Joshua Ramjist

27 statements · 1 topic

Pectus Excavatum · guest expert

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Despite an excellent operation, the post-operative period has been plagued by pain which has resulted in significant morbidity and increased length of stay
clinical · Pectus Excavatum
The protocol includes perioperative education and counseling to establish reasonable expectations using educational materials and a boarding pass
clinical · Pectus Excavatum

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Joshua's statements about Pectus Excavatum 27 statements

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BOB Ped Surg 2023 - Joshua Ramjist, CAPS - Presentation

Statement Pectus excavatum affects patients at a vulnerable time in their lives in the childhood and adolescent years Open
Statement The Nuss procedure has been revolutionary in correcting pectus excavatum deformity Open
Quotation However, despite an excellent operation, the post-operative period has been plagued by pain and subsequentus, and that's resulted in a significant morbidity and an increased length of stay. Open
Quotation This is a real problem for our patients, as it affects them at a vulnerable time in their lives in the childhood and adolescent years. Open
Statement Despite an excellent operation, the post-operative period has been plagued by pain which has resulted in significant morbidity and increased length of stay Open
Statement Pectus excavatum is the most common congenital chest deformity Open
Statement Pectus excavatum affects one in 400 births Open
Statement The protocol includes perioperative education and counseling to establish reasonable expectations using educational materials and a boarding pass Open
Statement The transitional pain service facilitates both pharmacologic and non-pharmacologic interventions to manage patient pain Open
Statement Multimodal analgesia intraoperatively includes serratus anterior block and cryoablation at the time of procedure Open
Statement A perioperative bowel regimen was included in the protocol Open
Statement The boarding pass was a primary instrument to facilitate shared decision making and establish a therapeutic relationship between the team and patients Open
Quotation And finally, no general surgery project is complete without thinking about the bowel. Open
Statement The five-point ERAS protocol spans the entirety of the patient's perioperative experience Open
Statement 92% of patients expressed satisfaction with their overall experience Open
Statement All patients were approximately 15 years of age at the time of repair Open
Statement Haller indices were typically above 4.5 Open
Statement This is a single institution study at the Hospital for Sick Children with retrospective data for the pre-ERAS cohort and prospective data after implementation Open
Statement 53 patients were recruited from August 2015 to December 2021 Open
Quotation To put this in real terms, the majority of our patients were leaving on post-operative day one. Open
Statement There was a significant decrease in length of stay by 50%, from 4 days to just under 2 days Open
Statement The mean length of stay was 1.8 days Open
Statement The majority of patients were leaving on post-operative day one Open
Statement There was a significant decrease in opioid consumption in the post-operative period from 6.36 to 3.12 morphine milliequivalents Open
Statement Successful surgical outcomes are predicated on a multi-disciplinary team working in each phase of care to optimize the patient's experience Open
Statement Surgery remains a team sport Open
Quotation So while our study utilized a five-point s protocol for patients undergoing pectus repair, our underlying message is that surgery remains a team sport. Open