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Hamilton GM, Ladha K, Wheeler K, Nguyen F, McCartney CJL, McIsaac DI. Incidence of persistent postoperative opioid use in patients undergoing ambulatory surgery: a retrospective cohort study. Anaesthesia 2023; 78:170-179. [PMID: 36314355 DOI: 10.1111/anae.15900] [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: 10/10/2022] [Indexed: 01/11/2023]
Abstract
The opioid crisis remains a major public health concern. In ambulatory surgery, persistent postoperative opioid use is poorly described and temporal trends are unknown. A population-based retrospective cohort study was undertaken in Ontario, Canada using routinely collected administrative data for adults undergoing ambulatory surgery between 1 January 2013 and 31 December 2017. The primary outcome was persistent postoperative opioid use, defined using best-practice methods. Multivariable generalised linear models were used to estimate the association of persistent postoperative opioid use with prognostic factors. Temporal trends in opioid use were examined using monthly time series, adjusting for patient-, surgical- and hospital-level variables. Of 340,013 patients, 44,224 (13.0%, 95%CI 12.9-13.1%) developed persistent postoperative opioid use after surgery. Following multivariable adjustment, the strongest predictors of persistent postoperative opioid use were pre-operative: utilisation of opioids (OR 9.51, 95%CI 8.69-10.39); opioid tolerance (OR 88.22, 95%CI 77.21-100.79); and utilisation of benzodiazepines (OR 13.75, 95%CI 12.89-14.86). The time series model demonstrated a small but significant trend towards decreasing persistent postoperative opioid use over time (adjusted percentage change per year -0.51%, 95%CI -0.83 to -0.19%, p = 0.003). More than 10% of patients who underwent ambulatory surgery experienced persistent postoperative opioid use; however, there was a temporal trend towards a reduction in persistent opioid use after surgery. Future studies are needed that focus on interventions which reduce persistent postoperative opioid use.
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Affiliation(s)
- G M Hamilton
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
| | - K Ladha
- Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto and Institute of Health Policy, Management, and Evaluation, University of Toronto, ON, Canada
| | - K Wheeler
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - F Nguyen
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada
| | - C J L McCartney
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
| | - D I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, ON, Canada
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Compère V, Mauger A, Allard E, Clavier T, Selim J, Besnier E. Incidence of Postoperative Pain at 7 Days After Day Surgery Reported Using a Text Messaging Platform: Retrospective Observational Study. JMIR Perioper Med 2022; 5:e33276. [DOI: 10.2196/33276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/10/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022] Open
Abstract
Background
The most frequent complication observed after ambulatory surgery is acute postoperative pain.
Objective
The purpose of this study was to evaluate the late incidence of postoperative pain at 7 days after day surgery.
Methods
We retrospectively included patients who underwent day surgery under general or regional anesthesia and those who underwent local anesthesia in Rouen University Hospital from January 2018 to February 2020. Data collected were moderate-to-severe pain reports defined as numeric rating scale (NRS)>3/10 at 1 day (secondary end point) and 7 days (primary end point) after surgery. These data were collected using a semi-intelligent SMS text messaging platform to follow up with the patient at home after ambulatory surgery. Univariate and multivariate analyses were performed to analyze the risk factors for pain.
Results
We analyzed 6099 patients. On the day after the surgery, 5.2% (318/6099) of the patients presented with moderate-to-severe pain: 5.9% (248/4187) in the general or regional anesthesia group and 3.7% (70/1912) in the local anesthesia group. At 7 days after the surgery, 18.6% (1135/6099) of the patients presented with moderate-to-severe pain, including 21.3% (892/4187) of the patients in the general or regional anesthesia group and 12.7% (243/1912) of the patients in the local anesthesia group. General surgery (odds ratio [OR] 1.54, 95% CI 1.23-1.92; P<.01) and orthopedic surgery (OR 1.66, 95% CI 1.42-1.94; P<.01) were associated with more late postoperative pain risk. Male gender (OR 0.66, 95% CI 0.57-0.76; P<.01), ophthalmology surgery (OR 0.51, 95% CI 0.42-0.62; P<.01), and gynecologic surgery (OR 0.67, 95% CI 0.50-0.88; P=.01) were associated with less late postoperative pain risk. The rate of emergency consultation or rehospitalization at 7 days after the surgery was 11.1% (679/6099). Late postoperative pain (OR 2.54, 95% CI 1.98-3.32; P<.001), general surgery (OR 2.15, 95% CI 1.65-2.81; P<.001), and urology surgery (OR 1.62, 95% CI 1.06-2.43; P=.02) increased the risk of emergency consultation or rehospitalization. Orthopedic surgery (OR 0.79, 95% CI 0.63-0.99; P=.04) and electroconvulsive therapy (OR 0.43, 95% CI 0.27-0.65; P<.001) were associated with less rates of emergency consultation or rehospitalization.
Conclusions
Our study shows that postoperative pain at 7 days after ambulatory surgery was reported in more than 18% of the cases, which was also associated with an increase in the emergency consultation or rehospitalization rates.
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Mihailescu SD, Maréchal I, Thillard D, Gillibert A, Compère V. Socioenvironmental criteria and postoperative complications in ambulatory surgery in a French university hospital: a prospective cross-sectional observational study. BMJ Open 2020; 10:e036795. [PMID: 33247006 PMCID: PMC7703412 DOI: 10.1136/bmjopen-2020-036795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ambulatory surgery lowers hospitalisation costs, shortens the time to return to work but requires caution regarding socioenvironmental risk factors for complications and rehospitalisation. METHODS This was a single-centre prospective cross-sectional observational study conducted in a university hospital centrein January 2017. The primary objective was to assess the rate of conversion from ambulatory surgery to conventional hospitalisation or emergency department visit within 30 days following discharge from ambulatory unit. Secondary objectives were to describe the socioenvironmental characteristics of outpatients and to identify risk factors for severe postoperative complications. RESULTS 598 outpatients were included. The most represented surgical specialties were ophthalmology (23.5%), gynaecology (19%) and orthopaedics (17.7%). Patients' mean age was 50.8 years (SD, 19.8) and the male/female sex ratio was 0.68. There were 22 (3.68%, 95% CI 2.32% to 5.52%) severe complications, including 11 (1.84%, 95% CI 0.92% to 3.27%) conversions to conventional hospitalisation and 11 (1.84%) conversions to emergency department visit, 3 of which led to readmission. Regarding socioenvironmental characteristics, 116 outpatients (19.7%) lived alone but were not isolated and 15 (2.6%) lived alone and were socially isolated. Following ambulatory surgery, 9 outpatients (1.6%) returned home on foot, 20 (3.4%) by public transportation and 8 (1.4%) drove home; 133 outpatients (13.7%) were alone the first night following surgery. Severe complication rates were not significantly different according to socioenvironmental subgroups. CONCLUSION In our study, the prevalence of severe complications was low, conforming to the literature. The study was underpowered to estimate the effect of socioenvironmental variables.
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Affiliation(s)
- Sorina-Dana Mihailescu
- Rouen University Hospital, Unit for the Prevention of Care-Associated Risks, Rouen, France
| | - Isabelle Maréchal
- Rouen University Hospital, Unit for the Prevention of Care-Associated Risks, Rouen, France
| | - Denis Thillard
- Rouen University Hospital, Unit for the Prevention of Care-Associated Risks, Rouen, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Vincent Compère
- Department of Anesthesia and Intensive Care, Normandie Univ, UNIROUEN, Inserm U 982, Rouen University Hospital, Rouen, France
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Chevallier T, Buzancais G, Occean BV, Rataboul P, Boisson C, Simon N, Lannelongue A, Chaniaud N, Gricourt Y, Lefrant JY, Cuvillon P. Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart Angel™ app and an original web platform for patients following outpatient surgery: a prospective observational pilot study. BMC Anesthesiol 2020; 20:259. [PMID: 33032541 PMCID: PMC7545846 DOI: 10.1186/s12871-020-01178-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background Remote monitoring of mean arterial blood pressure (MAP), heart rate (HR) or oxygen saturation (SpO2) remains a challenge in outpatient surgery. This study evaluates a new digital technology (Smart Angel™) for remotely monitoring hemodynamic data in real time: data transmitted from the patient’s home to a central server, using a dedicated web-based software package. Methods Adults scheduled for elective outpatient surgery were prospectively enrolled. In the first 5 postoperative days, patients completed a self-report questionnaire (pain, comfort, nausea, vomiting) and recorded SpO2, HR and MAP via two wireless Bluetooth monitors connected to a 4G tablet to transmit the data to a website, in real time, using Smart Angel™ software. Before transmission to the website, these data were also self-reported by the patient on a paper form. The primary outcome was the proportion of variables (self-monitored physiological data + questionnaire scores) correctly transmitted to the hospital via the system compared with the paper version. On Day 5, a system usability scale survey (SUS score 1–100) was also attributed. Results From May 2018 to September 2018, data were available for 29 out of 30 patients enrolled (1 patient was not discharged from hospital after surgery). The remote monitoring technology recorded 2038 data items (62%) compared with 2656 (82%) items recorded on the paper form (p = 0.001). The most common errors with the remote technology were software malfunctioning when starting the MAP monitor and malfunctioning between the tablet and the Bluetooth monitor. No serious adverse events were noted. The SUS score for the system was 85 (68–93) for 26 patients. Conclusion This work evaluates the ability of a pilot system for monitoring remote physiological data using digital technology after ambulatory surgery and highlights the digital limitations of this technology. Technological improvements are required to reduce malfunctioning (4G access, transmission between apps). Trial registration ClinicalTrials.gov (NCT03464721) (March 8, 2018).
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Affiliation(s)
- Thierry Chevallier
- Department of Biostatistics, Epidemiology, Public Health and and Methodological innovation (BESPIM), Nîmes University Hospital, University Montpellier 1, Montpellier, France
| | - Gautier Buzancais
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Bob-Valéry Occean
- Department of Biostatistics, Epidemiology, Public Health and and Methodological innovation (BESPIM), Nîmes University Hospital, University Montpellier 1, Montpellier, France
| | - Pierre Rataboul
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Christophe Boisson
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Natacha Simon
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Ariane Lannelongue
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Noémie Chaniaud
- UR 7273 CRP-CPO, Université Picardie Jules Verne, Chemin du Thil, 80000, Amiens, France
| | - Yann Gricourt
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Jean-Yves Lefrant
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Philippe Cuvillon
- Staff anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France.
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Sawhney M, Goldstein DH, Wei X, Pare GC, Wang L, VanDenKerkhof EG. Pain and haemorrhage are the most common reasons for emergency department use and hospital admission in adults following ambulatory surgery: results of a population-based cohort study. Perioper Med (Lond) 2020; 9:25. [PMID: 32832075 PMCID: PMC7436986 DOI: 10.1186/s13741-020-00155-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients return to hospital following discharge. However, the reason for unplanned healthcare use after ambulatory surgery in Canada is not well understood. Aims To examine unplanned healthcare use, specifically emergency department visit and hospital admissions, in the 3 days after ambulatory surgery in Ontario, Canada. Methods This population-based retrospective cohort study was conducted using de-identified administrative databases. Participants were residents in the province of Ontario, Canada; 18 years and older; and underwent common ambulatory surgical procedures between 2014 and 2018. The outcomes included emergency department (ED) visit and hospital admission. Incidence rates were calculated for the total cohort, for each patient characteristic and for surgical category. The odds ratios and 95% confidence intervals were calculated for each outcome using bivariate and multivariate logistic regression. Results 484,670 adults underwent select common surgical procedures during the study period. Patients had healthcare use in the first 3 days after surgery, with 14,950 (3.1%) ED visits and 14,236 (2.9%) admissions. The incidence of ED use was highest after tonsillectomy (8.1%), cholecystectomy (4.2%) and appendectomy (4.0%). Incidence of admissions was highest after appendectomy (21%). Acute pain (19.7%) and haemorrhage (14.2%) were the most frequent reasons for an ED visit and "convalescence following surgery" (49.2%) followed by acute pain (6.2%) and haemorrhage (4.5%) were the main reasons for admission. Conclusions These findings can assist clinicians in identifying and intervening with patients at risk of healthcare use after ambulatory surgery. Pain management strategies that can be tailored to the patient, and earlier follow-up for some patients may be required. In addition, administrative decision-makers could use the results to estimate the impact of specific ambulatory procedures on hospital resources for planning and allocation of resources.
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Affiliation(s)
- Monakshi Sawhney
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, Ontario K7L 3N6 Canada.,Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7 Canada
| | - David H Goldstein
- Department of Anesthesiology, University of Calgary, South Health, Campus, 4448 Front Street SE, Calgary, Alberta T3M 1M4 Canada
| | - Xuejiao Wei
- Institute for Clinical Evaluative Sciences, Queen's University, 21 Arch Street, Suite 208, Kingston, Ontario K7L 3N6 Canada
| | - Genevieve C Pare
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, Ontario K7L 3N6 Canada
| | - Louie Wang
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7 Canada
| | - Elizabeth G VanDenKerkhof
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, Ontario K7L 3N6 Canada.,Department of Anesthesiology and Perioperative Medicine, Queen's University, Victory 2, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7 Canada
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Zheng S, Wu YX, Wang JY, Li Y, Liu ZJ, Liu XG, Dang GT, Sun Y, Li J. Identifying the Characteristics of Patients With Cervical Degenerative Disease for Surgical Treatment From 17-Year Real-World Data: Retrospective Study. JMIR Med Inform 2020; 8:e16076. [PMID: 32242824 PMCID: PMC7165306 DOI: 10.2196/16076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/15/2019] [Accepted: 01/26/2020] [Indexed: 01/23/2023] Open
Abstract
Background Real-world data (RWD) play important roles in evaluating treatment effectiveness in clinical research. In recent decades, with the development of more accurate diagnoses and better treatment options, inpatient surgery for cervical degenerative disease (CDD) has become increasingly more common, yet little is known about the variations in patient demographic characteristics associated with surgical treatment. Objective This study aimed to identify the characteristics of surgical patients with CDD using RWD collected from electronic medical records. Methods This study included 20,288 inpatient surgeries registered from January 1, 2000, to December 31, 2016, among patients aged 18 years or older, and demographic data (eg, age, sex, admission time, surgery type, treatment, discharge diagnosis, and discharge time) were collected at baseline. Regression modeling and time series analysis were conducted to analyze the trend in each variable (total number of inpatient surgeries, mean age at surgery, sex, and average length of stay). A P value <.01 was considered statistically significant. The RWD in this study were collected from the Orthopedic Department at Peking University Third Hospital, and the study was approved by the institutional review board. Results Over the last 17 years, the number of inpatient surgeries increased annually by an average of 11.13%, with some fluctuations. In total, 76.4% (15,496/20,288) of the surgeries were performed in patients with CDD aged 41 to 65 years, and there was no significant change in the mean age at surgery. More male patients were observed, and the proportions of male and female patients who underwent surgery were 64.7% (13,126/20,288) and 35.3% (7162/20,288), respectively. However, interestingly, the proportion of surgeries performed among female patients showed an increasing trend (P<.001), leading to a narrowing sex gap. The average length of stay for surgical treatment decreased from 21 days to 6 days and showed a steady decline from 2012 onward. Conclusions The RWD showed its capability in supporting clinical research. The mean age at surgery for CDD was consistent in the real-world population, the proportion of female patients increased, and the average length of stay decreased over time. These results may be valuable to guide resource allocation for the early prevention and diagnosis, as well as surgical treatment of CDD.
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Affiliation(s)
- Si Zheng
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yun Xia Wu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Jia Yang Wang
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Li
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Zhong Jun Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Xiao Guang Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Geng Ting Dang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Yu Sun
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Jiao Li
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Nerve blocks improve early pain after ambulatory shoulder surgery; impact on postdischarge outcomes is poorly described. Our objective was to measure the association between nerve blocks and health system outcomes after ambulatory shoulder surgery.
Methods
We conducted a population-based cohort study using linked administrative data from 118 hospitals in Ontario, Canada. Adults having elective ambulatory shoulder surgery (open or arthroscopic) from April 1, 2009, to December 31, 2016, were included. After validation of physician billing codes to identify nerve blocks, we used multilevel, multivariable regression to estimate the association of nerve blocks with a composite of unplanned admissions, emergency department visits, readmissions or death within 7 days of surgery (primary outcome) and healthcare costs (secondary outcome). Neurology consultations and nerve conduction studies were measured as safety indicators.
Results
We included 59,644 patients; blocks were placed in 31,073 (52.1%). Billing codes accurately identified blocks (positive likelihood ratio 16.83, negative likelihood ratio 0.03). The composite outcome was not significantly different in patients with a block compared with those without (2,808 [9.0%] vs. 3,424 [12.0%]; adjusted odds ratio 0.96; 95% CI 0.89 to 1.03; P = 0.243). Healthcare costs were greater with a block (adjusted ratio of means 1.06; 95% CI 1.02 to 1.10; absolute increase $325; 95% CI $316 to $333; P = 0.005). Prespecified sensitivity analyses supported these results. Safety indicators were not different between groups.
Conclusions
In ambulatory shoulder surgery, nerve blocks were not associated with a significant difference in adverse postoperative outcomes. Costs were statistically higher with a block, but this increase is not likely clinically relevant.
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Hamilton GM, Ramlogan R, Lui A, McCartney CJL, Abdallah F, McIsaac DI. Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study. Can J Anaesth 2018; 66:63-74. [DOI: 10.1007/s12630-018-1234-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 12/27/2022] Open
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Heller JA, Weiner MM. In Reply to "Letter to the Editor: Surgical Start Times and Outcomes: It's Not Just the Hour, but the Day as Well". J Cardiothorac Vasc Anesth 2018; 32:e38-e39. [PMID: 29402625 DOI: 10.1053/j.jvca.2017.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua A Heller
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, New York, NY
| | - Menachem M Weiner
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
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Oh TK, Park YM, Do SH, Hwang JW, Jo YH, Kim JH, Jeon YT, Song IA. A comparative study of the incidence of in-hospital cardiopulmonary resuscitation on Monday-Wednesday and Thursday-Sunday: Retrospective analysis in a tertiary care hospital. Medicine (Baltimore) 2018; 97:e9741. [PMID: 29419666 PMCID: PMC5944682 DOI: 10.1097/md.0000000000009741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Because most medical staff work from Monday-Friday, it is possible that they are relatively more fatigued and less capable of providing emergency supportive services on Thursday-Sunday (Thu-Sun) than on Monday-Wednesday (Mon-Wed). In this study, we aimed to analyze the incidence of in-hospital cardiopulmonary resuscitation (CPR) to determine if it differed between Thu-Sun and Mon-Wed.This retrospective observational study of in-hospital CPR was performed during 2012 to 2016 among inpatients at the Seoul National University Bundang Hospital. The primary outcome was the incidence of in-hospital CPR per 1000 inpatients in the Mon-Wed and Thu-Sun periods. Secondary outcomes included differences in the CPR incidence by time of day and season.In the study, 1195 cases of in-hospital CPR were included. The incidence of in-hospital CPR per 1000 inpatients was significantly higher on Thu-Sun (mean: 0.595, 95% confidence interval [CI]: 0.564-0.626) than on Mon-Wed (mean: 0.505, 95% CI: 0.474-0.536, P < .001). There were no seasonal variations in the incidence of in-hospital CPR. However, in-hospital CPR was most frequently performed between 16:00 and 24:00, and the return of spontaneous circulation (ROSC) rate was the lowest among cases that occurred between 0:00 and 8:00. In addition, the ROSC rate was lowest among female patients, patients with cardiac arrest, and after in-hospital CPR performed on a Sunday.The incidence of in-hospital CPR per 1000 inpatients was significantly higher on Thu-Sun than on Mon-Wed. No seasonal variations were observed in the incidence of in-hospital CPR, but the data suggest circadian variations and differences in ROSC rates.
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Affiliation(s)
- Tak Kyu Oh
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - Young Mi Park
- Medical Research Collaborating Center, Seoul National University Bundang Hospital
| | - Sang-Hwan Do
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - Jung-Won Hwang
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Kim
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - Young-Tae Jeon
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - In-Ae Song
- Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
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11
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Grocott HP. Surgical Start Times and Outcomes: It's Not Just the Hour, But the Day As Well. J Cardiothorac Vasc Anesth 2017; 32:e12-e13. [PMID: 29102257 DOI: 10.1053/j.jvca.2017.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Hilary P Grocott
- Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Qiu C, Rinehart J, Nguyen VT, Cannesson M, Morkos A, LaPlace D, Trivedi NS, Mercado PD, Kain ZN. An Ambulatory Surgery Perioperative Surgical Home in Kaiser Permanente Settings: Practice and Outcomes. Anesth Analg 2017; 124:768-774. [PMID: 28027086 DOI: 10.1213/ane.0000000000001717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study is to describe the design, implementation, and associated outcome changes of a Perioperative Surgical Home (PSH) for patients undergoing ambulatory laparoscopic cholecystectomy in a Kaiser Permanente practice model. METHODS A multidisciplinary planning committee of 15 individuals developed and implemented a new PSH program. A total of 878 subjects were included in the preimplementation period (T-fast), and 1082 patients were included in the postimplementation period (PSH) based on the date of their surgery. The primary goal of this report was to assess the changes in patient outcomes associated with this new PSH implementation on variables such as total length of stay and unplanned hospital admission (UHA). RESULTS Patients assigned to the PSH model had a significantly shorter mean length of stay compared with patients in the T-fast group (162 ± 308 vs 369 ± 790 minutes, P = .00005). UHA was significantly higher in the T-fast group as compared with the PSH group (8.5% [95% CI 6.6-10.4] vs 1.7% [0.9-2.5], P < .00005). There was no difference in the 7 days readmission rates between patients managed in the T-fast track and the PSH track (5.4% [3.8-7.0] vs 5.0% [3.6-6.3], P = .066). CONCLUSIONS Introduction of the PSH into a Kaiser Permanente model of care was associated with a simultaneous decrease of length of stay and UHA for laparoscopic cholecystectomy patients.
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Affiliation(s)
- Chunyuan Qiu
- From the *Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California; †Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California; ‡Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California; and §Department of Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
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13
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Rosero EB, Joshi GP. Hospital readmission after ambulatory laparoscopic cholecystectomy: incidence and predictors. J Surg Res 2017; 219:108-115. [PMID: 29078868 DOI: 10.1016/j.jss.2017.05.071] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/22/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of the study was to assess the rate of 30-d hospital readmissions after ambulatory laparoscopic cholecystectomy. MATERIALS AND METHODS The 2009 to 2011 State Ambulatory Surgery and Services and State Inpatient Databases from California, Florida, and New York were analyzed to evaluate the incidence of 30-d readmissions after laparoscopic cholecystectomy performed in outpatient settings. Hospital transfers and the principal diagnoses of hospital readmission were analyzed as secondary outcomes. Multilevel generalized mixed linear regression analyses with fixed and random effects were used to evaluate variables associated with increased likelihood of readmissions. RESULTS A total of 230,745 encounters for ambulatory laparoscopic cholecystectomies performed in 890 ambulatory facilities between 2009 and 2011 in the three states were analyzed. The rate of 30-d readmission was 20.2 per 1000 discharges. The rate of direct transfers from the ambulatory surgery center to an acute care hospital was 0.6 per 1000 discharges. The most common diagnoses of readmission were surgical complications, postoperative pain, infection, and nausea or vomiting. After adjusting for comorbidities, increasing age, male sex, non-Hispanic white race/ethnicity, any nonprivate insurance type, diagnosis of acute cholecystitis, use of intraoperative cholangiography, and having the procedure performed on a weekend were significantly associated with increased odds of 30-d readmissions. CONCLUSIONS This large-state data analysis reveals that the unplanned admission and readmission rates after laparoscopic cholecystectomy are very low. Some causes of readmission (e.g., pain, nausea, and vomiting) are modifiable by the intervention of surgeons and anesthesia providers.
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Affiliation(s)
- Eric B Rosero
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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The "Friday effect": Can epidemiology tell us when to operate? Can J Anaesth 2015; 62:852-6. [PMID: 26024721 DOI: 10.1007/s12630-015-0407-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022] Open
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