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do Nascimento TS, Pereira ROL, Maia E, Ohnuma T, da Costa MG, Slawka E, Galhardo C, Krishnamoorthy V. The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis. Perioper Med (Lond) 2024; 13:78. [PMID: 39039540 PMCID: PMC11264430 DOI: 10.1186/s13741-024-00439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Glucagon-like peptide-1 agonist receptors (GLP-1RAs), medications used for glycemic control and weight loss, are increasing worldwide. In the perioperative period, the major concern related to GLP-1RA is gastric emptying delay and risk of aspiration. This meta-analysis and systematic review compared the risks and benefits of using GLP-1 agonist receptors and control in surgical and nonsurgical procedures under anesthesia or sedation. METHODS We systematically searched MEDLINE, Embase, and Cochrane for randomized controlled trials and observational studies involving patients > 18 years undergoing elective surgeries or procedures. Outcomes of interest were pre-procedural gastrointestinal (GI) symptoms, residual gastric content assessed by endoscopy, pulmonary aspiration during anesthesia/sedation, perioperative glycemic control, postoperative inotropic support, nausea/vomiting (PONV), atrial fibrillation, and 30-day mortality rate. We used a random effects model, with odds ratio and mean difference computed for binary and continuous outcomes, respectively. RESULTS Fourteen randomized and observational studies with 2143 adult patients undergoing elective surgeries and procedures were included. GLP-1RA resulted in increased pre-procedural GI symptoms (OR 7.66; 95% CI 3.42, 17.17; p < 0.00001; I2 = 0%) and elevated residual gastric content (OR 6.08; 95% CI 2.86, 12.94; p < 0.00001; I2 = 0%). GLP-1RA resulted in lower glycemic levels (MD - 0.73; 95% CI - 1.13, - 0.33; p = 0.0003; I2 = 90%) and lower rate of rescue insulin administration (OR 0.39; 95% CI 0.23, 0.68 p = 0.0009; I2 = 35%). There was no significant difference in rate of perioperative hypoglycemia (OR 0.60; 95% CI 0.29, 1.24; p = 0.17; I2 = 0%), hyperglycemia (OR 0.89; 95% CI 0.59, 1.34; p = 0.58; I2 = 38%), need for postoperative inotropic support (OR 0.57; 95% CI 0.33, 1.01; p = 0.05; I2 = 0%), atrial fibrillation (OR 1.02; 95% CI 0.52, 2.01; p = 0.95; I2 = 16%), rate of PONV (OR 1.35; 95% CI 0.82, 2.21; p = 0.24; I2 = 0%), and 30-day mortality rate (OR 0.54; 95% CI 0.14, 2.05; p = 0.25; I2 = 0%). CONCLUSION Compared to control, pre-procedural GLP-1RA increased the rate of GI symptoms and the risk of elevated residual gastric content despite adherence to fasting guidelines. GLP-1RA improved glycemic control and decreased the rate of rescue insulin administration. There was no significant difference in the rates of perioperative hypo or hyperglycemia, postoperative inotropic support, PONV, atrial fibrillation, and 30-day mortality.
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Affiliation(s)
- Tatiana S do Nascimento
- Department of Anesthesiology, Cardoso Fontes Federal Hospital, Av. Menezes Cortes, Rio de Janeiro, RJ, 3245, Brazil.
| | - Rodrigo O L Pereira
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Eduardo Maia
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Tetsu Ohnuma
- Division of Critical Care, Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Mariana G da Costa
- Department of Anesthesiology, University Medical Center of Groningen, Groningen, The Netherlands
| | - Eric Slawka
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carlos Galhardo
- Department of Anesthesiology, McMaster University & DeGroot School of Medicine, Hamilton, ON, Canada
| | - Vijay Krishnamoorthy
- Division of Critical Care, Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
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Turzhitsky V, Bash LD, Urman RD, Kattan M, Hofer I. Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis. JMIR Perioper Med 2024; 7:e52278. [PMID: 39038283 DOI: 10.2196/52278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/21/2023] [Accepted: 04/09/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents. OBJECTIVE We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends. METHODS A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19-era patients would have been treated before the pandemic. RESULTS More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post-COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre-COVID-19 trend (odds ratio [OR] 1.008, 95% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95% CI 0.983-0.992; P<.001). CONCLUSIONS We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends.
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Affiliation(s)
| | | | - Richard D Urman
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Ira Hofer
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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103
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Choi UE, Nicholson RC, Thomas AJ, Crowe EP, Ulatowski JA, Resar LMS, Hensley NB, Frank SM. A Propensity-Matched Cohort Study of Intravenous Iron versus Red Cell Transfusions for Preoperative Iron-Deficiency Anemia. Anesth Analg 2024:00000539-990000000-00871. [PMID: 39037926 DOI: 10.1213/ane.0000000000006974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND While preoperative anemia is associated with adverse perioperative outcomes, the benefits of treatment with iron replacement versus red blood cell (RBC) transfusion remain uncertain. We used a national database to establish trends in preoperative iron-deficiency anemia (IDA) treatment and to test the hypothesis that treatment with preoperative iron may be superior to RBC transfusion. METHODS This study is a propensity-matched retrospective cohort analysis from 2003 to 2023 using TriNetX Research Network, which included surgical patients diagnosed with IDA within 3 months preoperatively. After matching for surgery type and comorbidities, we compared a cohort of patients with preoperative IDA who were treated with preoperative intravenous (IV) iron but not RBCs (n = 77,179), with a cohort receiving preoperative RBCs but not IV iron (n = 77,179). Propensity-score matching was performed for age, ethnicity, race, sex, overweight and obesity, type 2 diabetes, hyperlipidemia, essential hypertension, heart failure, chronic ischemic heart disease, neoplasms, hypothyroidism, chronic kidney disease, nicotine dependence, surgery type, and lab values from the day of surgery including ferritin, transferrin, and hemoglobin split into low (<7 g/dL), medium (7-<12 g/dL), and high (≥12 g/dL) to account for anemia severity. The primary outcome was 30-day postoperative mortality with the secondary outcomes being 30-day morbidity, postoperative hemoglobin level, and 30-day postoperative RBC transfusion. RESULTS Compared with RBC transfusion, preoperative IV iron was associated with lower risk of postoperative mortality (n = 2550/77,179 [3.3%] vs n = 4042/77,179 [5.2%]; relative risk [RR], 0.63, 95% confidence interval [CI], 0.60-0.66), and a lower risk of postoperative composite morbidity (n = 14,174/77,179 [18.4%] vs n = 18,632/77,179 [24.1%]; RR, 0.76, 95% CI, 0.75-0.78) (both P = .001 after Bonferroni adjustment). Compared with RBC transfusion, IV iron was also associated with a higher hemoglobin in the 30-day postoperative period (10.1 ± 1.8 g/dL vs 9.4 ± 1.7 g/dL, P = .001 after Bonferroni adjustment) and a reduced incidence of postoperative RBC transfusion (n = 3773/77,179 [4.9%] vs n = 12,629/77,179 [16.4%]; RR, 0.30, 95% CI, 0.29-0.31). CONCLUSIONS In a risk-adjusted analysis, preoperative IDA treatment with IV iron compared to RBC transfusion was associated with a reduction in 30-day postoperative mortality and morbidity, a higher 30-day postoperative hemoglobin level, and reduced postoperative RBC transfusion. This evidence represents a promising opportunity to improve patient outcomes and reduce blood transfusions and their associated risk and costs.
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Affiliation(s)
- Una E Choi
- From the Departments of Anesthesiology and Critical Care Medicine
| | - Ryan C Nicholson
- From the Departments of Anesthesiology and Critical Care Medicine
| | - Ananda J Thomas
- From the Departments of Anesthesiology and Critical Care Medicine
| | | | - John A Ulatowski
- From the Departments of Anesthesiology and Critical Care Medicine
| | - Linda M S Resar
- Department ofHematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nadia B Hensley
- From the Departments of Anesthesiology and Critical Care Medicine
| | - Steven M Frank
- From the Departments of Anesthesiology and Critical Care Medicine
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104
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Passos RDH, Andari LVDWBU, Assuncão MSC. Monitor smart, use better: the future of haemodynamic monitoring. J Clin Monit Comput 2024:10.1007/s10877-024-01196-5. [PMID: 39031234 DOI: 10.1007/s10877-024-01196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/22/2024]
Abstract
The review article "Haemodynamic Monitoring During Noncardiac Surgery" offers valuable insights but lacks evidence linking specific haemodynamic strategies to improved outcomes. There's a need for standardized protocols, ongoing clinician education, and further validation of new technologies. Additionally, balancing the use of invasive versus noninvasive methods and addressing cost-effectiveness and sustainability are essential. Continued research and adaptive practices are crucial for optimizing perioperative care.
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Affiliation(s)
- Rogerio Da Hora Passos
- Departamento de Medicina Intensiva, Intensive Care Unity - Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, São Paulo, SP, CEP: 05651-901, Brasil.
| | - Leonardo Van de Wiel Barros Urbano Andari
- Departamento de Medicina Intensiva, Intensive Care Unity - Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, São Paulo, SP, CEP: 05651-901, Brasil
| | - Murillo Santucci Cesar Assuncão
- Departamento de Medicina Intensiva, Intensive Care Unity - Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, São Paulo, SP, CEP: 05651-901, Brasil
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105
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Vlasov H, Wilkman E, Petäjä L, Suojaranta R, Hiippala S, Tolonen H, Jormalainen M, Raivio P, Juvonen T, Pesonen E. Comparison of 4% Albumin and Ringer's Acetate on Hemodynamics in On-pump Cardiac Surgery: An Exploratory Analysis of a Randomized Clinical Trial. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00462-2. [PMID: 39098542 DOI: 10.1053/j.jvca.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Compare hemodynamics between 4% albumin and Ringer's acetate. DESIGN Exploratory analysis of the double-blind randomized ALBumin In Cardiac Surgery trial. SETTING Single-center study in Helsinki University Hospital. PARTICIPANTS We included 1,386 on-pump cardiac surgical patients. INTERVENTION We used 4% albumin or Ringer's acetate administration for cardiopulmonary bypass priming, volume replacement intraoperatively and 24 hours postoperatively. MEASUREMENTS AND MAIN RESULTS Hypotension (time-weighted average mean arterial pressure of <65 mmHg) and hyperlactatemia (time-weighted average blood lactate of >2 mmol/L) incidences were compared between trial groups in the operating room (OR), and early (0-6 hours) and late (6-24 hours) postoperatively. Associations of hypotension and hyperlactatemia with the ALBumin In Cardiac Surgery primary outcome (≥1 major adverse event [MAE]) were studied. In these time intervals, hypotension occurred in 118, 48, and 17 patients, and hyperlactatemia in 313, 131, and 83 patients. Hypotension and hyperlactatemia associated with MAE occurrence. Hypotension did not differ between the groups (albumin vs Ringer's: OR, 8.8% vs 8.5%; early postoperatively, 2.7% vs 4.2%; late postoperatively, 1.2% vs 1.3%; all p > 0.05). In the albumin group, hyperlactatemia was less frequent late postoperatively (2.9% vs 9.1%; p < 0.001), but not earlier (OR, 22.4% vs 23.6%; early postoperatively, 7.9% vs 11.0%; both p > 0.025 after Bonferroni-Holm correction). CONCLUSIONS In on-pump cardiac surgery, hypotension and hyperlactatemia are associated with the occurrence of ≥1 MAE. Compared with Ringer's acetate, albumin did not decrease hypotension and decreased hyperlactatemia only late postoperatively. Albumin's modest hemodynamic effect is concordant with the finding of no difference in MAEs between albumin and Ringer's acetate in the ALBumin In Cardiac Surgery trial.
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Affiliation(s)
- Hanna Vlasov
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Erika Wilkman
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Liisa Petäjä
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Raili Suojaranta
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Hiippala
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Tolonen
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Jormalainen
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Peter Raivio
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tatu Juvonen
- HUS Pharmacy, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Pesonen
- Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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106
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Burgess R. Factors influencing the fasting decisions of day-case surgery patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:666-673. [PMID: 39023021 DOI: 10.12968/bjon.2023.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Patients admitted on the day of surgery are asked to arrive fasted, and they often fast for longer than necessary. Although pre-assessment supports patients to prepare for surgery, little is known about how they make fasting decisions. AIMS To explore factors influencing the fasting decisions of day-case patients and how to provide information pre-operatively. METHODS A qualitative descriptive study design was used. Semi-structured telephone interviews were carried out with 10 patients recruited from a single day-case unit. Data were analysed using thematic analysis. FINDINGS Three themes provided context for fasting decisions: the operation as a serious event; the patient as an active partner; and the patient as a rule follower. Length of fast is determined by fasting decisions and practicalities. CONCLUSION Patients approach fasting decisions according to their knowledge and experience and their individual preferences for information. Pre-assessment nurses should tailor information to the patient and explain the rationale for fasting.
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Affiliation(s)
- Ruth Burgess
- Staff Nurse, Department of Cardiorespiratory Research, Leeds Teaching Hospitals Trust, Leeds
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107
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Chang L, Wang Y, Zhang J, Zhao W, Li X, Yang L. Effect of music therapy combined with aerobic exercise on sleep quality among breast cancer patients undergoing chemotherapy after a radical mastectomy: a randomized controlled trial. BMC Womens Health 2024; 24:408. [PMID: 39026220 PMCID: PMC11256659 DOI: 10.1186/s12905-024-03241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE We aimed to study the effect of music therapy combined with aerobic exercise on the sleep quality of patients undergoing chemotherapy after a radical mastectomy. METHODS A randomized controlled trial was conducted at the Breast Disease Diagnosis and Treatment Center, Shaanxi Province Tumor Hospital, from July 2017 to June 2019. 110 female breast cancer patients who underwent a radical mastectomy were recruited and randomly allocated into an intervention group or a control group. The intervention group completed music therapy combined with aerobic exercise from the first to the sixth admission to the hospital for chemotherapy, while the control group received only routine nursing care. The sleep quality of these patients was measured using the Pittsburgh Sleep Quality Index (PSQI). A linear mixed model was used to adjust the PSQI of patients after controlling for other confounding factors. RESULTS The mean sleep quality score of the breast cancer patients who received chemotherapy after a radical mastectomy (baseline) was 8.86 ± 2.34. The intervention group had a significantly lower mean global PSQI score than the control group from the first test to the third test, with an adjusted mean difference of -1.05 (95%CI: -1.86, -0.24; P = 0.01), -2.89 (95%CI: -3.70, -2.08; P < 0.001) and - 4.84 (95%CI: -5.65, -4.03; P < 0.001), respectively. A change in the global PSQI score from baseline for the intervention group was from 0.55 (95%CI: -0.24, 1.34; P = 0.171) at the first test to 2.75 (95%CI: 1.96, 3.53; P < 0.001) at the last test, and for the control group was from - 0.51 (95%CI: -1.31, 0.29; P = 0.213 at the first test to -2.10 (95%CI: -2.91, -1.30; P < 0.001) at the last test. CONCLUSIONS An intervention of music therapy combined with aerobic exercise can significantly improve the sleep quality of female breast cancer patients undergoing chemotherapy after a radical mastectomy, and this intervention continuously improves many aspects of sleep reactivity. CLINICAL TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100042975, 02/02/2021).
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Affiliation(s)
- Li Chang
- Shaanxi No. 3 People's Hospital, Shaanxi Provincial Tumor Hospital, Xi'an, 710061, Shaanxi, China
| | - Yan Wang
- Shaanxi No. 3 People's Hospital, Shaanxi Provincial Tumor Hospital, Xi'an, 710061, Shaanxi, China
| | - Jie Zhang
- Shaanxi No. 3 People's Hospital, Shaanxi Provincial Tumor Hospital, Xi'an, 710061, Shaanxi, China
| | - Wenqian Zhao
- School of Nursing, Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiaomei Li
- School of Nursing, Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Lei Yang
- School of Nursing, Health Science Centre, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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108
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Wang Z, Ma J, Liu X, Gao J. Development and validation of a predictive model for PACU hypotension in elderly patients undergoing sedated gastrointestinal endoscopy. Aging Clin Exp Res 2024; 36:149. [PMID: 39023685 PMCID: PMC11258065 DOI: 10.1007/s40520-024-02807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Hypotension, characterized by abnormally low blood pressure, is a frequently observed adverse event in sedated gastrointestinal endoscopy procedures. Although the examination time is typically short, hypotension during and after gastroscopy procedures is frequently overlooked or remains undetected. This study aimed to construct a risk nomogram for post-anesthesia care unit (PACU) hypotension in elderly patients undergoing sedated gastrointestinal endoscopy. METHODS This study involved 2919 elderly patients who underwent sedated gastrointestinal endoscopy. A preoperative questionnaire was used to collect data on patient characteristics; intraoperative medication use and adverse events were also recorded. The primary objective of the study was to evaluate the risk of PACU hypotension in these patients. To achieve this, the least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection, involving cyclic coordinate descent with tenfold cross-validation. Subsequently, multivariable logistic regression analysis was applied to build a predictive model using the selected predictors from the LASSO regression. A nomogram was visually developed based on these variables. To validate the model, a calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used. Additionally, external validation was conducted to further assess the model's performance. RESULTS The LASSO regression analysis identified predictors associated with an increased risk of adverse events during surgery: age, duration of preoperative water abstinence, intraoperative mean arterial pressure (MAP) <65 mmHg, decreased systolic blood pressure (SBP), and use of norepinephrine (NE). The constructed model based on these predictors demonstrated moderate predictive ability, with an area under the ROC curve of 0.710 in the training set and 0.778 in the validation set. The DCA indicated that the nomogram had clinical applicability when the risk threshold ranged between 20 and 82%, which was subsequently confirmed in the external validation with a range of 18-92%. CONCLUSION Incorporating factors such as age, duration of preoperative water abstinence, intraoperative MAP <65 mmHg, decreased SBP, and use of NE in the risk nomogram increased its usefulness for predicting PACU hypotension risk in elderly patient undergoing sedated gastrointestinal endoscopy.
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Affiliation(s)
- Zi Wang
- Department of Anesthesiology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Jiangsu, Yangzhou, 225001, China
- Yangzhou University, Jiangsu, Yangzhou, 225001, China
| | - Juan Ma
- Department of Anesthesiology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Jiangsu, Yangzhou, 225001, China
- Yangzhou University, Jiangsu, Yangzhou, 225001, China
| | - Xin Liu
- Department of Anesthesiology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Jiangsu, Yangzhou, 225001, China
| | - Ju Gao
- Department of Anesthesiology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Jiangsu, Yangzhou, 225001, China.
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Lee KS, Kim JE, Kang G, Won YJ, Choi YJ. The effect of human albumin administration on postoperative renal function following major surgery: a systematic review and meta-analysis. Sci Rep 2024; 14:16599. [PMID: 39025929 PMCID: PMC11258253 DOI: 10.1038/s41598-024-62495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/17/2024] [Indexed: 07/20/2024] Open
Abstract
Optimal fluid management during major surgery is of considerable concern to anesthesiologists. Although crystalloids are the first choice for fluid management, the administration of large volumes of crystalloids is associated with poor postoperative outcomes. Albumin can be used for fluid management and may protect renal function. However, data regarding the effects of albumin administration on kidney function are conflicting. As such, the present study aimed to investigate the effect of albumin administration on renal function in patients undergoing major surgery and compare its effects with those of crystalloid fluid. The Embase, Medline, Web of Science, Cochrane Library, and KoreaMed databases were searched for relevant studies. The primary endpoint of the meta-analysis was the incidence of postoperative kidney injury, including acute kidney injury and renal replacement therapy. Twelve studies comprising 2311 patients were included; the primary endpoint was analyzed in four studies comprising 1749 patients. Perioperative albumin levels in patients undergoing major surgery did not significantly influence kidney dysfunction (p = 0.98). Postoperative fluid balance was less positive in patients who underwent major surgery and received albumin than in those who received crystalloids. Owing to the limitations of this meta-analysis, it remains unclear whether albumin administration during major surgery is better than crystalloid fluid for improving postoperative renal function.
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Affiliation(s)
- Kuen Su Lee
- Department of Anesthesiology and Pain Medicine, Eulji University Uijeongbu Eulji Medical Center, Eulji Uni-Versity School of Medicine, Uijeongbu, 11759, Republic of Korea
| | - Ji Eun Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea
| | - Giung Kang
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Sin CF, Wong KP, Siu CW, Wong TF, Wong HM. Utilization of international normalized ratio-derived formula to predict plasma rivaroxaban level-Validation study and real-world experience. Int J Lab Hematol 2024. [PMID: 39019497 DOI: 10.1111/ijlh.14347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/27/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Specific assays of plasma rivaroxaban level are not always readily available with short turnaround time, which hamper the management of urgent clinical situations. In this study, we aimed to build a predictive formula of plasma rivaroxaban levels from international normalized ratio (INR) value and validated in real world clinical situations. METHODS Ninety-four patients who were taking rivaroxaban participated in the study. Patients were randomized into testing cohort and validation cohorts. The prediction formula was built from the testing cohort and then validated in validation cohort. The predictive performance was further validated on real-world clinical requests. RESULTS The root mean square error (RMSE) of the predictive formula for the testing and validation cohorts were 61.81 and 69.32 ng/mL, respectively. The sensitivity and specificity for the formula to predict the threshold plasma rivaroxaban level of 75 ng/mL were 95% (95% CI: 85.4%-100%) and 87.5% (95% CI: 71.3%-100%), respectively, in real-world clinical situations. CONCLUSION Plasma rivaroxaban level of threshold level of 75 ng/mL can be calculated from prediction formula by INR value with satisfactory accuracy and it can be used to guide the decision for reversal.
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Affiliation(s)
- Chun-Fun Sin
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka-Ping Wong
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Chun Wah Siu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Tsz-Fu Wong
- Division of Haematology and Blood Bank, Department of Pathology, Queen Mary Hospital, Hong Kong, China
| | - Hoi-Man Wong
- Division of Haematology and Blood Bank, Department of Pathology, Queen Mary Hospital, Hong Kong, China
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Sigurdardottir M, Sigurdsson MI, Vias RD, Olafsson Y, Gunnarsdottir I, Sigurdsson EL, Karason S. Preoperative optimization of modifiable risk factors is associated with decreased superficial surgical site infections after total joint arthroplasty: a prospective case-control study. Acta Orthop 2024; 95:392-400. [PMID: 39016247 PMCID: PMC11253708 DOI: 10.2340/17453674.2024.41012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/08/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND AND PURPOSE The aim of our study was to investigate change in modifiable risk factors following preoperative optimization and whether risk of superficial surgical site infection (SSI) after total joint arthroplasty (TJA) could be reduced. METHODS This is a prospective study of implementation of a preoperative optimization pathway for patients waiting for primary TJA. Information regarding the intervention arm was collected from January 2019 to January 2021, first at decision for operation and then at preoperative assessment 1 week prior to operation. The control arm was included between August 2018 and September 2020 after receiving conventional preoperative preparation and information gathered at preoperative assessment. Follow up occurred 6 weeks postoperatively for both groups. The primary outcome was postoperative superficial SSI. RESULTS The optimization effort resulted in improvement of weight, anemia, HbA1c, vitamin D, and patient engagement. At preoperative assessment the baseline characteristics of the 2 groups were similar except that the intervention group had substantially more comorbidities. Regarding superficial SSI, association was found with BMI ≥ 30 and HbA1c ≥ 42 mmol/mol in the control group but not in the intervention group. When corrected for differences in ASA classification (reflecting comorbidities), age, and sex, being in the intervention group was associated with lower odds of occurrence of superficial SSI compared with the control group (OR 0.64, 95% confidence interval 0.42-0.97). CONCLUSION We showed that preoperative optimization in a structured cooperation between hospital and primary care was associated with a reduced risk of superficial SSI.
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Affiliation(s)
- Maria Sigurdardottir
- Department of Anaesthesia and Intensive Care, Landspitali - The National University Hospital of Iceland, Reykjavik; Faculty of Medicine, University of Iceland, Reykjavik
| | - Martin Ingi Sigurdsson
- Department of Anaesthesia and Intensive Care, Landspitali - The National University Hospital of Iceland, Reykjavik; Faculty of Medicine, University of Iceland, Reykjavik
| | - Rafael Daniel Vias
- Department of Mathematics, Faculty of Physical Sciences, University of Iceland, Reykjavik
| | - Yngvi Olafsson
- Department of Orthopeadics, Landspitali - The National University Hospital of Iceland, Reykjavik
| | - Ingibjorg Gunnarsdottir
- Department of Clinical Nutrition, Landspitali - The National University Hospital of Iceland, Reykjavik; Faculty of Food Science and Nutrition, University of Iceland
| | - Emil L Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik; Development Centre for Primary Health Care, Reykjavik, Iceland
| | - Sigurbergur Karason
- Department of Anaesthesia and Intensive Care, Landspitali - The National University Hospital of Iceland, Reykjavik; Faculty of Medicine, University of Iceland, Reykjavik.
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Abdelhack M, Tripathi S, Chen Y, Avidan MS, King CR. Social vulnerability and surgery outcomes: a cross-sectional analysis. BMC Public Health 2024; 24:1907. [PMID: 39014400 PMCID: PMC11253435 DOI: 10.1186/s12889-024-19418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. METHODS In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. RESULTS Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. CONCLUSIONS Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.
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Affiliation(s)
- Mohamed Abdelhack
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sandhya Tripathi
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Yixin Chen
- Department of Computer Science, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher R King
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
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García Sánchez F, Mudarra García N. Evaluation of postoperative results after a presurgical optimisation programme. Perioper Med (Lond) 2024; 13:73. [PMID: 39010120 PMCID: PMC11247769 DOI: 10.1186/s13741-024-00430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/24/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Presurgical optimisation programmes decrease the risk of postoperative complications, reduce hospital stays and speed up patient recovery. They usually involve a multidisciplinary team addressing physical, nutritional and psychosocial issues. The objective of this study was to assess the results of implementing a presurgical optimisation programme led by a liaison nurse in patients undergoing major surgery in a primary general hospital. METHODS An observational, retrospective, descriptive, cross-sectional, comparative study based on the revision of patients' health records undergoing major surgery between January 2019 and December 2022. Patients entering the presurgical optimisation programme (intervention group) were compared with patients receiving usual medical care (control group). The presurgical optimisation programme consisted of oral nutritional supplementation, physical exercise, strengthening of lung capacity and psychological and emotional support. Frequency (%) of surgery complications and use of healthcare resources (duration of hospitalisation, time spent in the intensive care unit (ICU), and readmission) at day 30 were recorded. Descriptive statistics were applied. RESULTS Two hundred eleven patients (58.5% men, mean age: 65.76 years (SD 11.5), 75.2%. non-smokers; mean body mass index (BMI): 28.32 (SD 5.38); mean Nutritional Risk Score (NRS) 3.71 (SD 1.35; oncology diagnosis: 88.6%) were included: 135 in the intervention group, and 76 in the control group. The average duration of the presurgical optimisation programme was 20 days (SD 5). Frequency of postoperative complications was 25% (n = 33) in the intervention group and 52.6% (n = 40) in the control group (p < 0.001) [odds ratio (OR) = 3.4; 95% confidence interval (CI) (1.8; 6.2)]. 14.5% (n = 19) of patients in the intervention group and 34.2% (n = 26) in the control group had remote postoperative complications [OR = 3.1; 95% CI (1.6; 6.2)]. Patients in the intervention group spent fewer days in the hospital [mean 8.34 (SD 6.70) vs 11.63 (SD 10.63)], and there were fewer readmissions at 30 days (7.6% vs 19.7%) compared with the control group. CONCLUSIONS A presurgical optimisation programme led by a liaison nurse decreases the rate of immediate and late surgical complications and reduces hospital stays and readmissions in patients undergoing major surgery.
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Affiliation(s)
- Francisco García Sánchez
- Surgical Prehabilitation Unit, Infanta Cristina University Hospital., Avenida 9 de Junio 2. Parla., Madrid, 28981, Spain.
- IDIPHISA. Medical Department. Faculty of Medicine, University Complutense of Madrid, Madrid, Spain.
| | - Natalia Mudarra García
- Surgical Prehabilitation Unit, Infanta Cristina University Hospital., Avenida 9 de Junio 2. Parla., Madrid, 28981, Spain
- IDIPHISA. Nurse Department. Faculty of Nurse. University Complutense of Madrid, Madrid, Spain
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Low WX, Friend H, Dulleston J, Heppenstall S, Spacey K, Liew I. Outcomes of perioperative intravenous iron infusion in femoral fracture surgery: A systematic review and meta-analysis of randomised controlled trials. Surgeon 2024:S1479-666X(24)00070-2. [PMID: 39009491 DOI: 10.1016/j.surge.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Patient blood management recommends the use of intravenous (IV) iron infusion to reduce inappropriate blood transfusion perioperatively for anaemic surgical patients. However, evidence regarding its use in urgent femoral fracture surgery is limited. This systematic review aims to collate the current evidence regarding the utilisation of IV iron in femoral fracture surgery. METHOD MEDLINE, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and the WHO ICTRP databases were systematically searched for randomised controlled trials (RCT) comparing the outcomes of perioperative IV iron infusion with placebo in adults requiring surgical management for femoral fractures. Risk ratios (RR) were calculated using the Mantel-Haenszel method for dichotomous outcomes, and mean differences (MD) were calculated with the inverse-variance method for continuous outcomes. RESULTS Six RCTs with 1292 patients were included. No statistically significant difference was found in the proportion of patients receiving red blood cell (RBC) transfusion (RR = 0.87, 95%CI: 0.75; 1.01, p = 0.058) between groups. Statistically significant difference in postoperative haemoglobin concentration was found between groups measured between day 4-7 of admission (MD = 1.93 g/L, 95%CI: 0.48; 3.39, p = 0.024), but not clinically significant. No statistically significant differences were found between groups in mortality rate, length of hospital stay, infection rate, or return to home rate. CONCLUSION Current evidence indicates that IV iron infusion alone does not provide any clinically significant benefit in femoral fracture surgery. Further high-quality RCTs are needed to explore its synergistic potential when used in combination with other perioperative optimisation methods, including tranexamic acid, erythropoietin and cell salvage.
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Affiliation(s)
- Wen Xian Low
- Queen Mary University of London, Garrod Building, Turner St, London, E1 2AD, UK.
| | - Hetta Friend
- Clinical School of Medicine, University of Cambridge, Hill's Rd, Cambridge, CB2 0SP, UK
| | - Joseph Dulleston
- Clinical School of Medicine, University of Cambridge, Hill's Rd, Cambridge, CB2 0SP, UK
| | | | - Kate Spacey
- Norfolk and Norwich University Hospital, Colney Ln, Norwich, NR4 7UY, UK
| | - Ignatius Liew
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
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Amirkhosravi F, Allenson KC, Moore LW, Kolman JM, Foster M, Hsu E, Sasangohar F, Dhala A. Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis. Sci Rep 2024; 14:16012. [PMID: 38992072 PMCID: PMC11239889 DOI: 10.1038/s41598-024-66633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran's Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (- 0.38 [- 0.75- - 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (- 0.96 [- 1.38- - 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (- 0.91 [- 1.67- - 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.
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Affiliation(s)
| | | | - Linda W Moore
- Department of Surgery, Houston Methodist, Houston, TX, USA
| | - Jacob M Kolman
- Office of Faculty and Research Development, Department of Academic Affairs, Houston Methodist, Houston, TX, USA
| | - Margaret Foster
- School of Medicine, Department of Medical Education, Texas A&M University, College Station, TX, USA
| | - Enshuo Hsu
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
- Center for Critical Care, Houston Methodist, Houston, TX, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist, Houston, TX, USA.
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Zhu B, Cao A, Chen Y. Commentary on the "A multidisciplinary opioid-reduction pathway for robotic prostatectomy: outcomes at year one". Perioper Med (Lond) 2024; 13:71. [PMID: 38992730 PMCID: PMC11241976 DOI: 10.1186/s13741-024-00392-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/25/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Opioid-sparing multimodal analgesia is increasingly emphasized for postoperative pain management. This commentary discusses a study by Manning et al. on an opioid reduction pathway for robotic prostatectomy. METHODS We reviewed the Manning et al. study, which implemented a multidisciplinary opioid reduction pathway and compared outcomes before and after pathway implementation. Outcomes included opioid use, pain scores, antiemetic use, length of stay, and readmissions. RESULTS The study found reduced opioid consumption, lower antiemetic use, shorter length of stay, and similar pain scores after pathway implementation. However, the pre-post-study design has limitations in attributing causality to the pathway itself. Key confounders were not fully accounted for. The clinical significance of the small reduction in length of stay is also questionable. CONCLUSIONS This commentary highlights important limitations of the Manning et al. study, including the retrospective design, potential confounding factors, small effect size, and lack of long-term outcomes. While the study provides early evidence for a multidisciplinary opioid reduction approach, further rigorous prospective research is needed to confirm the observed benefits and long-term impacts. Additional focus on direct opioid consumption, equivalent analgesia assessment, and clinically meaningful outcomes is warranted.
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Affiliation(s)
- Binbin Zhu
- Anesthesiology Department, The First Affiliated Hospital of Ningbo University, Ningbo, China.
- Health Science Center, Ningbo University, Ningbo, China.
| | - Angyang Cao
- Anesthesiology Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Yijun Chen
- Anesthesiology Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
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Kohnke J, Pattberg K, Nensa F, Kuhlmann H, Brenner T, Schmidt K, Hosch R, Espeter F. A proof of concept for microcirculation monitoring using machine learning based hyperspectral imaging in critically ill patients: a monocentric observational study. Crit Care 2024; 28:230. [PMID: 38987802 PMCID: PMC11238485 DOI: 10.1186/s13054-024-05023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/06/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Impaired microcirculation is a cornerstone of sepsis development and leads to reduced tissue oxygenation, influenced by fluid and catecholamine administration during treatment. Hyperspectral imaging (HSI) is a non-invasive bedside technology for visualizing physicochemical tissue characteristics. Machine learning (ML) for skin HSI might offer an automated approach for bedside microcirculation assessment, providing an individualized tissue fingerprint of critically ill patients in intensive care. The study aimed to determine if machine learning could be utilized to automatically identify regions of interest (ROIs) in the hand, thereby distinguishing between healthy individuals and critically ill patients with sepsis using HSI. METHODS HSI raw data from 75 critically ill sepsis patients and from 30 healthy controls were recorded using TIVITA® Tissue System and analyzed using an automated ML approach. Additionally, patients were divided into two groups based on their SOFA scores for further subanalysis: less severely ill (SOFA ≤ 5) and severely ill (SOFA > 5). The analysis of the HSI raw data was fully-automated using MediaPipe for ROI detection (palm and fingertips) and feature extraction. HSI Features were statistically analyzed to highlight relevant wavelength combinations using Mann-Whitney-U test and Benjamini, Krieger, and Yekutieli (BKY) correction. In addition, Random Forest models were trained using bootstrapping, and feature importances were determined to gain insights regarding the wavelength importance for a model decision. RESULTS An automated pipeline for generating ROIs and HSI feature extraction was successfully established. HSI raw data analysis accurately distinguished healthy controls from sepsis patients. Wavelengths at the fingertips differed in the ranges of 575-695 nm and 840-1000 nm. For the palm, significant differences were observed in the range of 925-1000 nm. Feature importance plots indicated relevant information in the same wavelength ranges. Combining palm and fingertip analysis provided the highest reliability, with an AUC of 0.92 to distinguish between sepsis patients and healthy controls. CONCLUSION Based on this proof of concept, the integration of automated and standardized ROIs along with automated skin HSI analyzes, was able to differentiate between healthy individuals and patients with sepsis. This approach offers a reliable and objective assessment of skin microcirculation, facilitating the rapid identification of critically ill patients.
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Affiliation(s)
- Judith Kohnke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Kevin Pattberg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Felix Nensa
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Henning Kuhlmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karsten Schmidt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - René Hosch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
| | - Florian Espeter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Huang J, Qin TS, Bo Y, Li YJ, Liu RS, Yu Y, Li XD, He JC, Ma AX, Tao DP, Ren WJ, Peng J. The Role of the Intestinal Flora and Its Derivatives in Neurocognitive Disorders: A Narrative Review from Surgical Perspective. Mol Neurobiol 2024:10.1007/s12035-024-04322-1. [PMID: 38985257 DOI: 10.1007/s12035-024-04322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024]
Abstract
Perioperative neurocognitive dysfunction is a significant concern for population health, impacting postoperative recovery and increasing the financial burden on patients. With an increasing number of surgical procedures being performed, the prevention and management of perioperative neurocognitive dysfunction have garnered significant attention. While factors such as age, lifestyle, genetics, and education are known to influence the development of cognitive dysfunction, recent research has highlighted the role of the gut microbiota in neurological health. An increased abundance of pro-inflammatory gut microbiota can trigger and worsen neuroinflammation, neuronal cell damage, and impaired cellular autophagy. Moreover, the inflammation-promoting gut microbiota can disrupt immune function, impair neuroautophagy, and affect the production and circulation of extracellular vesicles and neurotransmitters. These factors collectively play a role in the onset and advancement of cognitive impairment. This narrative review delves into the molecular mechanisms through which gut microbiota and their derivatives contribute to cognitive impairment, focusing on the impact of anesthesia surgery, changes in gut microbial populations, and perioperative cognitive impairment associations. The study suggests that alterations in the abundance of various bacterial species and their metabolites pre- and post-surgery may be linked to postoperative cognitive impairment. Furthermore, the potential of probiotics or prebiotics in addressing cognitive impairment is discussed, offering a promising avenue for investigating the treatment of perioperative neurocognitive disorders.
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Affiliation(s)
- Jian Huang
- The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People's Republic of China
| | - Tian-Shou Qin
- The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People's Republic of China
| | - Yun Bo
- Department of Anesthesiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
| | - Yu-Jin Li
- Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
| | - Rong-Sheng Liu
- Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
| | - Yang Yu
- Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
| | - Xiao-Dong Li
- The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People's Republic of China
| | - Jin-Can He
- The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People's Republic of China
| | - Ai-Xin Ma
- The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People's Republic of China
| | - Da-Peng Tao
- School of Information Science and Engineering, Yunnan University, Kunming, 650504, China
| | - Wen-Jun Ren
- Department of Cardiovascular Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China.
| | - Jun Peng
- Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, China
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Gezginci E, Cakin A, Goktas S. The Effect of Internet Information Pollution on Surgical Fear in Patients Undergoing Surgery. J Perianesth Nurs 2024:S1089-9472(24)00120-5. [PMID: 39001739 DOI: 10.1016/j.jopan.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE This study aimed to determine the effect of internet information pollution on levels of surgical fear among patients undergoing surgery. DESIGN Observational study. METHODS This study was conducted with 407 patients scheduled for surgery in the surgical wards of a university hospital. Data were collected preoperatively using a patient information form, the Internet Information Pollution Scale, and the Surgical Fear Questionnaire. FINDINGS A very weak positive correlation was found between total internet information pollution score and total surgical fear score (r = 0.184; P < .001). In regression analysis of the impact of internet information pollution on total surgical fear score, the regression model was significant (F = 13.183; P < .001), with 2.9% of the total change in surgical fear score explained by the total internet information pollution score (R2 = 0.029). CONCLUSIONS The results of this study suggest that the information pollution surgical patients encounter on the internet may increase their surgical fear. We recommend directing patients to reliable information sources and attempting to control unreliable data sources to prevent online information pollution and reduce patients' surgical fear.
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Affiliation(s)
- Elif Gezginci
- Department of Surgical Nursing, Hamidiye Faculty of Nursing, University of Health Sciences, Istanbul, Turkey.
| | - Arife Cakin
- Occupational Health and Safety Program, Seben Izzet Baysal Vocational School, Abant Izzet Baysal University, Bolu, Turkey
| | - Sonay Goktas
- Department of Surgical Nursing, Hamidiye Faculty of Nursing, University of Health Sciences, Istanbul, Turkey
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Silva L, Abbas Mohamed S, Meggy A, Ng JH, Torkington J, Moug S, Watts T, Bisson J, Cornish JA. Psychosocial outcomes following emergency laparotomy (POLO) study: a study protocol for a multicentre mixed-methods prospective cohort study assessing the psycho-social outcomes following emergency laparotomy in adults. BMJ Open 2024; 14:e081821. [PMID: 38986553 PMCID: PMC11268063 DOI: 10.1136/bmjopen-2023-081821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/13/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Morbidity from an emergency laparotomy (EmLap) is difficult to define and poorly understood. Morbidity is a holistic concept, reliant upon an interplay of bio-psychosocial outcomes that evolve long after discharge. To date, no previous study has explored the psychosocial outcomes following EmLap as a collective, nor their change over time. This study aims to describe the holistic morbidity following EmLap within the first year following surgery. METHODS AND ANALYSIS This is a multicentre, mixed-methods prospective 12-month cohort study with two participant populations: patient participants and family caregivers (FCGs). A target of 160 adult patients who undergo EmLap and can give informed consent will be included in the patient participant group. Patient participants will be asked to complete three patient surveys, incorporating validated patient-reported outcome measures (PROMs) to assess bio-psychosocial outcomes (EuroQol five-dimension five-level (EQ5D-5L), Gastrointestinal Quality Life Index-36, Patient Health Questionnaire-9, Generalised Anxiety Disorder 7, International Trauma Questionnaire, Caregiver Interaction Scale and Fatigue Severity Scale) in the 12 months following surgery. A subgroup of 15 patient participants will be asked to take part in two semistructured interviews at 6 and 12 months. A target of 15 associated family caregivers will be included in the FCG group. FCGs will be asked to take part in a semi-structured interview at 6 months to assess the EmLap impact on the wider support network. The primary outcome will be a change in quality of life (EQ5D-5L) at 12 months. Secondary outcomes will be changes in bio-psychosocial status at 3 and 12 months. Qualitative analysis will allow contextualisation of PROMS and further explore themes of EmLap morbidity. It is anticipated that the results of this study will help inform and develop standards of aftercare for future EmLap patients. ETHICS AND DISSEMINATION This study has received ethical approval (Wales REC7;12/WA/0297) and will be undertaken in accordance with the principles of Good Clinical Practice. We intend to disseminate study results in peer-reviewed journals and medical conferences, as well as a lay report to study participants. TRIAL REGISTRATION NUMBER Clinical Trials.gov NCT05281627.
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Affiliation(s)
- Louise Silva
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
- Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | | | - Alun Meggy
- Research and Development, Cardiff and Vale University Hospital, Cardiff, UK
| | | | - Jared Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | | | - Tessa Watts
- School of Health Sciences, Cardiff University, Cardiff, UK
| | - Jonathan Bisson
- Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Julie A Cornish
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
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Juliana N, Abd Aziz NAS, Maluin SM, Abu Yazit NA, Azmani S, Kadiman S, Hafidz KM, Mohd Fahmi Teng NI, Das S. Nutritional Status and Post-Cardiac Surgery Outcomes: An Updated Review with Emphasis on Cognitive Function. J Clin Med 2024; 13:4015. [PMID: 39064055 PMCID: PMC11277625 DOI: 10.3390/jcm13144015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Nutritional status significantly influences cardiac surgery outcomes, with malnutrition contributing to poorer results and increased complications. This study addresses the critical gap in understanding by exploring the relationship between pre-operative nutritional status and post-operative cognitive dysfunction (POCD) in adult cardiac patients. Methods: A comprehensive search across key databases investigates the prevalence of malnutrition in pre-operative cardiac surgery patients, its effects, and its association with POCD. Factors exacerbating malnutrition, such as chronic illnesses and reduced functionality, are considered. The study also examines the incidence of POCD, its primary association with CABG procedures, and the impact of malnutrition on complications like inflammation, pulmonary and cardiac failure, and renal injury. Discussions: Findings reveal that 46.4% of pre-operative cardiac surgery patients experience malnutrition, linked to chronic illnesses and reduced functionality. Malnutrition significantly contributes to inflammation and complications, including POCD, with an incidence ranging from 15 to 50%. CABG procedures are particularly associated with POCD, and malnutrition prolongs intensive care stays while increasing vulnerability to surgical stress. Conclusions: The review underscores the crucial role of nutrition in recovery and advocates for a universally recognized nutrition assessment tool tailored to diverse cardiac surgery patients. Emphasizing pre-operative enhanced nutrition as a potential strategy to mitigate inflammation and improve cognitive function, the review highlights the need for integrating nutrition screening into clinical practice to optimize outcomes for high-risk cardiac surgery patients. However, to date, most data came from observational studies; hence, there is a need for future interventional studies to test the hypothesis that pre-operative enhanced nutrition can mitigate inflammation and improve cognitive function in this patient population.
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Affiliation(s)
- Norsham Juliana
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia; (S.M.M.); (S.A.)
| | - Nur Adilah Shuhada Abd Aziz
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | - Sofwatul Mokhtarah Maluin
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia; (S.M.M.); (S.A.)
| | - Noor Anisah Abu Yazit
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | - Sahar Azmani
- Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai 71800, Negeri Sembilan, Malaysia; (S.M.M.); (S.A.)
- KPJ Research Centre, KPJ Healthcare University, Nilai 71800, Negeri Sembilan, Malaysia
| | - Suhaini Kadiman
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | - Kamilah Muhammad Hafidz
- Department of Anesthesia and Intensive Care, Institut Jantung Negara, Kuala Lumpur 50400, Malaysia; (N.A.S.A.A.); (N.A.A.Y.); (S.K.); (K.M.H.)
| | | | - Srijit Das
- Department of Human & Clinical Anatomy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
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Studer AS, Atlas H, Belliveau M, Sleiman A, Deffain A, Garneau PY, Pescarus R, Denis R. Fully ambulatory robotic single anastomosis duodeno-ileal bypass (SADI): 40 consecutive patients in a single tertiary bariatric center. BMC Surg 2024; 24:204. [PMID: 38982419 PMCID: PMC11232187 DOI: 10.1186/s12893-024-02461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Single Anastomosis Duodeno-Ileal bypass (SADI) is becoming a key option as a revision procedure after laparoscopic sleeve gastrectomy (LSG). However, its safety as an ambulatory procedure (length of stay < 12 h) has not been widely described. METHODS A prospective bariatric study of 40 patients undergoing SADI robotic surgery after LSG with same day discharge (SDD), was undertaken in April 2021. Strict inclusion and exclusion criteria were applied and the enhanced recovery after bariatric surgery protocol was followed. Anesthesia and robotic procedures were standardized. Early follow-up (30 days) analyzed postoperative (PO) outcomes. RESULTS Forty patients (37 F/3 M, mean age: 40.3yo), with a mean pre-operative BMI = 40.5 kg/m2 were operated. Median time after LSG was 54 months (21-146). Preoperative comorbidities included: hypertension (n = 3), obstructive sleep apnea (n = 2) and type 2 diabetes (n = 1). Mean total operative time was 128 min (100-180) (mean robotic time: 66 min (42-85)), including patient setup. All patients were discharged home at least 6 h after surgery. There were four minor complications (10%) and two major complications (5%) in the first 30 days postoperative (one intrabdominal abscess PO day-20 (radiological drainage and antibiotic therapy) and one peritonitis due to duodenal leak PO day-1 (treated surgically)). There were six emergency department visits (15%), readmission rate was 5% (n = 2) and reintervention rate was 2.5% (n = 1) There was no mortality and no unplanned overnight hospitalization. CONCLUSIONS Robotic SADI can be safe for SDD, with appropriate patient selection, in a high-volume center.
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Affiliation(s)
- Anne-Sophie Studer
- Department of bariatric, robotic and minimally invasive surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada.
| | - Henri Atlas
- Department of bariatric, robotic and minimally invasive surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada
| | - Marc Belliveau
- Department of anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada
| | - Amir Sleiman
- Department of bariatric, robotic and minimally invasive surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada
| | - Alexis Deffain
- Department of bariatric, robotic and minimally invasive surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada
| | - Pierre Y Garneau
- Department of bariatric, robotic and minimally invasive surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada
| | - Radu Pescarus
- Department of bariatric, robotic and minimally invasive surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada
| | - Ronald Denis
- Department of bariatric, robotic and minimally invasive surgery, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada
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Ibrahim A, Steinvall I, Elawa S, Ellabban MA, Mohamed MK, Elmasry M, Abdelrahman I. Patient Weight and Chemoprophylaxis in Abdominoplasty: Does It Result in More Bleeding Events? Aesthetic Plast Surg 2024:10.1007/s00266-024-04220-w. [PMID: 38981898 DOI: 10.1007/s00266-024-04220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/21/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Bariatric surgery has gained popularity in recent decades as an effective treatment for obesity. Abdominoplasty is one of the most often performed aesthetic procedures all over the world. In post-bariatric patients undergoing abdominoplasty, the diameter size and number of the abdominal wall perforators increase proportionally with increased body weight. Postoperative complications that may occur are haematoma, and venous thromboembolism (VTE). In plastic surgery procedures VTE prophylaxis grades vary due to the lack of consensus and clear guidelines. The aim of this study was to explore the frequency of postoperative bleeding and VTE in patients undergoing abdominoplasty and to explore the risk factors associated with major bleeding. METHODS A retrospective single-centre study of adult patients who were operated on by abdominoplasty between 2011 and 2020. Chemoprophylaxis including low molecular weight heparin (LMHW) was recommended when the operating time exceeded 2 h. RESULTS A total of 102 patients were included. There were no patients with VTE. Eight patients were re-operated for major haematoma. The weight loss (peak weight to weight before the abdominoplasty) was 14.4 kg larger in the re-operation group (p = 0.03). Eighty-eight percent in the re-operation group and 67% in the other group were treated with LMWH (p = 0.43). Multivariable logistic regression showed that with each decrease from the peak in BMI kg/m2 the risk of re-operation for major haematoma was increased by 22% (p = 0.02). CONCLUSION Abdominoplasty in patients after massive weight loss has a higher risk of postoperative bleeding. Having a clear protocol for chemoprophylaxis should be considered. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ahmed Ibrahim
- Nottingham University Hospitals, Nottingham, England
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
| | - Sherif Elawa
- Department of Hand Surgery, Plastic Surgery and Burns and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
| | - Mohamed A Ellabban
- Department of Hand Surgery, Plastic Surgery and Burns and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
| | - Islam Abdelrahman
- Department of Hand Surgery, Plastic Surgery and Burns and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden.
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Cecconi M, Goretti G, Pradella A, Meroni P, Pisarra M, Torzilli G, Montorsi M, Spinelli A, Zerbi A, Castoro C, Casale P, Civilini E, Quagliuolo V, Klinger M, Spriano G, Vitobello D, Maradei L, Reimers B, Piccioni F, Martucci MR, Stomeo N, Vanni E, Babbini M, Monzani R, Capogreco MR, Lagioia M, Greco M. Value-based preoperative assessment in a large academic hospital. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:42. [PMID: 38978057 PMCID: PMC11232329 DOI: 10.1186/s44158-024-00161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Value-based healthcare (VBHC) is an approach that focuses on delivering the highest possible value for patients while driving cost efficiency in health services. It emphasizes improving patient outcomes and experiences while optimizing the use of resources, shifting the healthcare system's focus from the volume of services to the value delivered. Our study assessed the effectiveness of implementing a VBHC-principled, tailored preoperative evaluation in enhancing patient care and outcomes, as well as reducing healthcare costs. METHODS We employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs. RESULTS A total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51-72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes. CONCLUSIONS We demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.
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Affiliation(s)
- Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Giulia Goretti
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Pradella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Martina Pisarra
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Economics, Management and Quantitative Methods, University of Milan, Milan, 20122, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Montorsi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo Castoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Casale
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Efrem Civilini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vittorio Quagliuolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Klinger
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Domenico Vitobello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Leonardo Maradei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Cardiology, Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Federico Piccioni
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria Rosaria Martucci
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Niccolò Stomeo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Vanni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Babbini
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roberta Monzani
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo C, Lucas DN, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group. Reg Anesth Pain Med 2024; 49:471-501. [PMID: 37582578 DOI: 10.1136/rapm-2023-104817] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH. METHODS Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach. RESULTS Based on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence. CONCLUSIONS These clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients' interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.
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Affiliation(s)
- Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jessica Ansari
- Anesthesia Department, Stanford Health Care, Stanford, California, USA
| | - Zafeer Baber
- Department of Anesthesiology and Perioperative Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Yian Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Kathryn DelPizzo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Dan Sebastian Dirzu
- Anesthesia and Intensive Care, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Narayan R Kissoon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter G Kranz
- Depatement of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa Leffert
- Department of Anesthesiology, Yale New Haven Health System; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Lim
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics & Gynecology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Clara Lobo
- Anesthesiology Institute, Interventional Pain Medicine Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Dominique Nuala Lucas
- Department of Anaesthesia, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital - Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Stephen E Rodriguez
- Department of Anesthesia, Walter Reed Army Medical Center, Bethesda, Maryland, USA
| | - Herman Sehmbi
- Department of Anesthesia, Western University, London, Ontario, Canada
| | - Manuel C Vallejo
- Departments of Medical Education, Anesthesiology, Obstetrics & Gynecology, West Virginia University, Morgantown, West Virginia, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Samer Narouze
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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van Wyk L, Austin T, Barzilay B, Bravo MC, Breindahl M, Czernik C, Dempsey E, de Boode WP, de Vries W, Eriksen BH, Fauchére JC, Kooi EMW, Levy PT, McNamara PJ, Mitra S, Nestaas E, Rabe H, Rabi Y, Rogerson SR, Savoia M, Schena F, Sehgal A, Schwarz CE, Thome U, van Laere D, Zaharie GC, Gupta S. A recommendation for the use of electrical biosensing technology in neonatology. Pediatr Res 2024:10.1038/s41390-024-03369-z. [PMID: 38977797 DOI: 10.1038/s41390-024-03369-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/17/2024] [Accepted: 06/07/2024] [Indexed: 07/10/2024]
Abstract
Non-invasive cardiac output monitoring, via electrical biosensing technology (EBT), provides continuous, multi-parameter hemodynamic variable monitoring which may allow for timely identification of hemodynamic instability in some neonates, providing an opportunity for early intervention that may improve neonatal outcomes. EBT encompasses thoracic (TEBT) and whole body (WBEBT) methods. Despite the lack of relative accuracy of these technologies, as compared to transthoracic echocardiography, the use of these technologies in neonatology, both in the research and clinical arena, have increased dramatically over the last 30 years. The European Society of Pediatric Research Special Interest Group in Non-Invasive Cardiac Output Monitoring, a group of experienced neonatologists in the field of EBT, deemed it appropriate to provide recommendations for the use of TEBT and WBEBT in the field of neonatology. Although TEBT is not an accurate determinant of cardiac output or stroke volume, it may be useful for monitoring longitudinal changes of hemodynamic parameters. Few recommendations can be made for the use of TEBT in common neonatal clinical conditions. It is recommended not to use WBEBT to monitor cardiac output. The differences in technologies, study methodologies and data reporting should be addressed in ongoing research prior to introducing EBT into routine practice. IMPACT STATEMENT: TEBT is not recommended as an accurate determinant of cardiac output (CO) (or stroke volume (SV)). TEBT may be useful for monitoring longitudinal changes from baseline of hemodynamic parameters on an individual patient basis. TEBT-derived thoracic fluid content (TFC) longitudinal changes from baseline may be useful in monitoring progress in respiratory disorders and circulatory conditions affecting intrathoracic fluid volume. Currently there is insufficient evidence to make any recommendations regarding the use of WBEBT for CO monitoring in neonates. Further research is required in all areas prior to the implementation of these monitors into routine clinical practice.
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Affiliation(s)
- Lizelle van Wyk
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - Topun Austin
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Bernard Barzilay
- Neonatal Intensive Care Unit, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Maria Carmen Bravo
- Department of Neonatology, La Paz University Hospital and IdiPaz, Madrid, Spain
| | - Morten Breindahl
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoph Czernik
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Willem-Pieter de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Willem de Vries
- Division of Woman and Baby, Department of Neonatology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Beate Horsberg Eriksen
- Department of Paediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jean-Claude Fauchére
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elisabeth M W Kooi
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Centre, Groningen, The Netherlands
| | - Philip T Levy
- Department of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Subhabrata Mitra
- Institute for Women's Health, University College London, London, UK
| | - Eirik Nestaas
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Clinic of Paediatrics and Adolescence, Akershus University Hospital, Lørenskog, Norway
| | - Heike Rabe
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
| | - Marilena Savoia
- Neonatal Intensive Care Unit, S Maria Della Misericordia Hospital, Udine, Italy
| | | | - Arvind Sehgal
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - Christoph E Schwarz
- Department of Neonatology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Thome
- Division of Neonatology, Department of Pediatrics, University of Leipzig Medical Centre, Leipzig, Germany
| | - David van Laere
- Neonatal Intensive Care Unit, Universitair Ziekenhuis, Antwerp, Belgium
| | - Gabriela C Zaharie
- Neonatology Department, University of Medicine and Pharmacy, Iuliu Hatieganu, Cluj -Napoca, Romania
| | - Samir Gupta
- Department of Engineering, Durham University, Durham, UK
- Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar
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He Y, Zhang Z, Li R, Hu D, Gao H, Liu Y, Liu H, Feng S, Liu H, Zhong M, Li Y, Wang Y, Ma W. National survey on the current status of airway management in China. Sci Rep 2024; 14:15627. [PMID: 38972909 PMCID: PMC11228041 DOI: 10.1038/s41598-024-66526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024] Open
Abstract
Apparently, understanding airway management status may help to reduce risk and improve clinical practice. Given these facts, our team conducted a second survey on the current status of airway management for mainland China following our 2016 national airway survey. The national survey was conducted from November 7 to November 28, 2022. An electronic survey was sent to the New Youth Anesthesia Forum, where Chinese anesthesiologists completed the questionnaire via WeChat. A total of 3783 respondents completed the survey, with a response rate of 72.14%. So far, in 2022, 34.84% of anesthesiologists canceled or delayed surgery at least once due to difficult airway. For the anticipated difficult airway management, 66.11% of physicians would choose awake intubation under sedation and topical anesthesia, while the percentage seeking help has decreased compared to the 2016 survey. When encountering an emergency, 74.20% of respondents prefer to use the needle cricothyrotomy, albeit less than a quarter have actually performed it. Anesthesiologists with difficult airway training experience reached 72.96%, with a significant difference in participation between participants in Tier 3 hospitals and those in other levels of hospitals (P < 0.001). The videolaryngoscope, laryngeal mask, and flexible intubation scope were equipped at 97.18%, 95.96%, and 62.89%, respectively. Additionally, the percentage of brain damage or death caused by difficult airways was significantly decreased. The study may be the best reference for understanding the current status of airway management in China, revealing the current advancements and deficiencies. The future focus of airway management remains on training and education.
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Affiliation(s)
- Yuewen He
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Zhengze Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Ruogen Li
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Die Hu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Huan Gao
- Department of Anesthesiology, Fangcheng County People's Hospital, Henan, People's Republic of China
| | - Yurui Liu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Hao Liu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Siqi Feng
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Huihui Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Ming Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yuhui Li
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China.
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China.
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Wijma AG, Hogenbirk RNM, Driessens H, Kluifhooft DA, Jellema-Betten ES, Tjalsma-de Vries M, Liem MSL, Nieuwenhuijs VB, Manusama EM, Hoogwater FJH, Nijkamp MW, Beijer S, Klaase JM. Nutritional support in pancreatic cancer patients and its effect on nutritional status: an observational regional HPB network study investigating current practice. Support Care Cancer 2024; 32:487. [PMID: 38967804 PMCID: PMC11226478 DOI: 10.1007/s00520-024-08683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Preoperative malnutrition is associated with poor postoperative outcomes in patients with pancreatic cancer. This study evaluated the effectiveness of current practice in nutritional support for patients with pancreatic cancer. METHODS Observational multicenter HPB network study conducted at the Isala Clinics Zwolle, Medical Spectrum Twente, Medical Center Leeuwarden, and University Medical Center Groningen between October 2021 and May 2023. Patients with a suspected pancreatic malignancy scheduled for surgery were screened for malnutrition using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and referred to a dedicated dietician for nutritional support comprising pancreatic enzyme replacement therapy, dietary advice, and nutritional supplements to achieve adequate caloric and protein intake. At baseline, 1 day preoperatively, and 3 months postoperatively, the nutritional status and muscle thickness were evaluated. RESULTS The study included 30 patients, of whom 12 (40%) classified as malnourished (PG-SGA ≥ 4) at baseline. Compared to well-nourished patients, malnourished patients were younger, were predominantly female, and had a higher body mass index, despite having lost more body weight in the past 6 months. All malnourished patients and 78% of the well-nourished patients received nutritional support. Consequently, a preoperative increase in caloric and protein intake and body weight were observed. Postoperatively, despite a further increase in caloric intake, a considerable decrease in protein intake, body weight, and muscle thickness was observed. CONCLUSION Malnutrition is prevalent in patients undergoing pancreatic surgery. Nutritional support by a dedicated dietician is effective in enhancing patients' preoperative nutritional status. However, postoperative monitoring of adequate nutritional intake in patients could be improved.
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Affiliation(s)
- Allard G Wijma
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Rianne N M Hogenbirk
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Heleen Driessens
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Ellen S Jellema-Betten
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlies Tjalsma-de Vries
- Department of Dietetics and Nutrition, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mike S L Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | | | - Eric M Manusama
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten W Nijkamp
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra Beijer
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Li L, Du L, Chen G, Zhang W, Du B, Zhang L, Zheng J. Stroke volume variation induced by lung recruitment maneuver to predict fluid responsiveness in patients receiving mechanical ventilation: A systematic review and meta-analysis. J Clin Anesth 2024; 97:111545. [PMID: 38971135 DOI: 10.1016/j.jclinane.2024.111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/04/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
STUDY OBJECTIVE The aim of this study was to evaluate the accuracy of lung recruitment maneuver induced stroke volume variation (ΔSVLRM) in predicting fluid responsiveness in mechanically ventilated adult patients by systematic review and meta-analysis. METHODS A comprehensive electronic search of relevant literature was conducted in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang and VIP databases). Review Manager 5.4, Meta-DiSc 1.4 and STATA 16.0 were selected for data analysis, and QUADAS-2 tool was used for quality assessment. Data from selected studies were pooled to obtain sensitivity, specificity, diagnostic likelihood ratio (DLR) of positive and negative, diagnostic odds ratio (DOR), and summary receiver operating characteristic curve. RESULTS A total of 6 studies with 256 patients were enrolled through March 2024. The risk of bias and applicability concerns for each included study were low, and there was no significant publication bias. There was moderate to substantial heterogeneity for the non-threshold effect, but not for the threshold effect. The combined sensitivity and specificity were 0.84 (95% CI, 0.77-0.90) and 0.79 (95% CI, 0.70-0.86), respectively. The DOR and the area under the curve (AUC) were 22.15 (95%CI, 7.62-64.34) and 0.90 (95% CI, 0.87-0.92), respectively. The positive and negative predictive values of DLR were 4.53 (95% CI, 2.50-8.18) and 0.19 (95% CI, 0.11-0.35), respectively. Fagan's nomogram showed that with a pre-test probability of 52%, the post-test probability reached 83% and 17% for the positive and negative tests, respectively. CONCLUSIONS Based on the currently available evidence, ΔSVLRM has a good diagnostic value for predicting the fluid responsiveness in adult patients undergoing mechanical ventilation. Given the heterogeneity and limitations of the published data, further studies with large sample sizes and different clinical settings are needed to confirm the diagnostic value of ΔSVLRM in predicting fluid responsiveness. PROSPERO registration number: CRD42023490598.
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Affiliation(s)
- Lu Li
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China.
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55th, People's South Road, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Weiyi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China.
| | - Bin Du
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Lu Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China
| | - Jianqiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China.
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Aldana EM, Pérez de Arriba N, Valverde JL, Aldecoa C, Fábregas N, Fernández-Candil JL. National survey on perioperative cognitive dysfunction. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00122-7. [PMID: 38972351 DOI: 10.1016/j.redare.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Perioperative cognitive dysfunction (PCD) is a very prevalent clinical syndrome due to the progressive aging of the surgical population.The aim of our study is to evaluate the clinical practice of Spanish anesthesiologists surveyed regarding this entity. MATERIAL AND METHODS Prospective online survey conducted by the Neurosciences Section and distributed by SEDAR. RESULTS 544 responses were obtained, with a participation rate of 17%. 54.4% of respondents never make a preoperative assessment of cognitive impairment, only 7.5% always do it. 79.6% lack an intraoperative management protocol for the patient at risk of PCD. In the anesthetic planning, only 23.3% of the patients was kept in mind. Eighty-nine percent considered regional anesthesia with or without sedation preferable to general anesthesia for the prevention of PCD. 88.8% considered benzodiazepines to present a high risk of PCD. 71.7% considered that anesthetic depth monitoring could prevent postoperative cognitive deficit. Routine evaluation of postoperative delirium is low, only 14%. More than 80% recognize that PCD is underdiagnosed. CONCLUSIONS Among Spanish anesthesiologists surveyed, PCD is still a little known and underappreciated entity. It is necessary to raise awareness of the need to detect risk factors for PCD, as well as postoperative assessment and diagnosis. Therefore, the development of guidelines and protocols and the implementation of continuing education programs in which anesthesiologists should be key members of multidisciplinary teams in charge of perioperative care are suggested.
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Affiliation(s)
- E M Aldana
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, Spain.
| | - N Pérez de Arriba
- Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J L Valverde
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, Spain
| | - C Aldecoa
- Anestesiología y Reanimación, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - N Fábregas
- Anestesiología y Reanimación, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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Gao Z, Huang C, Fang S, Guan J, Dong W. Association between preoperative white blood cell counts and thirty-day surgical mortality after craniotomy in adult intracranial tumor patients. Front Neurol 2024; 15:1394568. [PMID: 39036628 PMCID: PMC11259970 DOI: 10.3389/fneur.2024.1394568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Objective White blood cell (WBC) counts has been identified as a prognostic biomarker which frequently predict adverse outcomes and mortality risk in various conditions. However, evidence for the association between WBC counts and short-term outcomes after intracranial tumor resection remains limited. This study aimed to explore associations between preoperative WBC counts and thirty-day surgical mortality after craniotomy in adult intracranial tumor patients. Methods This retrospective cohort study performed secondary analysis of 18,049 intracranial tumor craniotomy patients from the ACS NSQIP database (2012-2015). The major exposure and outcome were preoperative WBC counts and thirty-day surgical mortality, respectively. Cox regression modeling assessed the linear association between them. Non-linear associations between them were evaluated by conducting smooth curve fitting using an additive Cox proportional hazard model in conjunction with segmented linear regression modeling. Subgroup analysis and interaction testing assessed effect modification. Sensitivity analysis evaluated result robustness. Results The total thirty-day surgical mortality after craniotomy was 2.49% (450/18,049). The mean of preoperative WBC counts was 9.501 ± 4.402 × 10^9/L. Fully adjusted model shows that elevated preoperative WBC counts was independently associated with increased thirty-day surgical mortality (HR = 1.057, 95%CI: 1.040, 1.076). Further analysis revealed a non-linear association between them: below a WBC threshold of 13.6 × 10^9/L, higher WBC counts elevated thirty-day mortality (HR = 1.117; 95%CI: 1.077, 1.158), while risk plateaued and no significant mortality rise occurred above this level (HR = 1.015, 95%CI: 0.982, 1.050). Steroid usage status has a significant effect modification on the WBC-mortality association (P for interaction = 0.002). The non-linear WBC-mortality association was only present for non-steroid users (HR = 1.158, 95%CI: 1.108, 1.210) but not steroid users (HR = 1.009, 95%CI: 0.966, 1.055). The sensitivity analysis confirmed the result robustness. Conclusion Elevated preoperative WBC counts were independently and non-linearly associated with an increased risk of thirty-day surgical mortality in adult non-steroid use patients undergoing craniotomy for intracranial tumors. As a convenient predictor, preoperative WBC data allows improved risk profiling and personalized management in adult intracranial tumor patients.
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Affiliation(s)
- Zhichao Gao
- Department of Neurosurgery, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Cheng Huang
- Department of Coloproctology, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Shengjie Fang
- Department of Neurosurgery, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Jiaqing Guan
- Department of Neurosurgery, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Weifeng Dong
- Department of Neurosurgery, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
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Zong M, Zhao A, Han W, Chen Y, Weng T, Li S, Tang L, Wu J. Sarcopenia, sarcopenic obesity and the clinical outcome of the older inpatients with COVID-19 infection: a prospective observational study. BMC Geriatr 2024; 24:578. [PMID: 38965468 PMCID: PMC11223396 DOI: 10.1186/s12877-024-05177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE We aimed to investigate the impact of sarcopenia and sarcopenic obesity (SO) on the clinical outcome in older patients with COVID-19 infection and chronic disease. METHODS We prospectively collected data from patients admitted to Huadong Hospital for COVID-19 infection between November 1, 2022, and January 31, 2023. These patients were included from a previously established comprehensive geriatric assessment (CGA) cohort. We collected information on their pre-admission condition regarding sarcopenia, SO, and malnutrition, as well as their medical treatment. The primary endpoint was the incidence of intubation, while secondary endpoints included in-hospital mortality rates. We then utilized Kaplan-Meier (K-M) survival curves and the log-rank tests to compare the clinical outcomes related to intubation or death, assessing the impact of sarcopenia and SO on patient clinical outcomes. RESULTS A total of 113 patients (age 89.6 ± 7.0 years) were included in the study. Among them, 51 patients had sarcopenia and 39 had SO prior to hospitalization. Intubation was required for 6 patients without sarcopenia (9.7%) and for 18 sarcopenia patients (35.3%), with 16 of these being SO patients (41%). Mortality occurred in 2 patients without sarcopenia (3.3%) and in 13 sarcopenia patients (25.5%), of which 11 were SO patients (28%). Upon further analysis, patients with SO exhibited significantly elevated risks for both intubation (Hazard Ratio [HR] 7.43, 95% Confidence Interval [CI] 1.26-43.90, P < 0.001) and mortality (HR 6.54, 95% CI 1.09-39.38, P < 0.001) after adjusting for confounding factors. CONCLUSIONS The prevalence of sarcopenia or SO was high among senior inpatients, and both conditions were found to have a significant negative impact on the clinical outcomes of COVID-19 infection. Therefore, it is essential to regularly assess and intervene in these conditions at the earliest stage possible.
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Affiliation(s)
- Min Zong
- Department of Clinical nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Anda Zhao
- Department of Clinical nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Weijia Han
- Department of Clinical nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Yanqiu Chen
- Department of Clinical nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Tingwen Weng
- Department of Geriatrics, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Shijie Li
- Department of Clinical nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Lixin Tang
- Department of Clinical nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Jiang Wu
- Department of Clinical nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China.
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Ledesma I, Stieger A, Luedi MM, Romero CS. Spinal anesthesia in ambulatory patients. Curr Opin Anaesthesiol 2024:00001503-990000000-00211. [PMID: 38979677 DOI: 10.1097/aco.0000000000001412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
PURPOSE OF THIS REVIEW To assess current practice in the use of spinal anesthesia in major ambulatory surgery, highlighting its advantages over general anesthesia and identifying potential areas for improvement to facilitate a transition to a sustainable healthcare system. RECENT FINDINGS Spinal anesthesia might be preferred in selected populations when compared to general anesthesia providing the highest standards of healthcare quality.The use of local anesthetics with short half-life has proven to be efficient in achieving high anesthesia success rates. Spinal anesthesia does not increase perioperative complications; instead, it has shown a reduction in postoperative nausea and vomiting, an improvement in patient comfort, and a favorable economic impact when compared to general anesthesia. SUMMARY Spinal anesthesia is an appropriate method for anesthesia in ambulatory patients, offering advantages over general anesthesia in selected populations.The use of spinal anesthesia is expanding to meet surgical needs. Therefore, it is crucial to plan ahead and anticipate organizational failures in the ambulatory setting to maintain safety and efficiency during outpatient procedures and surgeries.
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Affiliation(s)
- Ignacio Ledesma
- Department of Anaesthesiology and Critical Care, Hospital General Universitario De Valencia, Valencia, Spain
| | - Andrea Stieger
- Department of Anaesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anaesthesiology, Rescue- and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S Romero
- Department of Anaesthesiology and Critical Care, Hospital General Universitario De Valencia, Valencia, Spain; Research Methods Department, Universidad Europea de Valencia, Valencia, Spain
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Cheney MA, Smith MP, Burkhardt JN, Davis WT, Brown DJ, Horn C, Hare J, Alderman M, Nelson E, Proctor M, Goodman M, Sams V, Thiele R, Strilka RJ. The Ability of Military Critical Care Air Transport Members to Visually Estimate Percent Systolic Pressure Variation. Mil Med 2024; 189:1514-1522. [PMID: 37489875 DOI: 10.1093/milmed/usad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/02/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Inappropriate fluid management during patient transport may lead to casualty morbidity. Percent systolic pressure variation (%SPV) is one of several technologies that perform a dynamic assessment of fluid responsiveness (FT-DYN). Trained anesthesia providers can visually estimate and use %SPV to limit the incidence of erroneous volume management decisions to 1-4%. However, the accuracy of visually estimated %SPV by other specialties is unknown. The aim of this article is to determine the accuracy of estimated %SPV and the incidence of erroneous volume management decisions for Critical Care Air Transport (CCAT) team members before and after training to visually estimate and utilize %SPV. MATERIAL AND METHODS In one sitting, CCAT team providers received didactics defining %SPV and indicators of fluid responsiveness and treatment with %SPV ≤7 and ≥14.5 defining a fluid nonresponsive and responsive patient, respectively; they were then shown ten 45-second training arterial waveforms on a simulated Propaq M portable monitor's screen. Study subjects were asked to visually estimate %SPV for each arterial waveform and queried whether they would treat with a fluid bolus. After each training simulation, they were told the true %SPV. Seven days post-training, the subjects were shown a different set of ten 45-second testing simulations and asked to estimate %SPV and choose to treat, or not. Nonparametric limits of agreement for differences between true and estimated %SPV were analyzed using Bland-Altman graphs. In addition, three errors were defined: (1) %SPV visual estimate errors that would label a volume responsive patient as nonresponsive, or vice versa; (2) incorrect treatment decisions based on estimated %SPV (algorithm application errors); and (3) incorrect treatment decisions based on true %SPV (clinically significant treatment errors). For the training and testing simulations, these error rates were compared between, and within, provider groups. RESULTS Sixty-one physicians (MDs), 64 registered nurses (RNs), and 53 respiratory technicians (RTs) participated in the study. For testing simulations, the incidence and 95% CI for %SPV estimate errors with sufficient magnitude to result in a treatment error were 1.4% (0.5%, 3.2%), 1.6% (0.6%, 3.4%), and 4.1% (2.2%, 6.9%) for MDs, RNs, and RTs, respectively. However, clinically significant treatment errors were statistically more common for all provider types, occurring at a rate of 7%, 10%, and 23% (all P < .05). Finally, students did not show clinically relevant reductions in their errors between training and testing simulations. CONCLUSIONS Although most practitioners correctly visually estimated %SPV and all students completed the training in interpreting and applying %SPV, all groups persisted in making clinically significant treatment errors with moderate to high frequency. This suggests that the treatment errors were more often driven by misapplying FT-DYN algorithms rather than by inaccurate visual estimation of %SPV. Furthermore, these errors were not responsive to training, suggesting that a decision-making cognitive aid may improve CCAT teams' ability to apply FT-DYN technologies.
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Affiliation(s)
- Mark A Cheney
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Anesthesiology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Maia P Smith
- Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, OH 45324, USA
| | - Joshua N Burkhardt
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
| | - William T Davis
- United States Air Force En Route Care Research Center, 59th Medical Wing, Science and Technology, Lackland AFB TX 78236, USA
| | - Daniel J Brown
- Department of Emergency Medicine, Wright State University, Dayton, OH 45324, USA
| | - Christopher Horn
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Jonathan Hare
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Mark Alderman
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Eric Nelson
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Melissa Proctor
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Michael Goodman
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Valerie Sams
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Robert Thiele
- Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville, VA 22903, USA
| | - Richard J Strilka
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
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Bakkes THGF, Mestrom EHJ, Ourahou N, Kaymak U, de Andrade Serra PJ, Mischi M, Bouwman AR, Turco S. Predictive modeling of perioperative patient deterioration: combining unanticipated ICU admissions and mortality for improved risk prediction. Perioper Med (Lond) 2024; 13:66. [PMID: 38956723 PMCID: PMC11220961 DOI: 10.1186/s13741-024-00420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE This paper presents a comprehensive analysis of perioperative patient deterioration by developing predictive models that evaluate unanticipated ICU admissions and in-hospital mortality both as distinct and combined outcomes. MATERIALS AND METHODS With less than 1% of cases resulting in at least one of these outcomes, we investigated 98 features to identify their role in predicting patient deterioration, using univariate analyses. Additionally, multivariate analyses were performed by employing logistic regression (LR) with LASSO regularization. We also assessed classification models, including non-linear classifiers like Support Vector Machines, Random Forest, and XGBoost. RESULTS During evaluation, careful attention was paid to the data imbalance therefore multiple evaluation metrics were used, which are less sensitive to imbalance. These metrics included the area under the receiver operating characteristics, precision-recall and kappa curves, and the precision, sensitivity, kappa, and F1-score. Combining unanticipated ICU admissions and mortality into a single outcome improved predictive performance overall. However, this led to reduced accuracy in predicting individual forms of deterioration, with LR showing the best performance for the combined prediction. DISCUSSION The study underscores the significance of specific perioperative features in predicting patient deterioration, especially revealed by univariate analysis. Importantly, interpretable models like logistic regression outperformed complex classifiers, suggesting their practicality. Especially, when combined in an ensemble model for predicting multiple forms of deterioration. These findings were mostly limited by the large imbalance in data as post-operative deterioration is a rare occurrence. Future research should therefore focus on capturing more deterioration events and possibly extending validation to multi-center studies. CONCLUSIONS This work demonstrates the potential for accurate prediction of perioperative patient deterioration, highlighting the importance of several perioperative features and the practicality of interpretable models like logistic regression, and ensemble models for the prediction of several outcome types. In future clinical practice these data-driven prediction models might form the basis for post-operative risk stratification by providing an evidence-based assessment of risk.
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Affiliation(s)
- Tom H G F Bakkes
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | | | - Nassim Ourahou
- Anesthesiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Uzay Kaymak
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Massimo Mischi
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Arthur R Bouwman
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Anesthesiology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Simona Turco
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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LaColla L, Nanez MA, Frabitore S, Lavage DR, Warraich N, Luke C, Sultan I, Sadhasivam S, Subramaniam K. Intravenous Methadone versus Intrathecal Morphine as Part of an Enhanced Recovery After Cardiac Surgery Protocol on Postoperative Pain and Outcomes: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00424-5. [PMID: 39043493 DOI: 10.1053/j.jvca.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Evaluate the effect of intravenous (IV) methadone versus intrathecal morphine (ITM) within an Enhanced Recovery After Cardiac Surgery (ERACS) pathway on postoperative pain and outcomes (length of hospital stay and postoperative complications) after cardiac surgery. DESIGN Retrospective cohort study. SETTING Two tertiary academic medical institutions within the same health system. PARTICIPANTS Eligible 289 adult patients undergoing elective cardiac surgery with an enhanced recovery pathway from January 2020 through July 2021. INTERVENTIONS Patients were administered ITM (0.25 mg) or IV methadone (0.1 mg/kg) if ITM was contraindicated. All patients were enrolled in an ERACS pathway using current Enhanced Recovery After Surgery society guidelines. MEASUREMENTS AND MAIN RESULTS Primary outcome measures included postoperative pain scores and opioid consumption measured as oral morphine equivalents. We analyzed patient demographics, procedural factors, intraoperative medications, and outcomes. Adjusted linear mixed models were fit to analyze associations between intervention and pain outcomes. ITM was associated with decrease in pain scores on postoperative day 0 after adjusting for clinical variables (average marginal effect, 0.49; 95% confidence interval, 0.002-0.977; p = 0.049). No difference in opioid consumption could be demonstrated between groups after adjusting for postoperative day and other variables of interest. CONCLUSIONS ITM when compared with IV methadone was associated with a decrease in pain scores without any difference in opioid consumption after elective cardiac surgery. Methadone can be considered as a safe and effective alternative to ITM for ERACS protocols. Future large prospective studies are needed to validate this finding and further improve analgesia and safety.
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Affiliation(s)
- Luca LaColla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maria A Nanez
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Stephen Frabitore
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Danielle R Lavage
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nav Warraich
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Charles Luke
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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137
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Rong LQ, Luhmann G, Di Franco A, Dimagli A, Perry LA, Martinez AP, Demetres M, Mazer CD, Bellomo R, Gaudino M. Pulmonary artery catheter use and in-hospital outcomes in cardiac surgery: a systematic review and meta-analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae129. [PMID: 38976638 PMCID: PMC11254303 DOI: 10.1093/icvts/ivae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/18/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To determine the association of intraoperative pulmonary artery catheter (PAC) use with in-hospital outcomes in cardiac surgical patients. METHODS MEDLINE, Embase, and Cochrane Library (Wiley) databases were screened for studies that compared cardiac surgical patients receiving intraoperative PAC with controls and reporting in-hospital mortality. Secondary outcomes included intensive care unit length of stay, cost of hospitalization, fluid volume administered, intubation time, inotropes use, acute kidney injury (AKI), stroke, myocardial infarction (MI), and infections. RESULTS Seven studies (25 853 patients, 88.6% undergoing coronary artery bypass graft surgery) were included. In-hospital mortality was significantly increased with PAC use [odds ratio (OR) 1.57; 95% confidence interval (CI) 1.12-2.20, P = 0.04]; PAC use was also associated with greater intraoperative inotrope use (OR 2.61; 95% CI 1.54-4.41) and costs [standardized mean difference (SMD) = 0.20; 95% CI 0.16-0.23], longer intensive care unit stay (SMD = 0.29; 95% CI 0.25-0.33), and longer intubation time (SMD = 0.44; 95% CI 0.12-0.76). CONCLUSIONS PAC use is associated with significantly increased odds of in-hospital mortality, but the amount and quality of the available evidence is limited. Prospective randomized trials testing the effect of PAC on the outcomes of cardiac surgical patients are urgently needed.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Grant Luhmann
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Luke A Perry
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew P Martinez
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell Medicine, New York, NY, USA
| | - C David Mazer
- Departments of Anaesthesia and Critical Care, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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Wang QH, Yang JJ, Han W, Wang HN. Comment on "The Diagnostic and Prognostic Value of miR‑155 in Cancers: An Updated Meta‑analysis". Mol Diagn Ther 2024; 28:507-508. [PMID: 38780684 DOI: 10.1007/s40291-024-00710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Qing-Hua Wang
- Department of Gastroenterology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, 215300, Jiangsu, People's Republic of China
| | - Jing-Jing Yang
- Department of Gastroenterology, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, 215300, Jiangsu, People's Republic of China
| | - Wei Han
- Department of General Surgery, Kunshan First People's Hospital Affiliated to Jiangsu University, Kunshan, 215300, Jiangsu, People's Republic of China
| | - Hao-Nan Wang
- Oncology Department, Wuxi Fifth People's Hospital, Wuxi, 214000, Jiangsu, People's Republic of China.
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Vetsch T, Eggmann S, Jardot F, von Gernler M, Engel D, Beilstein CM, Wuethrich PY, Eser P, Wilhelm M. Ventilatory efficiency as a prognostic factor for postoperative complications in patients undergoing elective major surgery: a systematic review. Br J Anaesth 2024; 133:178-189. [PMID: 38644158 DOI: 10.1016/j.bja.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Major surgery is associated with high complication rates. Several risk scores exist to assess individual patient risk before surgery but have limited precision. Novel prognostic factors can be included as additional building blocks in existing prediction models. A candidate prognostic factor, measured by cardiopulmonary exercise testing, is ventilatory efficiency (VE/VCO2). The aim of this systematic review was to summarise evidence regarding VE/VCO2 as a prognostic factor for postoperative complications in patients undergoing major surgery. METHODS A medical library specialist developed the search strategy. No database-provided limits, considering study types, languages, publication years, or any other formal criteria were applied to any of the sources. Two reviewers assessed eligibility of each record and rated risk of bias in included studies. RESULTS From 10,082 screened records, 65 studies were identified as eligible. We extracted adjusted associations from 32 studies and unadjusted from 33 studies. Risk of bias was a concern in the domains 'study confounding' and 'statistical analysis'. VE/VCO2 was reported as a prognostic factor for short-term complications after thoracic and abdominal surgery. VE/VCO2 was also reported as a prognostic factor for mid- to long-term mortality. Data-driven covariable selection was applied in 31 studies. Eighteen studies excluded VE/VCO2 from the final multivariable regression owing to data-driven model-building approaches. CONCLUSIONS This systematic review identifies VE/VCO2 as a predictor for short-term complications after thoracic and abdominal surgery. However, the available data do not allow conclusions about clinical decision-making. Future studies should select covariables for adjustment a priori based on external knowledge. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022369944).
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Affiliation(s)
- Thomas Vetsch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - François Jardot
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc von Gernler
- Medical Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Boden I, Reeve J, Jernås A, Denehy L, Fagevik Olsén M. Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data. J Physiother 2024; 70:216-223. [PMID: 38472053 DOI: 10.1016/j.jphys.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
QUESTIONS Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? DESIGN Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. PARTICIPANTS Adults undergoing major elective abdominal surgery. INTERVENTIONS Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. OUTCOME MEASURES PPC, hospital length of stay and 12-month mortality. RESULTS Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD -3.2 days, 95% CI -6.2 to -0.3). Effects on mortality were uncertain. CONCLUSION There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.
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Affiliation(s)
- Ianthe Boden
- University of Tasmania, Launceston, Tasmania, Australia; Launceston General Hospital, Launceston, Australia.
| | - Julie Reeve
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Physiotherapy Department, North Shore Hospital, Auckland, New Zealand
| | - Anna Jernås
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia; Peter McCallum Cancer Centre, Melbourne, Australia
| | - Monika Fagevik Olsén
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Chang OLB, Pawar N, Whitlock EL, Miller B, Possin KL. Gaps in cognitive care among older patients undergoing spine surgery. J Am Geriatr Soc 2024; 72:2133-2139. [PMID: 38407475 PMCID: PMC11226354 DOI: 10.1111/jgs.18843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Among older adults undergoing surgery, postoperative delirium is the most common complication. Cognitive impairment and dementia are major risk factors for postoperative delirium, yet they are frequently under-recognized. It is well established that applying delirium preventive interventions to at-risk individuals can reduce the likelihood of delirium by up to 40%. The aim of this study was to evaluate how often delirium preventive interventions are missing in patients at risk for delirium due to baseline cognitive impairment. METHODS We conducted a retrospective study using data from the observational study Perioperative Anesthesia Neurocognitive Disorder Assessment-Geriatric (PANDA-G) and clinical data from the University of California San Francisco delirium prevention bundle. Patients age 65+ received preoperative multidomain cognitive assessment as part of a research protocol prior to undergoing inpatient spine surgery at a single major academic institution. Results of the cognitive testing were not available to clinical teams. Using electronic medical records, we evaluated if patients who were cognitively impaired at baseline received delirium prevention orders, sleep orders, and avoidance of AGS Beers Criteria® potentially inappropriate medications. RESULTS Of the 245 patients included in the study, 42% were women. The mean [SD] age was 72 [5.2] years. Preoperative cognitive impairment was identified in 40% of participants (N = 98), and of these, 34% had postoperative delirium. Of patients with preoperative cognitive impairment, 45% did not receive delirium preventive orders, 43% received PIMs, and 49% were missing sleep orders. At least one of the three delirium preventive interventions was missing in 70% of the patients. DISCUSSION Undiagnosed preoperative cognitive impairment among older adults undergoing spine surgery is common. When cognitive test results were not available to clinicians, patients with baseline cognitive impairment frequently did not receive evidence-based delirium preventive interventions. These findings highlight an opportunity to improve perioperative brain health care via preoperative cognitive assessment and clinical communication.
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Affiliation(s)
- Odmara L. Barreto Chang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Niti Pawar
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth L. Whitlock
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Bruce Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
| | - Katherine L. Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
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Grob CA, Angehrn LW, Kaufmann M, Hahnloser D, Winiker M, Erb TO, Joller S, Schumacher P, Bruppacher HR, O'Grady G, Murtagh J, Gawria L, Albers K, Meier S, Heilbronner Samuel AR, Schindler C, Steiner LA, Dell-Kuster S. The number of comorbidities as an important cofactor to ASA class in predicting postoperative outcome: An international multicentre cohort study. Acta Anaesthesiol Scand 2024. [PMID: 38951959 DOI: 10.1111/aas.14494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Multimorbidity is a growing burden in our ageing society and is associated with perioperative morbidity and mortality. Despite several modifications to the ASA physical status classification, multimorbidity as such is still not considered. Thus, the aim of this study was to quantify the burden of comorbidities in perioperative patients and to assess, independent of ASA class, its potential influence on perioperative outcome. METHODS In a subpopulation of the prospective ClassIntra® validation study from eight international centres, type and severity of anaesthesia-relevant comorbidities were additionally extracted from electronic medical records for the current study. Patients from the validation study were of all ages, undergoing any type of in-hospital surgery and were followed up until 30 days postoperatively to assess perioperative outcomes. Primary endpoint was the number of comorbidities across ASA classes. The associated postoperative length of hospital stay (pLOS) and Comprehensive Complication Index (CCI®) were secondary endpoints. On a scale from 0 (no complication) to 100 (death) the CCI® measures the severity of postoperative morbidity as a weighted sum of all postoperative complications. RESULTS Of 1421 enrolled patients, the mean number of comorbidities significantly increased from 1.5 in ASA I (95% CI, 1.1-1.9) to 10.5 in ASA IV (95% CI, 8.3-12.7) patients. Furthermore, independent of ASA class, postoperative complications measured by the CCI® increased per each comorbidity by 0.81 (95% CI, 0.40-1.23) and so did pLOS (geometric mean ratio, 1.03; 95% CI, 1.01-1.06). CONCLUSIONS These data quantify the high prevalence of multimorbidity in the surgical population and show that the number of comorbidities is predictive of negative postoperative outcomes, independent of ASA class.
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Affiliation(s)
- Christian A Grob
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | | | - Mark Kaufmann
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Michael Winiker
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Thomas O Erb
- University Children's Hospital of Basel, Basel, Switzerland
| | - Sonja Joller
- University Children's Hospital of Basel, Basel, Switzerland
| | - Philippe Schumacher
- Department of Anaesthesiology, Bürgerspital Solothurn, Solothurn, Switzerland
| | | | - Gregory O'Grady
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jonathon Murtagh
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Larsa Gawria
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kim Albers
- Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sonja Meier
- Department of Anaesthesiology, Guy's and St Thomas' NHS Trust, London, UK
| | - Anna R Heilbronner Samuel
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | | | - Luzius A Steiner
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Salome Dell-Kuster
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Tahir S, Mir AA, Siddique IA, Hameed A. Routine Pre-operative Laboratory Evaluation: Our Experience at an Obstetric and Gynaecological Pre-anaesthetic Check-Up Clinic. Cureus 2024; 16:e64112. [PMID: 39119420 PMCID: PMC11306404 DOI: 10.7759/cureus.64112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Laboratory testing is done before surgery to identify body abnormalities that cannot be detected through clinical evaluation alone. Patients going in for low- or intermediate-risk surgeries are often encouraged to undergo a battery of tests as usual. This cross-sectional observational study evaluated the status of routine pre-operative laboratory tests in American Society of Anaesthesiologists (ASA) Grade I, II, and III adults undergoing elective surgery at a maternity hospital, as well as the impact of these tests on the outcome of the pre-anaesthetic check-up (PAC). Methods The present observational study was conducted on 500 patients scheduled for elective surgery under anaesthesia. The procedures included routine gynaecological and obstetric surgeries like abdominal hysterectomy, suction evacuation, laparotomy for ectopic pregnancy, diagnostic biopsy, and lower segment caesarean section, among others. A designated anaesthesiologist gathered information from the completed PAC sheets. As per the standard departmental policy, each patient underwent a clinical examination and routine investigations at the PAC clinic. In addition to demographic and other variables, laboratory test results and any peri-operative interventions performed due to abnormalities were assessed. Investigations already done, asked by anaesthesiologists, and referral services sought were noted. The impact of these investigations on anaesthetic decision-making was noted. Data were expressed in frequencies and percentages and statistically analysed using INSTAT software (GraphPad Prism Software Inc., La Zolla, USA). Results The age and weight of the patients range from 20 to 70 years and 55 to 95 kg. Most patients belonged to ASA Grade II (n=348, 69.6%). Hypothyroidism was the most common abnormal finding (n=122, 22.4%). Anaemia, hypertension, and diabetes were detected in n=8 (1.6%), n=82 (16.4%), and n=34 (6.8%) of patients, respectively. In 488 (97.6%) patients, one or more of the investigations from the list were pending. Based on the results of various preoperative laboratory investigations, 87 (17.4%) patients were advised of multiple specialty opinions before surgery. A total of 453 (90.6%) patients attending the clinic were recommended to review their PACs after their pending investigations and specialist consultations were completed. At the same time, n=41 (8.2%) was found to be fit for surgery, and n=6 (1.2%) was found unfit for surgery and was postponed. Conclusions The incidence of tests with abnormal results was a little high in our study. One reason could be that a particular group of patients is included in the study. Preoperative laboratory investigations substantially increase the costs. Not many patients with abnormal tests may require changes in their peri-anaesthetic management. Nonetheless, laboratory tests can help ensure the patient is in an ideal preoperative condition. Pre-operative laboratory investigations should be advised on a case-by-case basis to avoid inconveniencing the patient, delaying the surgical procedure, and driving up the cost of surgical treatment.
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Affiliation(s)
- Sifna Tahir
- Anaesthesia, Critical Care and Palliative Medicine, Government Medical College, Srinagar, IND
| | - Altaf A Mir
- Biochemistry, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
| | - Imran A Siddique
- Biochemistry, Employee State Insurance Corporation Medical College, Hyderabad, IND
| | - Abdul Hameed
- Anaesthesia, Critical Care and Palliative Medicine, Government Medical College, Srinagar, IND
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Fleurent-Grégoire C, Burgess N, Denehy L, Edbrooke L, Engel D, Testa GD, Fiore JF, McIsaac DI, Chevalier S, Moore J, Grocott MP, Copeland R, Levett D, Scheede-Bergdahl C, Gillis C. Outcomes reported in randomised trials of surgical prehabilitation: a scoping review. Br J Anaesth 2024; 133:42-57. [PMID: 38570300 PMCID: PMC11213997 DOI: 10.1016/j.bja.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Heterogeneity of reported outcomes can impact the certainty of evidence for prehabilitation. The objective of this scoping review was to systematically map outcomes and assessment tools used in trials of surgical prehabilitation. METHODS MEDLINE, EMBASE, PsychInfo, Web of Science, CINAHL, and Cochrane were searched in February 2023. Randomised controlled trials of unimodal or multimodal prehabilitation interventions (nutrition, exercise, psychological support) lasting at least 7 days in adults undergoing elective surgery were included. Reported outcomes were classified according to the International Society for Pharmacoeconomics and Outcomes Research framework. RESULTS We included 76 trials, mostly focused on abdominal or orthopaedic surgeries. A total of 50 different outcomes were identified, measured using 184 outcome assessment tools. Observer-reported outcomes were collected in 86% of trials (n=65), with hospital length of stay being most common. Performance outcomes were reported in 80% of trials (n=61), most commonly as exercise capacity assessed by cardiopulmonary exercise testing. Clinician-reported outcomes were included in 78% (n=59) of trials and most frequently included postoperative complications with Clavien-Dindo classification. Patient-reported outcomes were reported in 76% (n=58) of trials, with health-related quality of life using the 36- or 12-Item Short Form Survey being most prevalent. Biomarker outcomes were reported in 16% of trials (n=12) most commonly using inflammatory markers assessed with C-reactive protein. CONCLUSIONS There is substantial heterogeneity in the reporting of outcomes and assessment tools across surgical prehabilitation trials. Identification of meaningful outcomes, and agreement on appropriate assessment tools, could inform the development of a prehabilitation core outcomes set to harmonise outcome reporting and facilitate meta-analyses.
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Affiliation(s)
- Chloé Fleurent-Grégoire
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nicola Burgess
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
| | - John Moore
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael P Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Denny Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill Research, Centre for Physical Activity & Health, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada.
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145
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Canelli RJ, Louca J, Gonzalez RM, Rendon LF, Hartman CR, Bilotta F. Trends in preoperative carbohydrate load practice: A systematic review. JPEN J Parenter Enteral Nutr 2024; 48:527-537. [PMID: 38676554 DOI: 10.1002/jpen.2633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/22/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The preoperative carbohydrate load (PCL) is intended to improve surgical outcomes by reducing the catabolic state induced by overnight fasting. However, there is disagreement on the optimal PCL prescription, leaving local institutions without a standardized PCL recommendation. Results from studies that do not prescribe PCL in identical ways cannot be pooled to draw larger conclusions on outcomes affected by the PCL. The aim of this systematic review is to catalog prescribed PCL characteristics, including timing of ingestion, percentage of carbohydrate contribution, and volume, to ultimately standardize PCL practice. METHODS A comprehensive search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials were included if they studied at least one group of patients who were prescribed a PCL and the PCL was described with respect to timing of ingestion, carbohydrate contribution, and total volume. RESULTS A total of 67 studies with 6551 patients were included in this systematic review. Of the studies, 49.3% were prescribed PCL on the night before surgery and morning of surgery, whereas 47.8% were prescribed PCL on the morning of surgery alone. The mean prescribed carbohydrate concentration was 13.5% (±3.4). The total volume prescribed was 648.2 ml (±377). CONCLUSION Variation in PCL practices prevent meaningful data pooling and outcome analysis, highlighting the need for standardized PCL prescription. Efforts dedicated to the establishment of a gold standard PCL prescription are necessary so that studies can be pooled and analyzed with respect to meaningful clinical end points that impact surgical outcomes and patient satisfaction.
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Affiliation(s)
- Robert J Canelli
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Joseph Louca
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Rafael M Gonzalez
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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146
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Zhang C, Bews K, Klemen ND, Etzioni D, Habermann EB, Thiels C. Thrombotic and Hemorrhagic Outcomes After Elective Surgery in Preoperatively Anticoagulated Patients. Mayo Clin Proc 2024; 99:1038-1045. [PMID: 38960494 DOI: 10.1016/j.mayocp.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To better understand the incidence and timing of thrombotic and hemorrhagic complications in anticoagulated patients undergoing elective surgery. METHODS Using institutional American College of Surgeons National Surgical Quality Improvement Program data, we identified patients receiving preoperative anticoagulation undergoing elective surgery between 2011 and 2021. Medical records review supplemented National Surgical Quality Improvement Program data to detail complication and anticoagulation type and timing. Outcomes for postoperative hemorrhage, acute venous thromboembolism (VTE), and cerebrovascular accident (CVA) were collected. RESULTS A total of 1442 patients met inclusion criteria, and 84 patients (5.8%) experienced 1 or more complications. There were 4 CVA (0.3%), 16 VTE (1.1%), and 68 bleeding (4.7%) events postoperatively. Three patients (75%) with CVA, 10 patients (62.5%) with VTE, and 18 patients (26.5%) with postoperative bleeding had resumed therapeutic anticoagulation before the complication. In terms of long-term sequelae in the CVA cohort, there was 1 mortality (25%), and an additional patient (25%) continues to experience long-term physical and mild cognitive impairments. Patients who experienced postoperative VTE required only anticoagulation adjustments. In patients who experienced bleeding complications, 6 (8.8%) required intensive care unit admissions, and there was 1 mortality (1.5%). CONCLUSION Despite the increased use of anticoagulation over time, balancing postoperative bleeding and thrombotic risks remains challenging. Bleeding complications were most common in preoperatively anticoagulated patients undergoing elective surgery. Earlier postoperative resumption of anticoagulation is unlikely to prevent thrombotic events as 65% of patients had already resumed therapeutic anticoagulation.
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Affiliation(s)
- Chi Zhang
- Department of Surgery, Mayo Clinic, Phoenix, AZ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Katherine Bews
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | | | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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147
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Zhao T, Da M, Kang Y, Zhao J. A case of complete resection of double primary tumors of huge ovarian clear cell carcinoma and retroperitoneal leiomyoma in pelvis. Asian J Surg 2024; 47:3151-3152. [PMID: 38490861 DOI: 10.1016/j.asjsur.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Tiantian Zhao
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Mingxu Da
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, China; Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Yan Kang
- The First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Jing Zhao
- Department of Intensive Care Unit, Gansu Provincial Hospital, Lanzhou, 730000, China.
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148
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Bahadur A, Mallick BK, Heda A, Pathak A, Heda S, Mundhra R. Comparison of the Outcomes of Enhanced Recovery After Surgery and Traditional Recovery Pathway in Robotic Hysterectomy for Benign Indications: A Randomized Controlled Trial. J Minim Invasive Gynecol 2024; 31:601-606. [PMID: 38697258 DOI: 10.1016/j.jmig.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
STUDY OBJECTIVE The present study aimed to evaluate the impact of the implementation of the enhanced recovery after surgery (ERAS) program in patients undergoing robotic hysterectomy for benign indications in comparison with conventional management. DESIGN Randomized controlled trial. SETTING North Indian tertiary care hospital. PARTICIPANTS Patients aged 40 to 60 years willing to sign the informed written consent were included, whereas cases with contraindications for neuraxial anesthesia were excluded. A total of 130 subjects undergoing robotic hysterectomy were divided into ERAS (n = 65) and conventional (non-ERAS) (n = 65) groups. INTERVENTIONS Components of the ERAS protocol included preoperative counseling, carbohydrate loading, early removal of catheter, and early ambulation. Both groups underwent optimization of medical conditions, standardized anesthesia, and venous thromboembolism prophylaxis. MEASUREMENTS AND MAIN RESULTS Outcome measures included length of hospital stay (LOHS), time to tolerance of diet, postoperative complications, readmission rates, and quality of life assessed by WHO-QOL BREF. Baseline characteristics were comparable between groups. ERAS group showed significantly lower docking time (4.82 ± 0.73 vs 5.31 ± 0.92 minutes), faster tolerance of diet (0.14 ± 0.35 vs 1.14 ± 0.35 days), and earlier resumption of ambulation (0.42 ± 0.5 vs 1.26 ± 0.44 days). Time for "fit for discharge" (1.43 ± 0.61 vs 2.97 ± 1.1 days) and LOHS (2.85 ± 1.09 vs 3.78 ± 1.29 days) were significantly lower in the ERAS group. Postoperative complications and readmission rates were comparable. Quality-of-life scores favored the ERAS group at postoperative days 1 and 30. CONCLUSION The combination of ERAS and robotic surgery improves patient outcomes, shortens hospital stays, and enhances postoperative recovery without increasing complications. This research serves as a pioneering effort in assessing the impact of ERAS on robotic hysterectomy for benign indications, providing valuable insights for future multicentric studies and supporting the integration of ERAS protocols to enhance patient outcomes and quality of life.
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Affiliation(s)
- Anupama Bahadur
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Bhawana Kumari Mallick
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Ayush Heda
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Anjali Pathak
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Sakshi Heda
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)
| | - Rajlaxmi Mundhra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India (all authors)..
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149
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Passos SC, de Jezus Castro SM, Stahlschmidt A, da Silva Neto PC, Irigon Pereira PJ, da Cunha Leal P, Lopes MB, Dos Reis Falcão LF, de Azevedo VLF, Lineburger EB, Mendes FF, Vilela RM, de Araújo Azi LMT, Antunes FD, Braz LG, Stefani LC. Development and validation of the Ex-Care BR model: a multicentre initiative for identifying Brazilian surgical patients at risk of 30-day in-hospital mortality. Br J Anaesth 2024; 133:125-134. [PMID: 38729814 DOI: 10.1016/j.bja.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Surgical risk stratification is crucial for enhancing perioperative assistance and allocating resources efficiently. However, existing models may not capture the complexity of surgical care in Brazil. Using data from various healthcare settings nationwide, we developed a new risk model for 30-day in-hospital mortality (the Ex-Care BR model). METHODS A retrospective cohort study was conducted in 10 hospitals from different geographic regions in Brazil. Data were analysed using multilevel logistic regression models. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), Brier score, and calibration plots. Derivation and validation cohorts were randomly assigned. RESULTS A total of 107,372 patients were included, and 30-day in-hospital mortality was 2.1% (n=2261). The final risk model comprised four predictors related to the patient and surgery (age, ASA physical status classification, surgical urgency, and surgical size), and the random effect related to hospitals. The model showed excellent discrimination (AUROC=0.93, 95% confidence interval [CI], 0.93-0.94), calibration, and overall performance (Brier score=0.017) in the derivation cohort (n=75,094). Similar results were observed in the validation cohort (n=32,278) (AUROC=0.93, 95% CI, 0.92-0.93). CONCLUSIONS The Ex-Care BR is the first model to consider regional and organisational peculiarities of the Brazilian surgical scene, in addition to patient and surgical factors. It is particularly useful for identifying high-risk surgical patients in situations demanding efficient allocation of limited resources. However, a thorough exploration of mortality variations among hospitals is essential for a comprehensive understanding of risk. CLINICAL TRIAL REGISTRATION NCT05796024.
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Affiliation(s)
- Sávio C Passos
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Anesthesiology and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Stela M de Jezus Castro
- Department of Statistics, Institute of Mathematics and Statistics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Adriene Stahlschmidt
- Anesthesiology and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Paulo C da Silva Neto
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | | | - Luiz F Dos Reis Falcão
- Department of Surgery, School of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Florentino F Mendes
- Department of Surgical Clinic, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Ramon M Vilela
- Department of Anesthesiology, Irmandade Santa Casa de Misericórdia Porto Alegre, Porto Alegre, Brazil
| | - Liana M T de Araújo Azi
- Department of Anesthesiology and Surgery, School of Medicine, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Fabrício D Antunes
- Department of Medicine, School of Medicine, Universidade Federal de Sergipe (UFS), Aracaju, Brazil
| | - Leandro G Braz
- Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, Brazil
| | - Luciana C Stefani
- Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre, Brazil.
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150
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Blacker SN, Woody N, Abate Shiferaw A, Burbridge M, Bustillo MA, Hazard SW, Heller BJ, Lamperti M, Mejia-Mantilla J, Nadler JW, Rath GP, Robba C, Vincent A, Admasu AK, Awraris M, Lele AV. Differences in Perioperative Management of Patients Undergoing Complex Spine Surgery: A Global Perspective. J Neurosurg Anesthesiol 2024; 36:218-227. [PMID: 37192477 DOI: 10.1097/ana.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/29/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The aim of this survey was to understand institutional spine surgery practices and their concordance with published best practices/recommendations. METHODS Using a global internet-based survey examining perioperative spine surgery practice, reported institutional spine pathway elements (n=139) were compared with the level of evidence published in guideline recommendations. The concordance of clinical practice with guidelines was categorized as poor (≤20%), fair (21%-40%), moderate (41%-60%), good (61%-80%), or very good (81%-100%). RESULTS Seventy-two of 409 (17.6%) institutional contacts started the survey, of which 31 (7.6%) completed the survey. Six (19.4%) of the completed surveys were from respondents in low/middle-income countries, and 25 (80.6%) were from respondents in high-income countries. Forty-one incomplete surveys were not included in the final analysis, as most were less than 40% complete. Five of 139 (3.6%) reported elements had very good concordance for the entire cohort; hospitals with spine surgery pathways reported 18 elements with very good concordance, whereas institutions without spine surgery pathways reported only 1 element with very good concordance. Reported spine pathways included between 7 and 47 separate pathway elements. There were 87 unique elements in the reviewed pathways. Only 3 of 87 (3.4%) elements with high-quality evidence demonstrated very good practice concordance. CONCLUSIONS This global survey-based study identified practice variation and low adoption rates of high-quality evidence in the care of patients undergoing complex spine surgery.
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Affiliation(s)
- Samuel N Blacker
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Nathan Woody
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | | | - Mark Burbridge
- Department of Anesthesiology, Perioperative and Pain Management, Stanford University School of Medicine, Stanford, CA
| | - Maria A Bustillo
- Department of Anesthesiology, Weill Cornell Medical College, New York City, NY
| | - Sprague W Hazard
- Department of Anesthesiology and Critical Care Medicine, Penn State Health, PA
| | - Benjamin J Heller
- Department of Anesthesiology and Pain Medicine, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Massimo Lamperti
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jorge Mejia-Mantilla
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY
| | - Jacob W Nadler
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Chiara Robba
- Department of Anesthesiology and Critical Care Medicine, George Washington University Hospital, Washington, DC
| | | | - Azarias K Admasu
- Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meron Awraris
- Department of Anesthesiology, Fundación Valle Del Lili, Cali, Colombia
| | - Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA
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