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Since the onset of the COVID-19 pandemic the use of telehealth has burgeoned. Numerous surgical specialties have already adopted the use of virtual postoperative visits, but there is data lacking in both robotics and gynecology. In this single-institution prospective cohort study we sought to evaluate the patient satisfaction, feasibility and safety of postoperative telehealth visits following robotic gynecologic surgery. Thirty-three patients undergoing robotic gynecologic procedures participated in a postoperative telehealth visit approximately 2 weeks following surgery, of which 27 completed a survey which assessed participant satisfaction with the telehealth visit, overall health-related quality of life following surgery, exposure to telehealth visits, and social determinants of health. The mean satisfaction score was just below ‘excellent’. Only 2 participants (6.3%) required an in-person visit. Postoperative telehealth visit satisfaction score was significantly associated only with BMI (Pearson r = 0.45, p = 0.018). These data suggest that telehealth visits following robotic gynecologic procedures appear to be safe and feasible, and are associated with a high level of patient satisfaction. Supplementary Information The online version contains supplementary material available at 10.1007/s11701-021-01354-w.
Objective: to study baseline autonomic tone and autonomic responsiveness in patients with neuroreflectory syncopal states (NSS) during a passive orthotest in orthostatic and clinostatic phases. Subjects and methods. A study group comprised 40 patients with NSS, a comparative group included 57 patients with panic attacks (PA); a control group consisted of 22 subjects without the above conditions. Cardiac rhythm variability was estimated applying a Neuron-spectrum device. Results. During the orthotest, the patients with NSS showed inadequate activity of the sympathetic nervous system as compared with the patients with PA and the control group. At the same time, the clinostatic test revealed that the indicators restored to the normal values in patients with NSS, unlike in those with PA.
OBJECTIVE: To examine the impact of a 24-hour post-cesarean section patient-controlled epidural analgesia (PCEA) in women with opioid use disorder (OUD). Subjective pain scores and quantitative request for and use of opioid medications were compared between the PCEA group and the standard care group. STUDY DESIGN: A retrospective chart review was performed including women who received a PCEA for 24 hours following c-section at an urban academic hospital July 2016-November 2019. Collected data included demographics, pain scores, and morphine-equivalent medications received both inpatient and on discharge. RESULTS: 42 patients with OUD were included in the analysis with 13 in the PCEA group and 29 in the standard care group. There were no significant intergroup differences in age, parity, BMI, or co-morbidities. Compared to the standard care group, the PCEA group reported lower pain scores on postoperative days 0-3 (all p<0.05) and received a significantly lower quantity of opioid medications on postoperative day 1 (6.85 vs 24.58mg, p¼0.003). Quantity of morphine equivalents received were lower on postoperative days 0, 2 and 3, but did not reach statistical significance. The PCEA group had fewer PRN requests for opioid medications on postoperative days 0 and 1 (0 vs 3.36, p¼0.021 and 0.40 vs 2.21, p¼0.001) and were discharged home with a significantly lower quantity of opioid medications (1.77 vs 8.10 tablets, p¼0.01). There were no intergroup differences in complication rates. CONCLUSION: Use of a post-caesarian PCEA was associated with reduced pain scores, fewer requests for PRN opioid medications, lower morphine equivalents received inpatient, and decreased amount of discharge opioid tablets without effect on length of stay or postoperative complications. Our novel protocol presents a pain management plan that may improve postoperative pain control while deferring use of opioid-based analgesics. Further larger and randomized controlled trials should be performed to further investigate this finding.
Iatrogenic injury to the urinary system is a known complication of gynecologic surgery; therefore, intraoperative cystoscopy is frequently performed to assess for such injuries. However, if an abnormality is seen, the differential diagnosis extends beyond iatrogenic causes. A 42-year-old patient underwent a total abdominal hysterectomy and had absent efflux from the right ureteral orifice on cystoscopy. While iatrogenic injury was initially suspected, the intraoperative workup (including intravenous pyelography (IVP)) that ensued led to an empiric diagnosis of right ureteral atresia with ipsilateral renal atrophy that was then confirmed on postoperative imaging. When an abnormality is seen on cystoscopy following gynecologic surgery, it is important to maintain a broad differential diagnosis and to pursue an intraoperative workup with early involvement and close collaboration with urology.
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