Does Early-Period Patient Dissatisfaction Turn Into Satisfaction Over Time After Total Knee Replacement? - Article abstract #936792

Background: Recovery following total joint arthroplasty varies substantially among patients, and psychological factors may partly account for this variability. Although anxiety and depression have been widely investigated, the specific contribution of preoperative surgical fear to postoperative pain and quality of recovery remains unclear. This study aimed to examine the association between preoperative surgical fear and postoperative pain intensity and quality of recovery. Methods: This prospective, hospital-based observational study enrolled 89 patients undergoing primary total knee or hip arthroplasty. Preoperative surgical fear was measured using the Surgical Fear Questionnaire (SFQ). Pain intensity was assessed with the Numeric Rating Scale (NRS) preoperatively and at three postoperative time points. Recovery quality at 24 h was evaluated using the Quality of Recovery-40 (QoR-40). Pearson correlation and multiple linear regression analyses were performed to evaluate associations and identify variables independently associated with recovery outcomes, controlling for potential confounders, including age, sex, ASA physical status, and type of surgery. Results: The mean SFQ score was 26.62 ± 15.19, and the mean QoR-40 score was 157.63 ± 16.66. Surgical fear was moderately and negatively correlated with overall recovery quality (r = −0.546, p < 0.001). In multiple linear regression analysis, surgical fear was most strongly associated with poorer overall recovery quality (β = −0.563, p < 0.001), within a model explaining 30.3% of the variance (adjusted R² = 0.303). At the subscale level, surgical fear was significantly associated with emotional state, pain, physical comfort, and perceived support. Pain intensity at 12 h postoperatively was significantly associated with reduced physical independence (β = −0.218, p = 0.038). Pain intensity peaked at 12 h postoperatively (p < 0.001). Conclusions: Higher levels of preoperative surgical fear are associated with poorer quality of recovery following total joint arthroplasty. These findings highlight surgical fear as a potentially relevant perioperative factor and support the integration of routine psychological assessment into perioperative care pathways in relation to early postoperative recovery outcomes. From a clinical perspective, early identification of patients with high surgical fear may facilitate targeted perioperative counseling and supportive interventions by healthcare professionals, potentially improving recovery outcomes.

Background. Pediatric supracondylar humerus fractures are common in children aged 5-7. The mechanism of injury, fracture type, and its relationship to the epiphysis significantly affect long-term outcomes. This study examines the impact of demographic data, fracture characteristics, and surgical timing and duration on postoperative results.Material and methods. Patients treated for supracondylar humerus fractures between February 2009 and January 2021 were included. Pre- and postoperative radiographs were analyzed, and surgical timing and duration were compared with fracture type and clinical outcomes.Results. A total of 121 patients (72 males, 49 females) at a mean age of 6.6 2.8 years were evaluated. The mean surgery duration was 50.1 29.2 minutes. Fractures were classified as Gartland type 2a (38 patients), type 2b (59 patients), and type 3 (24 patients). Closed reduction with percutaneous pinning was performed in 82 cases. Complications occurred in 7 patients with surgery delays of less than 8 hours and in 4 patients with delays over 8 hours. A significant correlation was found between surgical timing, hospital stay, and complications (p<0.05). The Flynn criteria indicated better outcomes in patients with surgery performed between midnight and 08 a.m. and within 8 hours of injury.Conclusions. 1. Pediatric patients operated on during nighttime hours exhibited higher complication rates and longer hospital stays. 2. Outcomes assessed using the Flynn criteria were superior in patients operated on during daytime hours or with surgical waiting times of less than 8 hours. 3. These findings suggest that there is no universal definitive limit for optimal surgical timing. 4. Patient-specific conditions and clinical features should guide surgeons in determining the appropriate timing for surgery.

Background and aim: This study aimed to examine the prognostic value of perioperative NLR level in terms of mortality in the first postoperative year in elderly patients undergoing hip fracture surgery. Method: A total of 236 patients (68.6% female and 31.4% male), who fit the inclusion criteria and underwent hip fracture surgery, were included in the study. The patients’ complete blood count taken at the time of admission and on the fifth postoperative day were recorded. NLR values calculated at admission (NLR-D0) and on the fifth postoperative day (NLR-D5) were determined as the main variable. Results: The mean age of the participants was 80.1 ± 7.9 years (min: 65 years to max: 99 years). The mean NLR-D0 and mean NLR-D5 values of surviving patients were 6.54 and 4.55, respectively. The mean NLR-D0 and mean NLR-D5 values of patients who died were 6.99 and 8.90, respectively. A significant difference was found in the NLR variability of the patients who survived and those who died. The examination of the effects of NLR-D0 and NLR-D5 parameters on mortality revealed no significant difference in NLR-D0 values between the patients who lived and those who died (P > 0.05), but the NLR-D5 value was significantly higher in the patients who died. The mortality rate at the end of the first postoperative year was 35.2%. Conclusion: A high NLR value (NLR-D5 >7.85) on the fifth postoperative day in elderly patients undergoing hip fracture surgery may be a predictor of 1-year mortality after hip fracture surgery.