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Rosero EB, Joshi GP. Hospital readmission after ambulatory laparoscopic cholecystectomy: incidence and predictors. J Surg Res 2017; 219:108-115. [PMID: 29078868 DOI: 10.1016/j.jss.2017.05.071] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/22/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of the study was to assess the rate of 30-d hospital readmissions after ambulatory laparoscopic cholecystectomy. MATERIALS AND METHODS The 2009 to 2011 State Ambulatory Surgery and Services and State Inpatient Databases from California, Florida, and New York were analyzed to evaluate the incidence of 30-d readmissions after laparoscopic cholecystectomy performed in outpatient settings. Hospital transfers and the principal diagnoses of hospital readmission were analyzed as secondary outcomes. Multilevel generalized mixed linear regression analyses with fixed and random effects were used to evaluate variables associated with increased likelihood of readmissions. RESULTS A total of 230,745 encounters for ambulatory laparoscopic cholecystectomies performed in 890 ambulatory facilities between 2009 and 2011 in the three states were analyzed. The rate of 30-d readmission was 20.2 per 1000 discharges. The rate of direct transfers from the ambulatory surgery center to an acute care hospital was 0.6 per 1000 discharges. The most common diagnoses of readmission were surgical complications, postoperative pain, infection, and nausea or vomiting. After adjusting for comorbidities, increasing age, male sex, non-Hispanic white race/ethnicity, any nonprivate insurance type, diagnosis of acute cholecystitis, use of intraoperative cholangiography, and having the procedure performed on a weekend were significantly associated with increased odds of 30-d readmissions. CONCLUSIONS This large-state data analysis reveals that the unplanned admission and readmission rates after laparoscopic cholecystectomy are very low. Some causes of readmission (e.g., pain, nausea, and vomiting) are modifiable by the intervention of surgeons and anesthesia providers.
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Affiliation(s)
- Eric B Rosero
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Ramachandran SK, Thompson A, Pandit JJ, Devine S, Shanks AM. Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization. PLoS One 2017; 12:e0175408. [PMID: 28520718 PMCID: PMC5435138 DOI: 10.1371/journal.pone.0175408] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/03/2017] [Indexed: 02/05/2023] Open
Abstract
Introduction The clinical importance of postoperative episodic hypoxemia is still unclear, and therefore largely under-studied. As a result, there is limited understanding of its relationship with early postoperative respiratory complications (PRC, defined as intubation within three days of surgery) and hospital resource utilization. Materials and methods This single center study was performed using a retrospective observational design. We described population based definitions of desaturation from continuous SpO2 monitoring data captured in the post anesthesia care unit (PACU), namely median SpO2 in PACU, duration of desaturation below median, nadir desaturation, and length of oxygen therapy relative to PACU duration. These measures were evaluated against the occurrence of early PRC in logistic regression models. Measures that were independently associated with early PRC were accepted as the primary study exposures. Stratified logistic regression models were planned if significant interaction occurred with high risk surgical procedures. Models were adjusted by including several patient conditions, procedural, and anesthesia risk factors. Propensity matching on desaturation occurrence was planned to evaluate the relationship with postoperative resource utilization. Results Among 125,740 patients included in the univariate analyses, 351 patients (0.3%) developed early PRC. Nadir desaturation <89% [14.3% of patients; adjusted odds ratio 2.02; 95% CI 1.52, 2.68; p<0.001] and PACU oxygen therapy requirements greater than 60 min [adjusted odds ratio 1.92 (>60 min) to 3.04 (>90 min); p<0.001] were identified as independent predictors of early PRC occurrence. A modest interaction was observed between desaturation and higher surgical risk. Propensity matching for postoperative oxygen requirement was performed in 37,354 matched patients. Matched analysis demonstrated significant increase in day of surgery charges, respiratory charges, total charges, hospital length of stay, reintubation and use of invasive or non-invasive ventilatory support. Conclusions In summary, we report that prolonged PACU oxygen therapy and nadir desaturation <89% in PACU as captured in a retrospective database are independently associated with early PRC. This study describes resource implications of PACU desaturation in a large academic medical center in North America.
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Affiliation(s)
- Satya Krishna Ramachandran
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Aleda Thompson
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jaideep J. Pandit
- Nuffield Department of Anaesthesia, Oxford, Oxfordshire, United Kingdom
| | - Scott Devine
- Center for Observational & Real-world Evidence: US Evidence & Value Strategies, Merck, Sharpe and Dohme, Whitehouse Station, New Jersey, United States of America
| | - Amy M. Shanks
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States of America
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Arnal Velasco D, Romero García E, Martínez Palli G, Muñoz Corsini L, Rey Martínez M, Postigo Morales S. [Patient safety recommendations for out of operating room procedure sedation]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2017; 32:155-165. [PMID: 27641104 DOI: 10.1016/j.cali.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. METHOD We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. RESULTS The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. CONCLUSION We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare.
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Affiliation(s)
- D Arnal Velasco
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Romero García
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario La Fe, Valencia, España
| | - G Martínez Palli
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Clínic y Centro de Investigaciones IDIBAPS, Barcelona, España
| | - L Muñoz Corsini
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario de Guadalajara, Guadalajara, España
| | - M Rey Martínez
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Povisa, Vigo, Pontevedra, España
| | - S Postigo Morales
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital de Galdakao, Usansolo, Bizkaia, España
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Zhao J, Guo Z, Liu X, Glaser DL, Elkassabany NM, Liu J. The development and application of a risk stratification index system for outpatient shoulder arthroscopy patient management-a single academic center's experience. JSES OPEN ACCESS 2017; 1:1-4. [PMID: 30675530 PMCID: PMC6340827 DOI: 10.1016/j.jses.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Our goal was to develop a risk stratification index (RSI) that could guide management of our patients. We hypothesized that the risks of unexpected overstay admission (OS) and emergency department (ED) transfer are predictable on the basis of patient factors for elective outpatient shoulder arthroscopic surgery. Methods We first identified 124,860 subjects who received shoulder arthroscopic surgery in the Healthcare Cost and Utilization Project database. We next conducted multivariable regression analysis to identify risk factors associated with unanticipated OS or ED transfer. The risk factors were then adopted to construct the RSI. We last applied the RSI into our practice and prospectively collected outcome data between August 2014 and June 2015. Results The significant risk factors included arrhythmia, chronic obstructive pulmonary disease, diabetes, obesity, neurologic disease with function impairment, and general anesthesia. All significant risk factors were then adopted to calculate the RSI with equal weight assignment. Simulated analysis concluded that a patient with 2 or fewer risk factors would carry a theoretical rate for OS or ED events of 0.73%. A total of 583 shoulder arthroscopy procedures were performed, among which 472 (81.0%) patients passed the RSI and were successfully managed in the outpatient surgical center without any admission. There were 111 (19.0%) subjects with procedures performed in the main hospital, with 2 unexpected admissions (1.8%). Conclusion We developed an RSI tool for shoulder arthroscopic surgery with an existing national database. It is our conclusion that the RSI system is an effective tool to optimize clinical practice. However, over time, a longer follow-up period might provide more convincing evidence.
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Affiliation(s)
- Jing Zhao
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Zhenggang Guo
- Department of Anesthesiology, First Affiliated Hospital of General Hospital of PLA, Beijing, China
| | - Xiaowen Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - David L Glaser
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jiabin Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Mull HJ, Rivard PE, Legler A, Pizer SD, Hawn MT, Itani KMF, Rosen AK. Comparing definitions of outpatient surgery: Implications for quality measurement. Am J Surg 2017; 214:186-192. [PMID: 28233538 DOI: 10.1016/j.amjsurg.2017.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Adverse event (AE) rates in outpatient surgery are inconsistently reported, partly because of the lack of a standard definition of outpatient surgery. We compared the types and rates of surgical procedures defined by two national healthcare agencies: Health Care Cost Institute (HCCI) and the Healthcare Cost and Utilization Project (HCUP) and considered implications for quality measurement. METHODS We used HCCI and HCUP definitions to identify FY2012-14 VA outpatient surgeries. RESULTS There were six times as many HCCI surgeries as HCUP (6,575,830 versus 1,086,640). Ninety-nine percent of HCUP-defined surgeries were also identified by HCCI. More HCUP surgeries had higher average Medicare Relative Value Units then HCCI surgeries [5.3 (SD = 4.4) versus 1.6 (SD = 2.3) RVUs]. CONCLUSIONS Rates and types of procedures vary widely between definitions. Quality measurement using HCCI versus HCUP may produce significantly lower AE rates because many of the surgeries included reflect low complexity and potentially low risk of AEs.
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Affiliation(s)
- Hillary J Mull
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
| | - Peter E Rivard
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Healthcare Administration, Sawyer Business School Suffolk University, Boston, MA, USA
| | - Aaron Legler
- Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, Boston, MA, USA
| | - Steven D Pizer
- Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, Boston, MA, USA; Northeastern University School of Pharmacy, Boston, MA, USA
| | - Mary T Hawn
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA
| | - Kamal M F Itani
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA; Department of Surgery, VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Department of Surgery, Boston University School of Medicine, Boston, MA, USA
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Abstract
An increasing number of orthopaedic surgeries are performed at ambulatory surgical centers (ASCs), as is exemplified by the 272% population-adjusted increase in outpatient rotator cuff repairs from 1996 to 2006. Outpatient surgery is convenient for patients and cost effective for the healthcare system. The rate of complications and adverse events following orthopaedic surgeries at ASCs ranges from 0.05% to 20%. The most common complications are pain and nausea, followed by infection, impaired healing, and bleeding; these are affected by surgical and patient risk factors. The most important surgeon-controlled factors are surgical time, type of anesthesia, and site of surgery, whereas the key patient comorbidities are advanced age, female sex, diabetes mellitus, smoking status, and high body mass index. As the use of ASCs continues to rise, an understanding of risk factors and outcomes becomes increasingly important to guide indications for and management of orthopaedic surgery in the outpatient setting.
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Arnal Velasco D, Romero García E, Martínez Palli G, Muñoz Corsini L, Rey Martínez M, Postigo Morales S. Patient safety recommendations for out of operating room procedure sedation. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:577-587. [PMID: 27545841 DOI: 10.1016/j.redar.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. METHOD We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. RESULTS The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. CONCLUSION We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare.
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Affiliation(s)
- D Arnal Velasco
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E Romero García
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario La Fe, Valencia, España
| | - G Martínez Palli
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Clínic y Centro de Investigaciones IDIBAPS, Barcelona, España
| | - L Muñoz Corsini
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Universitario de Guadalajara, Guadalajara, España
| | - M Rey Martínez
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital Povisa, Vigo, Pontevedra, España
| | - S Postigo Morales
- Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR), Hospital de Galdakao, Usansolo, Bizkaia, España
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Logotheti H, Pourzitaki C, Tsaousi G, Aidoni Z, Vekrakou A, Ekaterini A, Gourgoulianis K. The role of exhaled nitric oxide in patients with chronic obstructive pulmonary disease undergoing laparotomy surgery – The noxious study. Nitric Oxide 2016; 61:62-68. [DOI: 10.1016/j.niox.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
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Alboim C, Kliemann RB, Soares LE, Ferreira MM, Polanczyk CA, Biolo A. The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study. Eye (Lond) 2016; 30:1614-1622. [PMID: 27636228 DOI: 10.1038/eye.2016.203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 08/15/2016] [Indexed: 01/13/2023] Open
Abstract
PurposeAmbulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery.MethodsThis was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics.ResultsOut 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR=0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P=0.158) or postoperative adverse events (P=0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (P<0.001).ConclusionsIn the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.
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Affiliation(s)
- C Alboim
- Department of Anaesthesiology, Perioperative and Pain Medicine (SAMPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - R B Kliemann
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - L E Soares
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M M Ferreira
- Department of Anaesthesiology, Perioperative and Pain Medicine (SAMPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - C A Polanczyk
- Department of Internal Medicine, Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Post - Graduate Program in Cardiology, School of Medicine, UFRGS, Porto Alegre, Brazil.,Institute for Health Technology Assessment (IATS), HCPA, Porto Alegre, Brazil
| | - A Biolo
- Department of Internal Medicine, Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Post - Graduate Program in Cardiology, School of Medicine, UFRGS, Porto Alegre, Brazil.,Institute for Health Technology Assessment (IATS), HCPA, Porto Alegre, Brazil
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Mattheis L, Jung JS, Hiebl B, Garrels W, Kielstein H, Spielmann J. Perioperative support reduces mortality of obese BALB/c mice after ovariectomy. Lab Anim (NY) 2016; 45:262-7. [PMID: 27327014 DOI: 10.1038/laban.1042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/24/2015] [Indexed: 01/22/2023]
Abstract
The incidence of obesity is on the rise in most western countries and represents major risks to health. Obesity causes complex metabolic dysfunctions and can be associated with a large number of secondary diseases. To investigate causal mechanisms of obesity and develop better options for treatment, researchers study the condition in animal models. In addition to genetically engineered animal models, diet-induced obesity is often used because it occurs similarly in animals as it does in humans. For several types of investigations that use obesity models, investigators must carry out surgical interventions and they frequently encounter severe perioperative complications induced by anesthesia. In an example of this problem, we observed 100% mortality in obese BALB/c mice after ovariectomy, despite no obvious surgical complications. We supposed that a failure to recover from surgery was the primary cause of this increased mortality. Therefore, to support their recovery from surgery we administered atropine to obese mice in order to facilitate blood circulation, and we also increased the oxygen content of the ambient air. With this specific support before and after surgery, we increased the survival rate of obese ovariectomized mice up to 83%. These results confirm the assumption that obesity is a risk factor for the recovery of obese animal models after ovariectomy, and they highlight the need to provide additional interventions for such experimental animals.
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Affiliation(s)
- Laura Mattheis
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Juliane-Susanne Jung
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Bernhard Hiebl
- Center for Medical Basic Research, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Wiebke Garrels
- Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Julia Spielmann
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle, Germany
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Mijderwijk H, Stolker RJ, Duivenvoorden HJ, Klimek M, Steyerberg EW. Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making. Can J Anaesth 2016; 63:1022-32. [PMID: 27282374 DOI: 10.1007/s12630-016-0673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/22/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Ambulatory surgery patients are at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated a clinical prediction model to identify patients who were vulnerable to these psychological outcome parameters. METHODS We prospectively assessed 383 mixed ambulatory surgery patients for psychological vulnerability, defined as the presence of anxiety (state/trait), aggression (state/trait), fatigue, and depression seven days after surgery. Three psychological vulnerability categories were considered-i.e., none, one, or multiple poor scores, defined as a score exceeding one standard deviation above the mean for each single outcome according to normative data. The following determinants were assessed preoperatively: sociodemographic (age, sex, level of education, employment status, marital status, having children, religion, nationality), medical (heart rate and body mass index), and psychological variables (self-esteem and self-efficacy), in addition to anxiety, aggression, fatigue, and depression. A prediction model was constructed using ordinal polytomous logistic regression analysis, and bootstrapping was applied for internal validation. The ordinal c-index (ORC) quantified the discriminative ability of the model, in addition to measures for overall model performance (Nagelkerke's R (2) ). RESULTS In this population, 137 (36%) patients were identified as being psychologically vulnerable after surgery for at least one of the psychological outcomes. The most parsimonious and optimal prediction model combined sociodemographic variables (level of education, having children, and nationality) with psychological variables (trait anxiety, state/trait aggression, fatigue, and depression). Model performance was promising: R (2) = 30% and ORC = 0.76 after correction for optimism. CONCLUSION This study identified a substantial group of vulnerable patients in ambulatory surgery. The proposed clinical prediction model could allow healthcare professionals the opportunity to identify vulnerable patients in ambulatory surgery, although additional modification and validation are needed. (ClinicalTrials.gov number, NCT01441843).
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Affiliation(s)
- Herjan Mijderwijk
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hugo J Duivenvoorden
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anesthesiology, Erasmus University Medical Center, Room HS-203, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Should Deidentified Case Data Be Treated as Independent Data Points? Anesthesiology 2016; 124:1418-9. [DOI: 10.1097/aln.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kolh P, De Hert S, De Rango P. The Concept of Risk Assessment and Being Unfit for Surgery. Eur J Vasc Endovasc Surg 2016; 51:857-66. [PMID: 27053098 DOI: 10.1016/j.ejvs.2016.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
The concept of risk assessment and the identification of surgical unfitness for vascular intervention is a particularly controversial issue today as the minimally invasive surgical population has increased not only in volume but also in complexity (comorbidity profile) and age, requiring an improved pre-operative selection and definition of high risk. A practical step by step (three steps, two points for each) approach for surgical risk assessment is suggested in this review. As a general rule, the identification of a "high risk" patient for vascular surgery follows a step by step process where the risk is clearly defined, quantified (when too "high"?), and thereby stratified based on the procedure, the patient, and the hospital, with the aid of predictive risk scores. However, there is no standardized, updated, and objective definition for surgical unfitness today. The major gap in the current literature on the definition of high risk in vascular patients explains the lack of sound validated predictive systems and limited generalizability of risk scores in vascular surgery. In addition, the concept of fitness is an evolving tool and many traditional high risk criteria and definitions are no longer valid. Given the preventive purpose of most vascular procedures performed in elderly asymptomatic patients, the decision to pursue or withhold surgery requires realistic estimates not only regarding individual peri-operative mortality, but also life expectancy, healthcare priorities, and the patient's primary goals, such as prolongation of life versus maintenance of independence or symptom relief. The overall "frailty" and geriatric risk burden, such as cognitive, functional, social, and nutritional status, are variables that should be also included in the analyses for stratification of surgical risk in elderly vascular patients.
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Affiliation(s)
- P Kolh
- Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liège, Belgium.
| | - S De Hert
- Department of Anesthesiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - P De Rango
- Unit of Vascular Surgery, Hospital S.M. Misericordia, Perugia, Italy
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Gálvez JA, Rothman BS, Doyle CA, Morgan S, Simpao AF, Rehman MA. A Narrative Review of Meaningful Use and Anesthesia Information Management Systems. Anesth Analg 2015; 121:693-706. [PMID: 26287298 DOI: 10.1213/ane.0000000000000881] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The US federal government has enacted legislation for a federal incentive program for health care providers and hospitals to implement electronic health records. The primary goal of the Meaningful Use (MU) program is to drive adoption of electronic health records nationwide and set the stage to monitor and guide efforts to improve population health and outcomes. The MU program provides incentives for the adoption and use of electronic health record technology and, in some cases, penalties for hospitals or providers not using the technology. The MU program is administrated by the Department of Health and Human Services and is divided into 3 stages that include specific reporting and compliance metrics. The rationale is that increased use of electronic health records will improve the process of delivering care at the individual level by improving the communication and allow for tracking population health and quality improvement metrics at a national level in the long run. The goal of this narrative review is to describe the MU program as it applies to anesthesiologists in the United States. This narrative review will discuss how anesthesiologists can meet the eligible provider reporting criteria of MU by applying anesthesia information management systems (AIMS) in various contexts in the United States. Subsequently, AIMS will be described in the context of MU criteria. This narrative literature review also will evaluate the evidence supporting the electronic health record technology in the operating room, including AIMS, independent of certification requirements for the electronic health record technology under MU in the United States.
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Affiliation(s)
- Jorge A Gálvez
- From the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and Coast Anesthesia Medical Group, O'Connor Hospital, San Jose, California
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Stierer TL, Collop NA. Perioperative Assessment and Management for Sleep Apnea in the Ambulatory Surgical Patient. Chest 2015; 148:559-565. [PMID: 25856723 DOI: 10.1378/chest.14-3049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The overwhelming majority of surgical procedures performed in the United States are done on an outpatient basis. Patients with complicated medical problems are routinely scheduled for ambulatory procedures that have become progressively more complex. Appropriate patient selection is paramount to ensuring optimal perioperative outcomes, and the patient with known or suspected OSA presents unique challenges to the anesthesia care team regarding airway management, pain control, and postoperative monitoring requirements. Currently, a relative paucity of high-quality evidence exists on which to base guidelines or recommendations for the anesthetic care of these patients. It is generally agreed that early identification of those at risk for OSA allows for planning and implementation of strategies to help to reduce the risk of adverse perioperative events. Although various national societies have published consensus statements aimed at guiding the perioperative management of the patient at risk for OSA, more studies are needed to define the optimal approach to the perioperative care of this population.
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Affiliation(s)
- Tracey L Stierer
- Department of Anesthesiology and Critical Care Medicine and Department of Otolaryngology, Head and Neck Surgery (Dr Stierer), Johns Hopkins Medicine, Baltimore, MD.
| | - Nancy A Collop
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
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De Oliveira GS, Holl JL, Lindquist LA, Hackett NJ, Kim JYS, McCarthy RJ. Older Adults and Unanticipated Hospital Admission within 30 Days of Ambulatory Surgery: An Analysis of 53,667 Ambulatory Surgical Procedures. J Am Geriatr Soc 2015. [DOI: 10.1111/jgs.13537] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Gildasio S. De Oliveira
- Department of Anesthesiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Jane L. Holl
- Center for Healthcare Studies; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Lee Ann Lindquist
- Division of Geriatrics; Department of Internal Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Nicholas J. Hackett
- Division of Geriatrics; Department of Internal Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - John Y. S. Kim
- Department of Surgery; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Robert J. McCarthy
- Department of Anesthesiology; Feinberg School of Medicine; Northwestern University; Chicago Illinois
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Kurd MF, Schroeder GD, Vaccaro AR. Spine Surgery in an Ambulatory Setting: What Can Be Done Safely? JBJS Rev 2015; 3:01874474-201505000-00003. [PMID: 27491059 DOI: 10.2106/jbjs.rvw.n.00093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Mark F Kurd
- The Rothman Institute at Thomas Jefferson University, 5th Floor, 925 Chestnut Street, Philadelphia, PA 19107
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Melamed A, Katz Eriksen JL, Hinchcliff EM, Worley MJ, Berkowitz RS, Horowitz NS, Muto MG, Urman RD, Feltmate CM. Same-Day Discharge After Laparoscopic Hysterectomy for Endometrial Cancer. Ann Surg Oncol 2015; 23:178-85. [DOI: 10.1245/s10434-015-4582-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/18/2022]
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The impact of a dedicated research education month for anesthesiology residents. Anesthesiol Res Pract 2015; 2015:623959. [PMID: 25653678 PMCID: PMC4309211 DOI: 10.1155/2015/623959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 11/25/2022] Open
Abstract
An educational intervention was implemented at the University of Michigan starting in 2008, in which anesthesiology interns complete a dedicated month-long didactic rotation in evidence-based medicine (EBM) and research methodology. We sought to assess its utility. Scores on a validated EBM test before and after the rotation were compared and assessed for significance of improvement. A survey was also given to gauge satisfaction with the quality of the rotation and self-reported improvement in understanding of EBM topics. Fourteen consecutive interns completed the research rotation during the study period. One hundred percent completed both the pre- and postrotation test. The mean pretest score was 7.78 ± 2.46 (median = 7.5, 0–15 scale, and interquartile range 7.0–10.0) and the mean posttest score was 10.00 ± 2.35 (median = 9.5, interquartile range 8.0–12.3), which represented a statistically significant increase (P = 0.011, Wilcoxon signed-rank test). All fourteen of the residents “agreed” or “strongly agreed” that they would recommend the course to future interns and that the course increased their ability to critically review the literature. Our findings demonstrate that this can be an effective means of improving understanding of EBM topics and anesthesiology research.
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Farhan H, Moreno-Duarte I, McLean D, Eikermann M. Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery? CURRENT ANESTHESIOLOGY REPORTS 2014; 4:290-302. [PMID: 25530723 PMCID: PMC4267566 DOI: 10.1007/s40140-014-0073-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it's use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice.
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Affiliation(s)
- Hassan Farhan
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Ingrid Moreno-Duarte
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Duncan McLean
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
- Universitaet Duisburg-Essen, Essen, Germany
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Hein RE, Constantine RS, Cortez R, Miller T, Anigian K, Lysikowski J, Davis K, Reed G, Trussler A, Rohrich RJ, Kenkel JM. An alternative outpatient care model: postoperative guest suite-based care. Aesthet Surg J 2014; 34:1225-31. [PMID: 25270544 DOI: 10.1177/1090820x14546161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients recovering from outpatient surgery are responsible for managing their pain, managing ambulation, and even implementing thromboembolism prophylaxis after discharge. Because of the importance of postoperative care to prevent complications, a model of care that helps a patient transition to independent self-care could provide optimal results. OBJECTIVES The authors investigated the safety and morbidity rate for patients who underwent body contouring procedures and overnight care at an attached, nurse-staffed guest suite facility. METHODS A retrospective review was conducted of 246 patients who underwent major body contouring and who stayed at least 1 night in the guest suite facility. Major complications included a return to the operating room within 48 hours, major wound infection, and unplanned hospitalization within 48 hours. Minor complications included any postsurgical effect necessitating unplanned physician intervention within the first 30 days. Univariate analyses correlating patient characteristics and complication rates were conducted, as well as comparison of complication rates among same procedures reported in the literature. RESULTS The complication rate (major and minor complications) was 25.20%. Surgical site infection occurred in 8.13% of patients. The most common wound complication was erythema around the incision site (12.20%). Death, deep vein thrombosis, or pulmonary embolism did not occur. Comparison with relevant results reported in the literature indicated a significant reduction in the occurrence of postoperative venous thromboembolism. CONCLUSIONS Patient education after surgery is essential to healing and adequate care. The guest suite model provides improved care and education for the patient and family postsurgery by addressing some of the known risk factors of plastic surgery. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Rachel E Hein
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Ryan S Constantine
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Robert Cortez
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Travis Miller
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Kendall Anigian
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Jerzy Lysikowski
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Kathryn Davis
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Gary Reed
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Andrew Trussler
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Rod J Rohrich
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
| | - Jeffrey M Kenkel
- Ms Hein is a medical student, Mr Constantine is a research technician, Mr Cortez is a medical student, Mr Miller is a medical student at the University of Texas at Southwestern, DallasDr Lysikowski is a statistician in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasMs Anigian is a medical student at the University of Texas at San AntonioDr Davis is Assistant Professor and Co-Director of Research, Dr Reed is Professor of Internal Medicine and Chief Quality Officer of UTSW Hospitals and Clinics in the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, DallasDr Trussler is a physician, Dr Rohrich is Professor and Chairman, and Dr Kenkel is Professor and Vice-Chairman, Department of Plastic Surgery and the Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas
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Abstract
Measuring quality assessment in hand surgery remains an underexplored area. However, measuring quality is becoming increasingly transparent and important. Patients now have direct access to hospital and physician metrics and large payers have linked financial incentives to quality metrics. It is critical for hand surgeons to understand the essential elements of quality and its assessment. This article reviews several areas of hand surgery quality assessments including safety, outcomes, satisfaction, and cost.
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Affiliation(s)
- Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48103, USA
| | - Catherine Curtin
- Department of Surgery, Palo Alto Veterans Hospital, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
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Affiliation(s)
- R. D. Sanders
- Surgical Outcomes Research Centre; University College London Hospital; London UK
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Outcomes, Measures and Recovery After Ambulatory Surgery and Anaesthesia: A review. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0068-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Addison B, Zargar H, Lilic N, Merrilees D, Rice M. Analysis of 35 cases of Xanthogranulomatous pyelonephritis. ANZ J Surg 2014; 85:150-3. [PMID: 24661744 DOI: 10.1111/ans.12581] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND To retrospectively determine key demographic and clinical features of 35 patients with Xanthogranulomatous pyelonephritis (XGP) in a New Zealand setting and to compare it with the existing literature. METHODS A retrospective review of patients having a confirmed diagnosis of XGP on histopathology examination was performed. Key clinical and demographic features were analysed and compared with the published literature. RESULTS XGP was diagnosed in 35 patients over a 12-year (2001-2013) period in Auckland Public Hospital. Ninety-one percent of the patients were female. The population had significantly higher numbers of Maori and Pacific Island patients compared with the general population (74%). Staghorn calculi were the most common cause (51.4%) with obstructing ureteric calculi as the next most common (22.9%) cause. Twenty percent of cases were not thought to be XGP prior to nephrectomy (suspicious renal mass). Thirteen (38%) patients suffered serious complications post-operatively (Clavien 3-5). CONCLUSION XGP is a rare chronic inflammatory condition that appears to be overrepresented by Maori and Pacific islanders in our cohort when compared with the overall patient pool. Surgical treatment is associated with significant morbidity but remains the only definitive option. Obesity and other conditions associated with metabolic syndrome may coexist at the time of presentation and may be contributing factors to the development of XGP and poor outcomes associated with it.
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Affiliation(s)
- Ben Addison
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand
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