.45 logMAR (logarithm of the minimal angle of resolution) (SD, 0.24; range, 0.08-1.32). All patients had improved visual ability and high levels of satisfaction. Three quality assurance evaluations demonstrated full concordance between nurse and ophthalmologist assessments. CONCLUSIONS: Implementing a nurse-led cataract assessment clinic improved access to care for public patients with cataracts. The safety and efficacy of the program and its excellent visual and patient-centred outcomes commend its adaptation and implementation to other ophthalmology departments.

Aged↗
PubMed2001

A prospective randomized clinical trial to evaluate methods of postoperative care of hypospadias.

PURPOSE: Hypospadias repair is a common operation performed by pediatric urologists. Perhaps the greatest variable and source of controversy of postoperative care is the surgical dressing. We hypothesized that using no dressing would achieve surgically comparable results to those traditionally achieved by a postoperative dressing and it would also simplify postoperative parent delivered home care. Accordingly we designed a prospective randomized clinical trial to compare surgical outcome and postoperative care after hypospadias repair in boys with no dressing and those who received 1 of the 2 most common types of dressing. MATERIALS AND METHODS: In a 12-month period 120 boys with an average age of 2.2 years underwent primary 1-stage hypospadias repair at a single center with 4 participating surgeons. Repair was performed in 60 boys with proximal and 60 with distal hypospadias on an outpatient basis. Ethics and Internal Review Board approval, and informed consent were obtained. Boys were then prospectively randomized to receive no dressing, an adhesive biomembrane dressing or a compressive wrap dressing. Comprehensive instructions on postoperative care were distributed to all families and a questionnaire was distributed to the parents at the initial followup. Surgical outcome was evaluated and questionnaire responses were analyzed. Fisher's exact test was done to test the significance of differences in surgical outcomes and questionnaire responses. RESULTS: A total of 117 boys completed the prospective randomized trial. Surgical staff withdrew 3 cases from randomized selection to place a dressing for postoperative hemostasis. We obtained 101 questionnaires for response analysis. The type or absence of the dressing did not correlate with the need for repeat procedures, urethrocutaneous fistula, or meatal stenosis or regression. Analysis revealed less narcotic use in the no dressing group and fewer telephone calls to the urology nurse, or on-call resident and/or fellow. These findings were statistically significant. In addition, there were more unscheduled visits to the urology clinic, emergency room or primary physician office by boys with than without a dressing. Furthermore, 29% of the parents were not psychologically prepared to remove the dressing and 12% were so reluctant that the dressing was removed at the urology outpatient clinic. CONCLUSIONS: The surgical outcome and rate of adverse events or complications were not compromised without a postoperative dressing. An absent dressing simplified postoperative ambulatory parent delivered home care. We recommend that dressings should be omitted from routine use after hypospadias repair.

Bandages↗
PubMed2003

Systematic approach on postoperative care of the cardiac surgical patients.

With the medical advances and rising expectations among cardiac surgeons and patients, older and sicker patients now undergo ever more complex operations. However, fortunately, postoperative care of cardiac surgical patients also have shown important changes parallel to the surgical improvements. Although, the events within the operating room are accepted as the main determinants for the faith of the patient, some patients, who are very ill upon arrival in the intensive care unit, may have a good long-term prognosis when postoperative care is meticulously provided. Conversely, patients who are doing well as they leave the operating room may be put at significant risk for complications by poor postoperative management. In this paper, we draw an outline of systematical approach of intensive care of cardiac surgical patients and summarize a practical manual for physicians. By applying this approach effectively, it should be expected that, the clinician is able to recognize an impending disaster earlier, initiate the proper treatment timely, and increase patients chances of survival.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Postoperative care after esophagectomy: the surgeon's view.

Although in the past esophagectomy was associated with high rates of morbidity and mortality, currently specialized centers have reported reduced hospital death rates of less than 10%. This reduction has been mainly attributed to preoperative patient selection, improvements in anesthesia, surgical techniques, and postoperative care management. In recent years, clinical care pathways, namely physician-directed clinical plans, have been developed to standardize postoperative care after specific surgical procedures: primary goals are improvement in quality of care and reduction in hospital costs. These pathways could be planned after identification of the complications with the highest incidence and the highest hospital costs in order to optimally allocate resources. Aim of this study is to delineate an ideal clinical care pathway after esophagectomy by reporting the most common complications with an overview of advances in perioperative care and providing pointers to what might be achievable.

Critical Pathways↗
PubMed1990

[Prostanoids and leukotrienes in ophthalmology. III. Results of a clinical study of local administration of indomethacin in preoperative and postoperative care].

The authors submit results of the clinical investigation involving indomethacin administration during preoperative and postoperative care of patients with primary glaucoma who were submitted to trabeculectomy. The investigation was made by the method of a double blind trial. Indomethacin 0.5% eye drops or placebo were administered on the day prior to operation to the 10th day after operation, three times a day. During the final comparison of the two groups after indomethacin a reduction of the number of postoperative complications was observed, as well as a shorter hospitalization period, and the result of the filtering operation was not affected.

Double-Blind Method↗
PubMed1979

The immediate postoperative care of a child with cleft lip: time-proved suggestions.

An excellent cleft lip repair demands and depends upon good postoperative care. The strain caused by crying can be minimized by eliminating restraints and by early hospital dismissal. Protein and vitamin C are important in healing. A nongreasy pressure dressing capable of absorbing serum is applied for the first night only, then the suture line is sponged with cold water after each feeding. Following suture removal, effective bridging is achieved by applying perforated Zonas adhesive directly to the wound. The care outlined has been used successfully for 93 cleft lip patients over 24 years. Both sides of bilateral clefts were closed at one operation. Two patients among 18 with bilateral clefts had one side break down; 1 patient had a partial breakdown on both sides. This same postoperative routine has been used successfully when operating under less than ideal circumstances in primitive areas. Good postoperative care consists of attention to many little details, none of which are important by themselves but which, when added together, give perfection.

Bandages↗
PubMed1980

Preoperative and postoperative care of the pediatric surgical patient.

The preoperative and postoperative care of the pediatric surgical patient is considered under the headings of elective surgery, urgent surgery, surgery for trauma, and other emergency surgery. The specialized care of the neonatal surgical patient is not discussed. The approach outlined is the personal approach of the authors. Points stressed are the importance of preserving normal hydration and blood glucose levels before elective surgery, and the importance of correcting major deficits before urgent or emergency surgery.

Abdomen, Acute↗
PubMed1976

[Postoperative care of cancer patients: an interdisciplinary responsibility (author's transl)].

Postoperative care of cancer patients is the joint interdisciplinary responsibility of surgeons, general practitioners (GP'S) and registered specialists. The necessary centralization in hosptal is ensured through cooperation on the part of the general practitioners. By means of a standardized follow-up programme, the organizational model described guarantees 9 postoperative check-ups at predetermined intervals within a period of 5 years. Clinical cancer registers are a mark of quality for hospitals and ensure detection and analysis of the pathography of cancer patients. Surgeons must also acquire the knowledge necessary for their use.

Female↗
PubMed1999

Postoperative care in functional endoscopic sinus surgery?

OBJECTIVE: To assess the value of nonintervention after FESS. STUDY DESIGN: Prospective study. METHODS: Fifty-five patients with diagnosed chronic rhinosinusitis who failed adequate medical therapy were subjected to FESS. No postoperative care, apart from nasal douching with hypertonic saline after the tenth postoperative day, was done. No antibiotics or steroids were administered routinely. Because 10 patients were not available for follow-up, only 45 patients were included in the study. RESULTS: Success rate judged by at least 50% subjective improvement of symptoms was 95.5%. However, all patients derived some benefit. The occurrence of postoperative synechiae is discussed. CONCLUSIONS: The usefulness of postoperative care of the FESS cavity needs reappraisal.

Adult↗