General patient satisfaction after elective and acute thoracic surgery is associated with postoperative complications

Cairns, Alexander; Battleday, Finn McLennan; Velikova, Galina; Brunelli, Alessandro; Bell, H. E.; Favo, Joel; Patella, Miriam; Lindner, Oana C; Pompili, Cecilia

doi:10.21037/jtd-19-3345b

Cited by 5 publications

(5 citation statements)

References 19 publications

(20 reference statements)

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“…Patient satisfaction with pain management and overall hospital experience play a role in postoperative pain . In our study, the patient’s global satisfaction with pain control at 30 days was similar to that of previous studies . However, the numerical rating of neuropathic pain and the rate of patients requiring analgesia consumption at 30 days was surprisingly high.…”

Section: Discussionsupporting

confidence: 87%

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

Chenesseau,

Fourdrain,

Pastene

et al. 2023

JAMA Surg

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ImportanceIn minimally invasive thoracic surgery, paravertebral block (PVB) using ultrasound (US)–guided technique is an efficient postoperative analgesia. However, it is an operator-dependent process depending on experience and local resources. Because pain-control failure is highly detrimental, surgeons may consider other locoregional analgesic options.ObjectiveTo demonstrate the noninferiority of PVB performed by surgeons under video-assisted thoracoscopic surgery (VATS), hereafter referred to as PVB-VATS, as the experimental group compared with PVB performed by anesthesiologists using US-guided technique (PVB-US) as the control group.Design, Setting, and ParticipantsIn this single-center, noninferiority, patient-blinded, randomized clinical trial conducted from September 8, 2020, to December 8, 2021, patients older than 18 years who were undergoing a scheduled minimally invasive thoracic surgery with lung resection including video-assisted or robotic approaches were included. Exclusion criteria included scheduled open surgery, any antalgic World Health Organization level greater than 2 before surgery, or a medical history of homolateral thoracic surgery. Patients were randomly assigned (1:1) to an intervention group after general anesthesia. They received single-injection PVB before the first incision was made in the control group (PVB-US) or after 1 incision was made under thoracoscopic vision in the experimental group (PVB-VATS).InterventionsPVB-VATS or PVB-US.Main Outcomes and MeasuresThe primary end point was mean 48-hour post-PVB opioid consumption considering a noninferiority range of less than 7.5 mg of opioid consumption between groups. Secondary outcomes included time of anesthesia, surgery, and operating room occupancy; 48-hour pain visual analog scale score at rest and while coughing; and 30-day postoperative complications.ResultsA total of 196 patients were randomly assigned to intervention groups: 98 in the PVB-VATS group (mean [SD] age, 64.6 [9.5] years; 53 female [54.1%]) and 98 in the PVB-US group (mean [SD] age, 65.8 [11.5] years; 62 male [63.3%]). The mean (SD) of 48-hour opioid consumption in the PVB-VATS group (33.9 [19.8] mg; 95% CI, 30.0-37.9 mg) was noninferior to that measured in the PVB-US group (28.5 [18.2] mg; 95% CI, 24.8-32.2 mg; difference: −5.4 mg; 95% CI, −∞ to −0.93; noninferiority Welsh test, P ≤ .001). Pain score at rest and while coughing after surgery, overall time, and postoperative complications did not differ between groups.Conclusions and RelevancePVB placed by a surgeon during thoracoscopy was noninferior to PVB placed by an anesthesiologist using ultrasonography before incision in terms of opioid consumption during the first 48 hours.Trial RegistrationClinicalTrials.gov Identifier: NCT04579276

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Section: Discussionsupporting

confidence: 87%

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

Chenesseau,

Fourdrain,

Pastene

et al. 2023

JAMA Surg

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“…When patients experience complications after surgery their self-reported perception of the care they received is negatively impacted. Patients are less likely to recommend the hospital and are more likely to perceive the hospital staff as unresponsive ( 43 - 45 ). Although not directly investigated in the study by Gurland et al , one may theorize that if a patient is less likely to recommend the hospital, they may also be less likely to recommend the surgeon.…”

Section: Resultsmentioning

confidence: 99%

“…Surgical complications can lead to significant psychosocial distress, depression, anxiety and can negatively affect a patient’s quality of life ( 45 ). For example, when given the choice for management of prostate cancer, patients feeling anxious or depressed are more likely to prefer radical treatment options rather than active surveillance, as active surveillance can be anxiety producing ( 46 , 47 ).…”

Section: Resultsmentioning

confidence: 99%

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

Grimaud,

Barquin,

Kurnot

et al. 2024

Transl Androl Urol

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Background and Objective Since immediate salvage (IS) surgery for infected penile prosthesis (PP) was introduced nearly 30 years ago, an abundance of evidence has emerged in support of its use. IS remains underutilized by the modern urologist despite its distinct advantages. While some medical literature proposes reasons for the underuse of IS, no comprehensive review attempts to address the numerous factors limiting its implementation. Our objective is to analyze the barriers to IS surgery for infected PP with the goal of expanding utilization of this technique through a practical and standardized approach for treating urologists. Methods A narrative review of available English, peer-reviewed, medical literature relevant to the barriers to IS was completed. Searches were expanded to include literature from surgical specialties in general if hypothesized barriers were incompletely described in available PP publications. Key Content and Findings The major barriers that are likely contributing to the low rates of IS for PP surgery can be broadly classified into three major categories: institutional/systemic, medical/surgical, and patient preference. Institutional/systemically driven barriers include surgeon comfort with PP surgery, low national availability of urologists, inaccessibility of prosthetics or critical ancillary staff at the time of patient presentation and limited operating room (OR) access. Medical/surgical barriers primarily relate to reinfection fears, perceived contraindications to IS, and overall patient stability at the time of presentation. Patient preference factors inhibiting IS involve loss of trust in the medical team, psychosocial distress, dissatisfaction with the initial device prior to infection and anxiety regarding postoperative recovery. Many of the identified barriers can be overcome with increased surgical training, improved patient and surgeon understanding of PP infection, or precautionary planning. Conclusions Of the factors that contribute to low utilization of IS, many are misunderstood or unknown. Recognition of these barriers may equip urologists to provide better care to patients with prosthesis infection.

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“…Our finding of no association between suffering from postoperative complications and satisfaction are not supported by the literature. Previous studies report lower patient satisfaction among surgical and medical patients who suffered from postoperative complications or medical adverse effects [ 4 , 14 , 21 ]. Patient satisfaction involves several aspects, including the quality of the treatment, clinical outcome, and more subtle aspects, such as the relationship between patients and healthcare personnel.…”

Section: Discussionmentioning

confidence: 99%

“…Even if postoperative complications usually can be treated and healed, some studies have shown inferior patient satisfaction among patients who suffered complications [ 4 , 14 , 21 ]. We aimed to estimate the risk of postoperative complications after surgery for LSS using two different data sources to better estimate the frequency, and to demonstrate the differences between the two methods for recording postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources

Alhaug,

Dolatowski,

Kaur

et al. 2024

Acta Neurochir

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Purpose Lumbar spinal stenosis (LSS) is a prevalent disorder, and surgery for LSS is a common procedure. Postoperative complications occur after any surgery and impose costs for society and costs and additional morbidity for patients. Since complications are relatively rare, medical registries of large populations may provide valuable knowledge. However, recording of complications in registries can be incomplete. To better estimate the true prevalence of complications after LSS surgery, we reviewed two different sources of data and recorded complications for a sample of Norwegian LSS patients. Methods 474 patients treated surgically for LSS during 2015 and 2016 at four hospitals reported to a national spine registry (NORspine). Postoperative complications were recorded by patients in NORspine, and we cross-referenced complications documented in NORspine with the patients´ electronic patient records (EPR) to re-test the complication rates. We performed descriptive statistics of complication rates using the two different data sources above, and analyzed the association between postoperative complications and clinical outcome with logistic regression. Results The mean (95%CI) patient age was 66.3 (65.3–67.2) years, and 254 (53.6%) were females. All patients were treated with decompression, and 51 (10.7%) received an additional fusion during the index surgery. Combining the two data sources, we found a total rate for postoperative complications of 22.4%, the NORspine registry reported a complication rate of 15.6%, and the EPR review resulted in a complication rate of 16.0%. However, the types of complications were inconsistent across the two data sources. According to NORspine, the frequency of reoperation within 90 days was 0.9% and according to EPR 3.4%. The rates of wound infection were for NORspine 3.1% and EPR review 2.1%. There was no association between postoperative complication and patient reported outcome. Conclusion Postoperative complications occurred in 22% of LSS patients. The frequency of different postoperative complications differed between the two data sources.

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General patient satisfaction after elective and acute thoracic surgery is associated with postoperative complications

Cited by 5 publications

References 19 publications

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

Overcoming barriers to immediate penile implant salvage surgery: a narrative review

Postoperative complications after surgery for lumbar spinal stenosis, assessment using two different data sources

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