Category Archives: Postoperative care

What are the considerations for postoperative care in patients undergoing hyperthermic intraperitoneal chemotherapy (HIPEC)?

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Bottom line:  The implications of cytoreductive surgery and HIPEC on postoperative care include prevention of infection, nutritional support and support and education for devices or other procedures that often accompany this procedure.

Dunn D. Surgical Treatment of Patients With Peritoneal Surface Malignancy: Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy.  J Wound, Ostomy and Continence Nurs. 2010; 37(4): 379-85.
Review of cytoreductive surgery and HIPEC, as well as factors to consider in providing postoperative care to these patients, including prevention of surgical site infection, maintenance and education for patient/family on devices, such as drains, nutritional support, and pain control.

 

What is the evidence regarding use of yoga or aromatherapy with post-operative patients?

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Bottom line:  There are a number of experimental studies, mostly about use of aromatherapy to relieve pain.  Results from 2 RCTs indicate that aromatherapy is associated with improvement in postoperative pain and nausea.  However, other studies provide conflicting data.

Here are references from a PubMed search of the question concepts:
postoperative patients
aromatherapy
yoga
postoperative complications, postoperative pain

(postoperative care OR postoperative complications OR postoperative pain) AND (aromatherapy OR yoga) Limit: English

Here are references to the randomized trials on aromatherapy

How to develop a risk factor index to identify patients at an elevated risk of post op injury related to delays or impairment

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Bellino S, Quality of life of patients who undergo breast reconstruction after mastectomy: effects of personality characteristics. Plast Reconstr Surg. 2011 Jan;127(1):10-7.

Bech P, Generalized anxiety or depression measured by the Hamilton Anxiety Scale and the Melancholia Scale in patients before and after cardiac surgery. Psychopathology. 1984;17(5-6):253-63.

King, K. B. Coronary Artery Bypass Grafting Concerns Interview Schedule–1-6 Month Follow-Up. Nursing Research Vol. 49, 2000; p167-172, 6p.

Tu, J. V. Risk Index Score. Depressive symptoms and mortality two years after coronary artery bypass graft surgery (CABG) in men. Psychosomatic Medicine, Vol. 65, 2003; p508-510, 3p.

Does uterine fibroid size or patient weight affect outcome of uterine artery embolization?

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Review evidence summary of Uterine Fibroids in JBI.

Follow up studies addressing risk factors, such as fibroid size, for treatment failure or complications.  Pertinent studies include:

Parthipun AA, et al.   Does size really matter?  Analysis of the effect of large fibroids and uterine volumes on complication rates of uterine artery embolisation. Cardiovasc Intervent Radiol. 2010Oct;33(5):955-9. Epub 2010 May 5. PubMed PMID: 20442999.

Smeets AJ, Nijenhuis RJ, van Rooij WJ, Weimar EA, Boekkooi PF, Lampmann LE,
Vervest HA, Lohle PN. Uterine artery embolization in patients with a large
fibroid burden: long-term clinical and MR follow-up. Cardiovasc Intervent Radiol.
2010 Oct;33(5):943-8. Epub 2010 Jan 12. PubMed PMID: 20066419

Hirst A, et al.  A multi-centre retrospective cohort study comparing the
efficacy, safety and cost-effectiveness of hysterectomy and uterine artery
embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL
study. Health Technol Assess. 2008 Mar;12(5):1-248, iii. PubMed PMID: 18331704.

Arleo EK, Masheb RM, Pollak J, McCarthy S, Tal MG. Fibroid volume, location
and symptoms in women undergoing uterine artery embolization: does size or
position matter? Int J Fertil Womens Med. 2007 Mar-Jun;52(2-3):111-20. PubMed
PMID: 18320870.
In print at the WHSC Library

Firouznia K, Ghanaati H, Sanaati M, Jalali AH, Shakiba M. Uterine artery
embolization in 101 cases of uterine fibroids: do size, location, and number of
fibroids affect therapeutic success and complications? Cardiovasc Intervent
Radiol. 2008 May-Jun;31(3):521-6. Epub 2008 Jan 25. PubMed PMID: 18219521.

Siskin GP, et al.  UAE versus Myomectomy Study Group. A
prospective multicenter comparative study between myomectomy and uterine artery
embolization with polyvinyl alcohol microspheres: long-term clinical outcomes in
patients with symptomatic uterine fibroids. J Vasc Interv Radiol. 2006
Aug;17(8):1287-95. PubMed PMID: 16923975.

Reviewed 4/18/14  AA

Does nonsurgical pain interfere with rehabilitation activities in patients who’ve had total knee arthroplasty?

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Search Method

Searched PubMed, CINAHL, and EMBASE for combinations of these concepts:

  • Pain – etiology, drug therapy, prevention and control
  • Postoperative period or postoperative care
  • Rehabilitation OR physical therapy OR physiotherapy
  • Factors that interfere with rehabilitation (looked for these terms:  interfere* OR delay* OR prohibit*)
  • Arthroplasty/rehabilitation
  • Comparative study or clinical trial or cohort study or prospective study

Search Results
One article differentiated between pain associated with surgery and other pain:
Wittig Wells, Deborah R, Susan EShapiro, and Melinda KHiggins. “Patients’ experiences of pain in the 48 hours following total knee arthroplasty.” Orthopedic nursing 32.1 (2013):39-44.

View a selected collection of other studies on postoperative care of arthroplasty patients in this PubMed collection.

Reviewed and updated 4/30/2014 ldt

Are there studies on management of pain not related to surgery in postoperative patients?

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There are no studies addressing management of pain not related to surgery in postoperative patients.

Search Method

Searched PubMed, CINAHL, and EMBASE for different combinations of these concepts:

  • Pain – etiology, drug therapy, prevention and control
  • Postoperative period or postoperative care
  • Rehabilitation OR physical therapy OR physiotherapy
  • Factors that interfere with rehabilitation (looked for these terms:  interfere* OR delay* OR prohibit*)
  • Arthroplasty/rehabilitation
  • Comparative study or clinical trial or cohort study or prospective study

Reviewed 4/29/2014 ldt

 

What can happen if patients’ intake and output is not properly monitored after surgery?

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Bottom line: Monitoring and documenting intake and output after surgery is important for detecting conditions, such as postoperative urinary retention (POUR), which is associated with risk of overdistention and permanent detrusor muscle damage, leading to difficulties with urination.  Decreased output can also be an indicator of a urinary tract infection.

Summary:  Feliciano T, et al.  A retrospective, descriptive, exploratory study evaluating incidence of postoperative urinary retention after spinal anesthesia and its effect on PACU discharge.  J Perianesth Nursing.  2008; 23(6): 394-400.

Postoperative care.  In:  Lippincott’s Nursing Procedures and Skills.  Revised October 4, 2013.

Reviewed and updated 4/11/2014 ldt