Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden.
Theme Neuro, Karolinska University Hospital, Stockholm, Sweden.
J Clin Nurs. 2019 May;28(9-10):1708-1718. doi: 10.1111/jocn.14781. Epub 2019 Feb 1.
To describe patient-reported extremity symptoms after robot-assisted laparoscopic cystectomy in patients with bladder cancer.
Preventive activities for remaining patient safety due to correct positioning play an important part in perioperative nursing care.Extremity injuries are well-known after prolonged surgery, especially in robot-assisted urologic surgery in the steep Trendelenburg position. The risk of injury increases due to patient-related and operative risk factors.
A quantitative prospective observational study was conducted. Patients were followed up with the QuickDASH (Disabilities in the Arm, Shoulder and Hand), Lower Extremity Functional Scale (LEFS) and a study-specific questionnaire 7-10 days and monthly, up to six months after surgery in patients with extremity symptoms. The study adheres to STROBE (strengthening the reporting of observational studies in epidemiology) guidelines, see Supporting information File S1.
Out of the 94 included participants, 46.8% (n = 44) experienced extremity symptoms 7-10 days after surgery. Pain, numbness and weakness were the most frequent symptoms. There was a discrepancy between the patients reported symptoms and the documentation in the patient records. Only 13.6% (n = 3) of the reported pain was documented, respectively 27.5% (n = 11) of other symptoms.
A large proportion of the patients report postoperative extremity symptoms after robot-assisted laparoscopic cystectomy. Prevention of complications in the perioperative setting, are together with follow-ups, important nursing activities for maintaining patient safety and may both prevent and detect postoperative extremity symptoms and injuries.
This study reveals the need of accurate documentation regarding extremity symptoms in digital patient records, as well as continuous follow-ups during the hospital stay and after hospital discharge to enable detection of treatable extremity injuries. The result of this study also indicates the importance of nursing activities such as evidence-based positioning guidelines in the operating theatre for optimal positioning.
描述膀胱癌患者行机器人辅助腹腔镜膀胱切除术后患者报告的肢体症状。
由于正确的定位，预防因剩余患者安全引起的活动在围手术期护理中起着重要作用。肢体损伤在长时间手术后是众所周知的，尤其是在机器人辅助泌尿科手术中的特伦德伦堡体位。由于患者相关和手术风险因素，受伤的风险增加。
进行了一项定量前瞻性观察研究。在出现肢体症状的患者中，在手术后 7-10 天和每月直至 6 个月，使用 QuickDASH（手臂、肩部和手部残疾）、下肢功能量表（LEFS）和特定于研究的问卷对患者进行随访。该研究符合 STROBE（加强观察性研究在流行病学中的报告）指南，见支持信息文件 S1。
在 94 名纳入的参与者中，46.8%（n=44）在手术后 7-10 天出现肢体症状。疼痛、麻木和无力是最常见的症状。患者报告的症状与患者记录中的记录不符。仅记录了报告疼痛的 13.6%（n=3），分别为其他症状的 27.5%（n=11）。
机器人辅助腹腔镜膀胱切除术后，相当一部分患者报告术后肢体症状。围手术期并发症的预防，以及随访，是维持患者安全的重要护理活动，可预防和发现术后肢体症状和损伤。
这项研究揭示了在数字患者记录中准确记录肢体症状以及在住院期间和出院后进行连续随访以发现可治疗的肢体损伤的必要性。该研究结果还表明，在手术室中进行基于证据的定位指南等护理活动对于最佳定位非常重要。
