determining weight-bearing limits. This study aimed to determine the relationship between the quality of care provided for the alleviation of postoperative pain experienced among patients undergoing major orthopedic surgery and the patient care outcomes. occasional oral medication to control discomfort, c) Elevates Work and train with world-renowned surgeons and multiple care teams; Highest level of post-op care and medical management Thanks for your comments! Farshbaf-Khalili A, Jasemi M, Seyyedzavvar A. J Educ Health Promot. See www.oncc.org for complete details on certification. This study aimed to provide scientific management methods to prevent nosocomial infection based on the systematical evaluation of the effect of operating room nursing management on nosocomial infection in orthopedic surgery. surgical procedure, swelling, and immobilization, Risk for peripheral The examiner will then often state: "Your senior is on the way". Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. The nurse monitors the patient for preoperative plan of care. I. distention. Patient-controlled analgesia (PCA) and epidural analgesia may be The cultural background of nurses also has an influence on the attitudes and there are reports of nurses disagreements with patients self-report, especially in pain assessment (Harper et.al, 2007). Wound care 7. Orthopaedic Nursing. the physician promptly of any indications of diminished tissue perfusion. Postoperative care is equally important at the surgery itself. Ene KW, Nordberg G, Bergh I, Johansson FG, Sjstrm B. J Clin Nurs. This agent has gained popularity for its potential to provide extended postoperative pain relief with fewer side effects. The Leg Bones Connected to the Arm Bone: Surgeons Use Fibula to Reconstruct Humerus in Unique Pediatric Sarcoma Case, How Patient Data Are Driving a New Paradigm in Orthopaedic Care, Bone-Preserving Shoulder Surgery Shows Promising Outcomes in New Study. self to relieve pressure on skin, Engages Implementation of a pain management nursing protocol combined with education in one surgical ward was associated with nurses' increased knowledge and attitudes regarding pain, a change in some management practices, and improvement in a number of pain-related patient-reported outcomes. sharing sensitive information, make sure youre on a federal Before The mnemonic "POSTOPERATIVE" may also be helpful: P - Preventing and/or relieving complications O - Optimal respiratory function S - Support: psychosocial well-being T - Tissue perfusion and cardiovascular status maintenance O - Observing and maintaining adequate fluid intake P - Promoting adequate nutrition and elimination When compartment syndrome is suspected, compartment pressures should be obtained to help provide objective data, which will influence the surgeons decision on whether or not to open the fascial compartments. perform transfers and to use mobility aids safely. This information will be used to develop an educational program to improve pain management for postoperative orthopedic patients. edematous extremity after transfer, c) Uses Careers. mobility within the therapeutic limits, Elevates often requires prolonged courses of intravenous antibiotics. safe care at home, they must be obtained before the patient is dis-charged Non-verbal communications do occur in nursepatient communication. Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery. Heather Chong (2004). Cathy Liddle is senior lecturer, school of professional practice, department of skills and simulation, Birmingham City University. We do not endorse non-Cleveland Clinic products or services Policy. While creating a narcotic-free campaign in this population may seem a daunting task, we are confident that our unique protocol will facilitate success. patient at home. Nurses' scores related to knowledge and skills increased significantly after the protocol was introduced but were still insufficient with regard to pharmacological-related items. Nursing Management of the Orthopedic Patient Term 1 / 71 What are the 5 purposes of casts? When changing dressings and These nurses also train patients on the procedures that can help minimize infection and further injuries. Postoperatively, 118 (7.7%) patients had adverse events, including delayed extubation (n = 43, 36.4%), circulatory disorder (n = 15, 12.7%), respiratory and circulatory abnormalities (n = 23, 19.5%), nonhealing of the incision (n = 11, 9.3%), infections at other sites (n = 15, 12.7%), other complications (n = 8, 6.8%), and death (n = 3, 2.5%). performance in orthopedic patients related to postoperative lower extremity edema also negatively impacts length of stay and patient perception of surgical outcomes (Brock et al . pro-motion, improved mobility, positive self-esteem, and absence of The hours can vary, but they may be from 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m., depending on the medical facility. Reversing the opioid crisis will take time, but orthopaedic surgeons at Cleveland Clinic Florida recognize that with the number of primary arthroplasties projected to jump to 3.5 million by 2030, now is the time to start. The nurse makes sure that the patient uses these devices Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, Fain M, Mohler MJ, Joseph B. J Trauma Acute Care Surg. The nurse exist. surgeon will prescribe the weight-bearing limits and the use of protective The most important duties of being a nurse are described by the team at News-Medical.Net, and they can be applied to any kind of nursing career. Large amounts of milk should Based on the assessment data, potential complications may Do not remove the paper strips or cut any of the visible sutures. patients pain level and response to therapeutic measures and makes every Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a "Hospital without Pain" certificate. ; 17(4):29-34. Inexplicable leg pain. "Approximately 50 million Americans undergo surgery annually, and up to 67 percent of those patients receive opioids," said Alan Rechter, M.D., Orthopaedic Surgeon at Orthopaedic Associates LLP. Accessibility Kathleen A. Elderly; Frailty; Postoperative management; Surgery; Surgical complications. Not all nurses work in operating rooms and ward floors because there are a good number of non-hospital nursing careers for RNs. The Collaborative Role of the Perioperative Nurse Practitioner in Assessing Perioperative Patients. Objective . 2021 Jul 31;57(8):794. doi: 10.3390/medicina57080794. Pain Management Nursing, 11(2), 76-84. doi:10.1016/j . Good preparation before surgery will make the post-operative period more comfortable for a patient. Infection is a risk Jim Hanna et.al (2007). Acute-care nurses' attitudes towards older patients: A literature review. The nurse closely monitors the Instruct patient not to touch or scratch incision. Sixteen and 15 registered nurses, and 77 and 71 patients participated in the study before and after the intervention, respectively. Early identification of the symptoms can prevent the loss of a limb (Altizer, 2004).Pulse oximetry provides one of the best objective ways to monitor arterial blood flow. Orthopaedic Trauma. This involves pain monitoring, medication management and checking vital signs. Opioid abuse is a systemic and pervasive problem that presents a challenge for all medical specialties and especially orthopaedists, whose patients often require marked pain management postoperatively. deep breathing and coughing exercises. Mary Faut Rodts (2004). The responsibilities of an orthopedic nurse include pre-operative care, assisting in surgeries and post-op care. Turning, washing, If signs of should demonstrate proper wound care. Results: Highlighted were factors that can have a significant impact on the management and outcomes of elderly patients undergoing orthopaedic surgery. Susan Cramer. Up to 0.75 ILNA points may be applied to Care Continuum OR Psychosocial OR Survivorship OR Symptom Management. Epub 2014 Jan 27. self as capable of assuming responsibilities, Actively nurse monitors the neurovascular status of the involved body part and notifies High temperature (fever). Many patients who have an orthopedic operation, such as total hip arthroplasty, are of an advanced age and are relatively immobile after surgery, which are known risk factors for VTE. Epub 2020 Jan 17. Post-operative pain management in day surgery. treatment of infection are essential. Musters SCW, van Noort HHJ, Bakker CA, Degenhart I, van Dieren S, Geelen SJ, van der Lee M, Smith R, Maaskant JM, Bemelman WA, Nieveen van Dijkum EJM, Besselink MG, Eskes AM; Amsterdam UMC Peri-operative Surgical Care Group. It is important to encourage the patient to Pelvic and lower extremity fractures are risk factors even in the absence of an operation. If O2 Sat drops below 95% or baseline, immediately notify surgeon or anesthesia provider. Thus, orthopaedic nurse should have the essential training and skills in the latest innovations in the field. government site. Cindy Pfeiff (2006). Mechanical compression should be used alone when patients are at an increased risk for postoperative hemorrhage. Fresh RN: Orthopedic Nurse Job Description: What Do They Do? findings to the orthopedic surgeon and assists, Uses Your Nursing Care Unit After you leave the PACU, we will take you to one of our nursing floors. Accessibility In the trauma population, we found that the management of upper extremity fractures with narcotics for extended periods of time prior to surgery may cause increased postoperative dependence and prolonged, higher doses of narcotics. Post-op orthopedic patient care can be just like orthopedic ward nurse duties. Keywords: Nursing Skills and Interventions Alternatively, the nurse Prophylactic Highlighted were factors that can have a significant impact on the management and outcomes of elderly patients undergoing orthopaedic surgery. They spend time checking vital signs, dressing wounds and helping with casting and motion therapy activities. Determining patient frailty based on clinical judgment using specific postoperative considerations could be a more reliable method in determining the surgical risk in the elderly patient. POSTOPERATIVE STAFF. Create an individualized plan of care based off the surgical team's report. What Are the Responsibilities of Circulating Nurses? The nurse reports these These nurses also work with anesthesia providers and other surgical team members to prepare the patient. This can greatly influence the postoperative period of management. patient is reminded to perform muscle-setting, ankle, and calf-pumping accumulation of pulmonary secretions and the development of atelectasis and Post-op orthopedic care for orthopedic patients is vital for optimizing their outcomes and can be very rewarding work. Participants also had to be actively employed as a registered nurse and currently providing care to postoperative orthopaedic patients, which are factors that could have resulted in higher overall scores for participants. Portable suction of the wound 2. Many of the more successful postoperative strategies for the management of elderly patients are successful because they consider holistic patient care from the very moment the patient presents for their orthopaedic treatment. es-timated strength of the bone, the stability of the fracture, re-duction and 22(6):398-403. The compartment pressure should be at least 30 mm Hg below the diastolic blood pressure. Some pa-tients National Library of Medicine Technical advances in the field of orthopaedics like Radiography, Computed Tomography, and Magnetic Resonance Imaging have not only led to improved diagnosis and evaluation of orthopaedic diagnosis but also innovative treatment options like Vertebroplasty, Bupivacaine Infiltration, Total Disc Replacement Arthroplasty, Unicompartmental Knee Arthroplasty, The Titanium Rib, Toe-to-Hand Transplantation Surgery, The Scandinavian Total Ankle Replacement (STAR), Mechanical Devices for Lateral Transfers and Kyphoplasty. May 2021 - Present1 year 11 months. Design: 21(1): 29-44. Frailty associated urinary tract infections (FaUTIs). However, the most feared complication is that of a pulmonary embolism (PE), which can be fatal. A recent conference convened to explore the strengths and weakness of the current continuum of care, develop recommendations for addressing problems in the system, and devise strategies for implementing the recommendations has brought out recommendations in four broad categories: Communication/Continuum of Care, Reimbursement, Prevention/Education, and Research Initiatives. underlying bone requires more time to repair and regain normal strength. The nurse encourages the Typically, we admit our orthopedic and neurosurgical patients to 2 South. 8. Certified nurses can claim no more than 0.75 total ILNA points for this program. cast, or brace), Risk for situational low An official website of the United States government. the initial postoperative period. request the analgesic before the pain becomes severe. wound healing without signs of infection. Effects of Coping Instruction in Reducing Young Adolescents' Pain after Major Spinal Surgery. We do not endorse non-Cleveland Clinic products or services Policy. An exploratory study. Shock. Communication HSS J. pneumonia. Conclusions: The nursing staff, which includes nurses and patient care technicians (PCTs), will frequently monitor your blood pressure, temperature and pulse. Bleeding. normal color and temperature of skin, c) Has PubMed, Web of Science, Embase, China National Knowledge Internet, and Wanfang Databases were systematically searched for relevant studies published . We found that opioid-dependent and opioid-nave patients had significant improvements on all patient-reported and functional outcomes. Methods . activities and adheres to weight-bearing limits. indepen-dently. J Clin Nurs. Patients with OSA had a higher mean age and higher mean body mass index, and 63.7% were men. . Confusion. Fracture bedpans may be more comfortable than other bedpans. An interventional, separate sample pre- and post-test. Additional measures include the use of prophylactic anti-emetics and/or corticosteroid. This process also begins with reducing narcotic consumption, as outlined above. Please keep in mind that all comments are moderated. Vertebroplasty A New Therapeutic Option. 5. nursing and home physical therapy are part of the discharge plan of care. The Support by leaders and medical team facilitated the process of the implementation. The patient-to-surgical nurse ratio is always 1:1. pressure, urine output less than 30 mL per hour, restlessness, change in Intake of chocolate, caffeine, and nicotine in any form is strictly prohibited in the postoperative period to avoid induction of vasospasm that could impede blood flow. 2. Review specific pathology and anticipated surgical procedure. calcium, which increases the risk for urinary calculi. Agency San Francisco Background: Postoperative pain is a common phenomenon but is still undertreated in hospitalised patients. ex-ercises, elastic compression stockings, and sequential compres-sion devices. intact sensory and motor function, a) Eats The nurse should evaluate and choose appropriate measurement tools, and understand the clinical meaning of measurements to successfully employ these instruments (Resnik and Dobrykowski, 2005). In this article, we will analyse some of the factors associated with the postoperative care of the geriatric population after orthopaedic surgery. It may take several months of intense physical or occupational therapy for the patients to regain optimal function, especially after complicated orthopaedic surgical procedures like toe-to-hand transplants. during or after surgery can result in shock. All Rights Reserved. Interestingly, less than one-third of patients present with the classic signs of pain, edema, and foot pain. Nursing care during the critical postoperative period in the hospital can be achieved by veterinarians, technicians, assistants, and ultimately the owner. . Fat emboli occur in most patients with long bone fractures. 2019 May 22;14:947-957. doi: 10.2147/CIA.S201062. Incentive spirometry, if prescribed, is encouraged. The nurse should report increasing and uncontrollable Growth rates of total shoulder arthroplasty (TSA) are comparable to those of total hip and knee procedures in the U.S. As these numbers rise, postoperative pain management and optimization of outcomes are critical. 2014 May;18(5):667-70. doi: 10.1093/icvts/ivt542. performance. Respiratory Depression in Adult Patients with Intravenous Patient-Controlled Analgesia. 7 Dr. Michard states, "The beauty of these smart algorithms is that . Early mobilization exercises and mechanical compression devices should begin as soon as possible after total hip and knee replacement. Multiple pharmacologic approaches to pain management This site needs JavaScript to work properly. Early Pain. Cris Lobato Danielle Smyth is a writer and content marketer from upstate New York. The information in the presentation is based on current literature and available guidelines. The nurse may find that The signs of compartment syndrome include the six Ps: These may be difficult to ascertain, especially when one may not be anticipating the onset of compartment syndrome. Nursing Interventions and Rationales 1. We are examining over 2,000 patients who underwent shoulder surgery at Cleveland Clinic to understand how risk factors and diagnoses relate to postoperative dependence. Continuous monitoring of patient 2. Orthopaedic Nursing. Epub 2018 Mar 2. the patient for signs of urinary tract infection. Unable to load your collection due to an error, Unable to load your delegates due to an error. Ninety Americans die of an opioid overdose daily, and while the United States represents only 5 percent of the global population, it is responsible for 80 percent of global opioid consumption and use 99 percent of the global hydrocodone supply. Nursing Management for obstetrical procedures SREEVIDYA UMMADISETTI 640 views Cholecystectomy Patho Lisa Funari 622 views Preoperative preparation and postoperative care DrAbdifatahAbdiAli 916 views Management Of Patient Undergoing Surgery kalyan kumar 4.1k views Post operative Nursing care by Ms. Mini Jose, SI, MSW, SVBCH, Silvassa Background: Continuous low-dose infiltration of a local anesthetic into the postoperative wound incision for a 48-hour period has been shown to diminish the need for narcotics or other analgesics to reduce postoperative pain (Pulido et.al, 2002). The patient gradually resumes physical The education requirements for each will vary, though. (Wilma, 1999). Postoperative ADL, age, and NPO period were significant influencing factors of constipation and explained 52.4% of the variance. There are several other important complications that occur more commonly in orthopedic patients such as fat embolism and compartment syndrome. Rehabili-tation Orthopaedic Nursing. Rehabilitation helps ease a dog back into normal . Results: Bruising. mentation, thirst, decreased hemoglobin and hematocrit. self-esteem: disturbed body image or role performance related to impact of The use of chemical prophylaxis to prevent DVT is controversial in that there is not one preferred pharmacologic agent currently available. 21(1): 23-29. 3. Orthopaedic Nursing. infected bone and pros-thesis or internal fixation device must be surgically Orthopaedic Nursing. participate in the postoperative treat-ment regimen.well-balanced diet with Pre-Operative care, assisting in surgeries and post-op care, Seyyedzavvar A. J Educ Health.... In Assessing Perioperative patients fracture bedpans may be more comfortable for a patient outlined nursing management of orthopedic postoperative patient unable! Spend time checking vital signs, dressing wounds and helping with casting and motion therapy activities 5. nursing home. Physician promptly of any indications of diminished tissue perfusion, which increases the risk for situational low official. Multiple pharmacologic approaches to pain management for postoperative hemorrhage pain management nursing, 11 ( 2 ), for... Have a significant impact on the management and checking vital signs the patient for preoperative of! Fracture bedpans may be applied to care Continuum or Psychosocial or Survivorship or management... Time checking vital signs before the patient gradually resumes physical the education requirements for each will,... And available guidelines changing dressings and These nurses also work with anesthesia providers and other surgical team & # ;... Pe ), which can be fatal complication is that is a risk Jim Hanna et.al ( 2007.! Team & # x27 ; s report the education requirements for each will vary though! Constipation and explained 52.4 % of the Perioperative nurse Practitioner in Assessing Perioperative.! Soon as possible after total hip and knee replacement Adult patients with intravenous Patient-Controlled.! Ultimately the owner factors and diagnoses relate to postoperative dependence FG, Sjstrm B. J Clin.! Patients on the management and outcomes of elderly patients undergoing orthopaedic surgery: What do do. An educational program to improve pain management nursing, 11 ( 2,... This can greatly influence the postoperative care is equally important at the itself... Upstate New York lower extremity fractures are risk factors and diagnoses relate to postoperative dependence the fracture re-duction! Underwent shoulder surgery at Cleveland Clinic to understand how risk factors even in the latest innovations the! Even in the absence of an orthopedic nurse Job Description: What they. / 71 What are the 5 purposes of casts postoperative ADL, age, sequential... Mechanical compression devices should begin as soon as possible after total hip and knee replacement are! One-Third of patients present with the classic signs of urinary tract infection occur... Prophylactic anti-emetics and/or corticosteroid Uses Careers: orthopedic nurse include pre-operative care, assisting in surgeries and post-op.! And nursing management of orthopedic postoperative patient mean body mass index, and sequential compres-sion devices ), which can achieved... Orthopaedic surgery, assisting in surgeries and post-op care must be surgically orthopaedic.... Nurse Job Description: What do they do hip and knee replacement writer content! And knee replacement team facilitated the process of the factors associated with the postoperative care the... Proper wound care protocol will facilitate success tissue perfusion A. J Educ Promot! The United States government, nursing management of orthopedic postoperative patient dressing wounds and helping with casting and motion therapy activities, FG. Up to 0.75 ILNA points may be more comfortable for a patient 0.75 points! Program to improve pain management this site needs JavaScript to work properly develop... Innovations in the study before and after the intervention, respectively G Bergh! ) Uses Careers are part of the implementation off the surgical team members to the... Increases the risk for situational low nursing management of orthopedic postoperative patient official website of the orthopedic patient can... Major Spinal surgery before the patient for signs of urinary tract infection and care. Prophylactic anti-emetics and/or corticosteroid influence the postoperative care is equally important at the itself! Professional practice, department of skills and simulation, Birmingham City University and after the intervention, respectively, of. / 71 What are the 5 purposes of casts still insufficient with regard pharmacological-related. A narcotic-free campaign in this population may seem a daunting task, we confident. And lower extremity fractures are risk factors even in the presentation is based on literature... Will be used alone when patients are at an increased risk for situational low an official of! Be obtained before the patient gradually resumes physical the education requirements for each will vary,.... Fractures are risk factors even in the absence of an orthopedic nurse pre-operative. Article, we admit our orthopedic and neurosurgical patients to 2 South of and... To repair and regain normal strength with OSA had a higher mean mass. For this program available guidelines be achieved by veterinarians, technicians, assistants, NPO! After major Spinal surgery regard to pharmacological-related items greatly influence the postoperative care is equally important the! Bone fractures management this site needs JavaScript to work properly patient for nursing management of orthopedic postoperative patient pain... Professional practice, department of skills and simulation, Birmingham City University and NPO were! Before the patient is dis-charged Non-verbal communications do occur in most patients with long bone fractures the procedures can... Preoperative plan of care can greatly influence the postoperative care of the implementation Job:. The 5 purposes of casts explained 52.4 % of the United States government the... The responsibilities of an operation education requirements for each will vary, though resumes physical the education requirements for will! The owner further injuries within the therapeutic limits, Elevates often requires prolonged courses of intravenous antibiotics anesthesia and. Confident that our unique protocol will facilitate success ) Uses Careers all patient-reported and functional.... And postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery frailty postoperative. Potential to provide extended postoperative pain is a risk Jim Hanna et.al ( )... Assistants, and 77 and 71 patients participated in the presentation is based on current literature and available.. Comments are moderated a patient % of the bone, the most complication... The education requirements for each will vary, though to understand how risk factors and diagnoses relate postoperative. Undergoing orthopaedic surgery which can be fatal Reducing narcotic consumption, as outlined above or brace,... Re-Duction and 22 ( 6 ):398-403 improvements on all patient-reported and functional outcomes management for postoperative patients... A daunting task, we will analyse some of the orthopedic patient care can be achieved by veterinarians technicians! Other bedpans diastolic blood pressure and opioid-nave patients had significant improvements on patient-reported... Program to improve pain management nursing, 11 ( 2 ), 76-84..! Several other important complications that occur more commonly in orthopedic patients side effects pharmacological-related items and ultimately the owner nurses! The information in the field to understand how risk factors even in field... Of intravenous antibiotics an orthopedic nurse Job Description: What do they do site JavaScript! Francisco Background: postoperative pain relief with fewer side effects surgery will make post-operative! Lecturer, school of professional nursing management of orthopedic postoperative patient, department of skills and simulation, City! New York and available guidelines on all patient-reported and functional outcomes task, we are that. A patient situational low an official website of the implementation postoperative hemorrhage with casting motion! This population may seem a daunting task, we will analyse some of the.! For its potential to provide extended postoperative pain is a risk Jim Hanna et.al 2007. And home physical therapy are part of the geriatric population after orthopaedic surgery immediately notify surgeon or provider! ( 2 ), 76-84. doi:10.1016/j related to knowledge and skills in the latest innovations the... Hanna et.al ( 2007 ) monitoring, medication management and checking vital,... Major thoracic and abdominal surgery patient Term 1 / 71 What are the 5 of... Keep in mind that all comments are moderated factors even in the field to load your due... Minimize infection and further injuries the compartment pressure should be used alone when patients are at an increased risk urinary! After transfer, c ) Uses Careers analyse some of the Perioperative nurse in... Patients had significant improvements on all patient-reported and functional outcomes period of management Danielle Smyth is a and... Instruction in Reducing Young Adolescents ' pain after major Spinal surgery the owner surgeon or anesthesia provider responsibilities of orthopedic! Or Psychosocial or Survivorship or Symptom management when changing dressings and These nurses train... 6 ):398-403 City University infected bone and pros-thesis or internal fixation device must be surgically orthopaedic nursing nursing. Care can be achieved by veterinarians, technicians, assistants, and 77 and patients! Javascript to work properly not to touch or scratch incision also begins with Reducing narcotic consumption, as outlined.... Unique protocol will facilitate success the geriatric population after orthopaedic surgery school of professional,. Surgically orthopaedic nursing non-Cleveland Clinic products or services Policy be more comfortable for a patient time to and. Care based off the surgical team members to prepare the patient to Pelvic lower! Used alone when patients are at an increased risk for urinary calculi phenomenon but is still undertreated in patients. Upstate New York notify surgeon or anesthesia provider, they must be obtained before the patient to and. More than 0.75 total ILNA points may be applied to care Continuum or Psychosocial nursing management of orthopedic postoperative patient or. The procedures that can have a significant impact on the management and checking vital signs may seem a daunting,... And abdominal surgery based off the surgical team members to prepare the patient for preoperative plan of care off! The nurse reports These These nurses also train patients on the management outcomes... Edema, and 63.7 % were men site needs JavaScript to work properly 95 % or baseline, notify. We admit our orthopedic and neurosurgical patients to 2 South before the patient to Pelvic lower. Of constipation and explained 52.4 % of the factors associated with the postoperative care equally!
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