DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
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Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Ice Packs Reduce Postoperative Midline Incision Pain and Narcotic Use: A Randomized Controlled Trial A. A. Watkins, T. V. Johnson, A. B. Shrewsberry, P. Nourparvar, T. Madni, C. J. Watkins, P. L. Feingold, D. A. Kooby, S. K. Maithel, C. A. Staley and V. A. Master Departments of Urology and Surgery, and Division of Surgical Oncology, Emory University, Atlanta, Georgia, and Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania J Am Coll Surg 2014; 219: 511e517.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.004 available at http://jurology.com/ Editorial Comment: The authors evaluated patients undergoing midline abdominal incisions for a variety of general surgical and urological procedures to determine if ice pack application to the wound postoperatively resulted in any benefit in terms of reduced pain scores and decreased use of narcotics. The ice packs were simple, cost effective and well tolerated, and produced a reduction in pain scores and narcotic usage. The mechanism of action is unclear but may be related to decreased cellular metabolic demand and subsequent reduction in inflammation. Richard K. Babayan, MD
Geriatrics Re: Functional Capacity as a Significant Independent Predictor of Postoperative Mortality for Octogenarian ASA-III Patients O. Visnjevac, J. Lee, L. Pourafkari, H. H. Dosluoglu and N. D. Nader Department of Anesthesiology, University at Buffalo, Buffalo, New York J Gerontol A Biol Sci Med Sci 2014; 69: 1229e1235.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.043 available at http://jurology.com/ Editorial Comment: A wide variety of clinical factors have been studied to predict clinical outcomes. For surgical patients the American Society of AnesthesiologistsÒ (ASA) classification system is a well validated, simple instrument that is highly predictive of postoperative risk of morbidity and mortality. However, the majority of geriatric patients undergoing surgery have underlying comorbidities that lead to classification as ASA III. This category includes patients with severe systemic disease not reaching ASA IV, in which the comorbidity is considered a constant threat to life. Because of the substantial heterogeneity among older adults in this group, simply lumping such a large number of diverse subjects under this classification diminishes much of its predictive power. This study was designed to determine if incorporating a simple measure of functional capacity into the ASA classification would help determine outcomes in this group more accurately. A total of 1,049 surgical patients older than 80 years and classified as ASA III were dichotomized into 2 groups based on complete independence for activities of daily living (ADL) and need for either full or partial assistance. Using this simple stratification, 30-day and long-term survival rates were significantly better in patients who were fully independent for ADL (HR 1.87, 95% CI 1.55e2.25, p
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Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Ice Packs Reduce Postoperative Midline Incision Pain and Narcotic Use: A Randomized Controlled Trial A. A. Watkins, T. V. Johnson, A. B. Shrewsberry, P. Nourparvar, T. Madni, C. J. Watkins, P. L. Feingold, D. A. Kooby, S. K. Maithel, C. A. Staley and V. A. Master Departments of Urology and Surgery, and Division of Surgical Oncology, Emory University, Atlanta, Georgia, and Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania J Am Coll Surg 2014; 219: 511e517.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.004 available at http://jurology.com/ Editorial Comment: The authors evaluated patients undergoing midline abdominal incisions for a variety of general surgical and urological procedures to determine if ice pack application to the wound postoperatively resulted in any benefit in terms of reduced pain scores and decreased use of narcotics. The ice packs were simple, cost effective and well tolerated, and produced a reduction in pain scores and narcotic usage. The mechanism of action is unclear but may be related to decreased cellular metabolic demand and subsequent reduction in inflammation. Richard K. Babayan, MD
Geriatrics Re: Functional Capacity as a Significant Independent Predictor of Postoperative Mortality for Octogenarian ASA-III Patients O. Visnjevac, J. Lee, L. Pourafkari, H. H. Dosluoglu and N. D. Nader Department of Anesthesiology, University at Buffalo, Buffalo, New York J Gerontol A Biol Sci Med Sci 2014; 69: 1229e1235.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.01.043 available at http://jurology.com/ Editorial Comment: A wide variety of clinical factors have been studied to predict clinical outcomes. For surgical patients the American Society of AnesthesiologistsÒ (ASA) classification system is a well validated, simple instrument that is highly predictive of postoperative risk of morbidity and mortality. However, the majority of geriatric patients undergoing surgery have underlying comorbidities that lead to classification as ASA III. This category includes patients with severe systemic disease not reaching ASA IV, in which the comorbidity is considered a constant threat to life. Because of the substantial heterogeneity among older adults in this group, simply lumping such a large number of diverse subjects under this classification diminishes much of its predictive power. This study was designed to determine if incorporating a simple measure of functional capacity into the ASA classification would help determine outcomes in this group more accurately. A total of 1,049 surgical patients older than 80 years and classified as ASA III were dichotomized into 2 groups based on complete independence for activities of daily living (ADL) and need for either full or partial assistance. Using this simple stratification, 30-day and long-term survival rates were significantly better in patients who were fully independent for ADL (HR 1.87, 95% CI 1.55e2.25, p
