We assessed patients after their return home following gynaecological surgery, using a daily electronic diary. Thirty-two females aged 27-77 years took part. After a hospital stay of 1-6 days (mean 2.3), they were given a pen-based electronic diary and asked to record symptoms and other data over one month. They also completed a questionnaire at the end of the study. Substantial effects on quality and duration of sleep, pain during both the night and day, interference with daily activities, energy, and ability to concentrate were recorded, mostly during the first week of treatment. Symptoms reported in the final questionnaire correlated significantly with diary data. Most patients found the electronic diary easy to use, and none found it difficult. Daily electronic diaries are an acceptable method of obtaining better information on the extent and duration of symptoms and other difficulties after discharge following surgery. The costs of healthcare provision increase the pressure for efficient use of resources. Reducing the length of hospital stay after surgery is one approach to cost reduction. To properly assess cost effectiveness, information is needed on the degree to which patients are affected by postsurgical problems on their return home, and their speed of recovery.Most of the work in this area has investigated day case surgery, which now accounts for a large proportion of surgical procedures. In Scotland, for example, about 60% of elective surgery is carried out on a day basis [1]. Some studies have investigated the immediate postoperative recovery period using functional measures (ability to drink, void urine, or walk), symptom measures (pain, nausea) or cognitive testing [2][3][4][5]. Others have used questionnaires to assess symptoms and their impact, as well as overall satisfaction, after return home. Studies considering several time-points after discharge show that a substantial proportion of patients have at least moderate pain sufficient to interfere with daily activities, after their return home [4,6,7]. As well as pain, the after effects of surgery may include cognitive impairments. Thus Tzabar et al.[8] used the Cognitive Failures Scale over a 3-day period after day case surgery, and found more failures in patients who had received a general anaesthetic compared to those given only a local anaesthetic. 1101Work on patients undergoing surgery as in-patients has mostly focused on the recovery period before discharge [9][10][11]. Myles et al.[4] administered a Quality of Recovery Scale to patients daily for 6 days then weekly for up to 6 weeks after minor or major surgery. The scale assessed wellbeing, specific functions, symptoms, and need for support. Questionnaires were administered by telephone after discharge, but it is not clear from the report how long these patients stayed in hospital. Substantially greater effects were recorded after major surgery, as expected, with scores returning to baseline after about one week. Other studies have used questionnaires to assess patient satisfa...

P Pu ur rp po os se e: : We investigated the association between morbid obesity and difficult laryngoscopy (DL). M Me et th ho od ds s: :In a prospective, controlled study we evaluated the impact of different variables on the prediction of DL in 200 morbidly obese (study group-SG), and 1,272 non-obese (control group-CG) patients undergoing elective surgery. Variables assessed included age, sex, body mass index (BMI), protruding, loose, and missing upper teeth, thyro-mental distance, temporo-mandibular joint (TMJ) function, neck extension, and Mallampati class. A Cormack grade III or IV was considered DL.R Re es su ul lt ts s: : The SG patients were younger (P < 0.000), there were more females in the SG (P < 0.000) and more in the SG had teeth problems (P = 0.026). More patients in the SG (10% vs 1%), had obstructive sleep apnea (P < 0.001) with 90% of them in the SG having a grade III laryngoscopy. High BMI did not affect the laryngoscopy difficulty (P = 0.56). Multivariable regression analysis revealed that morbid obesity, increased age, male sex, pathology of TMJ, and higher Mallampati class, were independent predictors of DL. When interaction between the predictors and the group was added to the multivariable model, the SG was no longer a predictor by itself, rather its association with abnormal upper teeth turned to be significant for prediction of DL.C Co on nc cl lu us si io on ns s: : Increased age, male sex, TMJ pathology, Mallampati 3 and 4, a history of obstructive sleep apnea and abnormal upper teeth were associated with a higher incidence of DL. The magnitude of BMI had no influence on difficulty with laryngoscopy.

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