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Shirozu K, Umehara K, Takamori S, Takase S, Yamaura K. Associations between ondansetron and the incidence of postoperative nausea and vomiting and food intake in Japanese female undergoing laparoscopic gynecological surgery: a retrospective study. J Anesth 2024; 38:185-190. [PMID: 38108920 DOI: 10.1007/s00540-023-03295-0] [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: 11/01/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE Prevention of postoperative nausea and vomiting (PONV) is important to achieve DREAM (drinking, eating, mobilization). Ondansetron inhibits PONV, but its effects on postoperative food intake have not been investigated. This study aimed to examine associations between ondansetron and PONV incidence, and postoperative food intake. METHODS This retrospective study included adult patients (n = 632) who underwent laparoscopic gynecological surgery at Kyushu University Hospital between January 2017 and June 2023. Outcomes were PONV on the day of surgery, PONV up to the day after surgery, and food intake, which was assessed for breakfast and lunch on the day after surgery. Odds ratios (ORs) for PONV incidence and postoperative no-food intake were calculated between those with and without ondansetron during surgery. Multivariable-adjusted analysis was performed using possible confounding factors for PONV. Synergistic effects of combining ondansetron with dexamethasone or total intravenous anesthesia (TIVA) were assessed. RESULTS Multivariable-adjusted ORs for PONV on the day of surgery and up to the day after surgery were 0.56 (95% confidence interval, 0.32-0.99, p = 0.04) and 0.52 (0.30-0.93, p = 0.03), respectively, in the ondansetron group (n = 84) compared with the non-ondansetron group (n = 548). In contrast, multivariable-adjusted ORs for no-food intake of breakfast and lunch the day after surgery in the ondansetron group compared with the non-ondansetron group were not significant. Analysis of synergistic effects on PONV showed no significant interaction between ondansetron and dexamethasone or ondansetron and TIVA combinations. CONCLUSION Ondansetron administration during surgery was significantly associated with decreased PONV risk but was not associated with food intake the day after surgery.
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Affiliation(s)
- Kazuhiro Shirozu
- Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kaoru Umehara
- Department of Anesthesiology, Asakura Medical Association Hospital, Fukuoka, Japan
| | - Shinnosuke Takamori
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Sayuri Takase
- Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Oliver CM, Wagstaff D, Bedford J, Moonesinghe SR. Systematic development and validation of a predictive model for major postoperative complications in the Peri-operative Quality Improvement Project (PQIP) dataset. Anaesthesia 2024; 79:389-398. [PMID: 38369686 DOI: 10.1111/anae.16248] [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] [Accepted: 01/04/2024] [Indexed: 02/20/2024]
Abstract
Complications are common following major surgery and are associated with increased use of healthcare resources, disability and mortality. Continued reliance on mortality estimates risks harming patients and health systems, but existing tools for predicting complications are unwieldy and inaccurate. We aimed to systematically construct an accurate pre-operative model for predicting major postoperative complications; compare its performance against existing tools; and identify sources of inaccuracy in predictive models more generally. Complete patient records from the UK Peri-operative Quality Improvement Programme dataset were analysed. Major complications were defined as Clavien-Dindo grade ≥ 2 for novel models. In a 75% train:25% test split cohort, we developed a pipeline of increasingly complex models, prioritising pre-operative predictors using Least Absolute Shrinkage and Selection Operators (LASSO). We defined the best model in the training cohort by the lowest Akaike's information criterion, balancing accuracy and simplicity. Of the 24,983 included cases, 6389 (25.6%) patients developed major complications. Potentially modifiable risk factors (pain, reduced mobility and smoking) were retained. The best-performing model was highly complex, specifying individual hospital complication rates and 11 patient covariates. This novel model showed substantially superior performance over generic and specific prediction models and scores. We have developed a novel complications model with good internal accuracy, re-prioritised predictor variables and identified hospital-level variation as an important, but overlooked, source of inaccuracy in existing tools. The complexity of the best-performing model does, however, highlight the need for a step-change in clinical risk prediction to automate the delivery of informative risk estimates in clinical systems.
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Affiliation(s)
- C M Oliver
- Centre for Peri-operative Medicine, University College London, UK
- Department of Anaesthesia and Peri-operative Medicine, UCL Hospitals, London, UK
| | - D Wagstaff
- Department of Anaesthesia and Peri-operative Medicine, UCL Hospitals, London, UK
- Centre for Peri-operative Medicine, University College London, UK
| | - J Bedford
- Department of Anaesthesia and Peri-operative Medicine, UCL Hospitals, London, UK
- Centre for Peri-operative Medicine, University College London, UK
| | - S R Moonesinghe
- Department of Anaesthesia and Peri-operative Medicine, UCL Hospitals, London, UK
- Centre for Peri-operative Medicine, University College London, UK
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Yoon SH, Bae J, Yoon S, Na KJ, Lee HJ. Correlation Between Pain Intensity and Quality of Recovery After Video-Assisted Thoracic Surgery for Lung Cancer Resection. J Pain Res 2023; 16:3343-3352. [PMID: 37808464 PMCID: PMC10558582 DOI: 10.2147/jpr.s426570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose The Quality of Recovery-15 (QoR-15) questionnaire provides a multifaceted assessment of postoperative recovery, and the resulting score is recommended as an endpoint in clinical studies focused on postoperative pain. We aimed to investigate the correlation between the QoR-15 score and postoperative pain intensity in surgical patients. Patients and Methods Adult patients who underwent video-assisted thoracoscopic surgery (VATS) for lung cancer resection and were enrolled in a prospective registry or in a previous prospective study were included in this study. Baseline and perioperative data, including the results of assessment using the Korean version of the QoR-15 (QoR-15K) questionnaire at 48 hours postoperatively, were collected from the database. Correlations between the QoR-15K total score, questionnaire dimensions, and postoperative pain intensity at 48 hours postoperatively were determined using the Spearman correlation coefficient (ρ). Results We analyzed a total of 137 eligible patients. Significant negative correlations were noted between the QoR-15K total score and pain intensity at rest (ρ = -0.45, 95% confidence interval [CI]: -0.57 - -0.31, P < 0.001) and during coughing (ρ = -0.55, 95% CI: -0.65 - -0.42, P < 0.001) at 48 hours postoperatively. The pain dimension and pain intensity at 48 hours postoperatively showed significant correlations with physical comfort, emotional state, and physical independence dimensions. Multivariable logistic regression revealed a significant negative association between the pain score at 24 hours postoperatively and good or excellent postoperative recovery. Conclusion The results support the impact of postoperative pain on the overall postoperative quality of recovery in patients who underwent VATS for lung cancer resection. Moreover, the QoR-15K score may be considered as a primary endpoint in clinical studies on postoperative pain control.
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Affiliation(s)
- Soo-Hyuk Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Abstract
ABSTRACT Severe postoperative movement-evoked pain (MEP) can be immobilizing, instilling in patients the fear that further activity will produce unbearable pain. This impedes healing and restoration of function while also extending time to recovery. Therefore, it is critical to manage MEP effectively through timely evaluation and comprehensive care planning. This article builds on recent calls to standardize testing of MEP to inform care planning in a way that both reduces pain and improves functioning. Subsequent reassessment of MEP can guide the refinement of therapy. Although this approach may seem intuitive, it challenges common practices that focus too heavily on pain intensity, resulting in overtreating, undertreating, or not treating pain, while ignoring the risks of immobility and the importance of movement for improving functional capacity. The authors propose a multifaceted approach to overcoming MEP that nurse clinicians, educators, researchers, and compliance professionals can use to enhance the quality and safety of nursing practice.
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Affiliation(s)
- Paul Arnstein
- Staja Q. Booker is an assistant professor at the University of Florida College of Nursing, Gainesville. Paul Arnstein is an adjunct professor at Massachusetts General Hospital Institute of Health Professions, Boston. Rianne van Boekel is an assistant professor at Radboud University Medical Center, Nijmegan, The Netherlands. Contact author: Staja Q. Booker, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Benhamou D. Postoperative nausea and vomiting: is the big little problem becoming a smaller little problem? Br J Anaesth 2023:S0007-0912(23)00178-2. [PMID: 37179157 DOI: 10.1016/j.bja.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) has been identified as a big (very frequently encountered) little (not linked to life-threatening outcomes) problem. Traditional drugs (dexamethasone, droperidol or similar drugs, serotonin receptor antagonists) each have significant but limited effect, leading to an increasing use of combination therapies. High-risk patients, often identified through use of risk scoring systems, remain with a significant residual risk despite combining up to three traditional drugs. A recent correspondence in this Journal proposes the use of up to five anti-emetic drugs to further minimise the risk. This disruptive strategy was supported by favourable initial results, absence of side-effects and lower acquisition costs of the added new drugs (aprepitant and palonosetron) because of their recent loss of patent protection. These results are provocative and hypothesis generating, but need confirmation and do not warrant immediate changes in clinical practice. The next steps will also necessitate wider implementation of protocols protecting patients from PONV and a search for additional drugs and techniques aimed at treating established PONV.
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Affiliation(s)
- Dan Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Université Paris-Saclay Hôpital Bicêtre, Le Kremlin Bicêtre Cedex, France.
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Moonesinghe SR. The Anesthesiologist as Public Health Physician. Anesth Analg 2023; 136:675-678. [PMID: 36928152 DOI: 10.1213/ane.0000000000006437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- S Ramani Moonesinghe
- From the UCL/UCLH Surgical Outcomes Research Center (SOuRCe), Center for Perioperative Medicine, Research Department for Targeted intervention, Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
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Bubb CAB, Weber M, Kretsch N, Heim R, Zellhuber I, Schmid S, Kagerbauer SM, Kreuzer J, Schaller SJ, Blobner M, Jungwirth B. Wearable in-ear pulse oximetry validly measures oxygen saturation between 70% and 100%: A prospective agreement study. Digit Health 2023; 9:20552076231211169. [PMID: 38025105 PMCID: PMC10631342 DOI: 10.1177/20552076231211169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Postoperative monitoring outside intensive and post-anaesthesia care units is seldom, partly due to lack of suitable and approved systems. We therefore aim to validate the oxygen saturation (SpO2) and pulse rate measurement of the in-ear sensor c-med° alpha with a reference pulse oximeter. Methods This prospective agreement study was conducted in 12 healthy (ASA 1) adult (18-50 years) volunteers according to the EN ISO 80601-2-61. The sitting volunteers were equipped with the finger pulse oximeter Rad-5 and two c-med° alpha sensors in each ear. The inspiratory oxygen content was reduced via a tight-fitting breathing mask to achieve five defined plateaus with stable SpO2 between 99% and 70%. The deviation of the SpO2 and pulse rate measurements of the c-med° alpha from those of the Rad-5 was calculated using the mean square error (Arms). Bias and limits of agreement between both devices were calculated using the Bland-Altman technique. The precision was compared based on the repeatability coefficients. Results The c-med° alpha measured SpO2 had an Arms = 1.9% relative to the Rad-5, a non-significant bias (-0.1% (-0.2% to 0.0%)), levels of agreement from -4.0% to 3.8%, and the same repeatability coefficient (0.8% vs. 0.8%). The c-med° alpha measured pulse rate did not deviate from the one measured with the certified finger pulse oximeter (bias: 0.1 min-1 (0 to 0.1 min-1), level of agreement: -3.6 to 3.7 min-1, Arms: 1.8 min-1). Conclusions The c-med° alpha fulfils the EN ISO 80601-2-61 standard and is sufficiently accurate for measuring SpO2 and pulse rate in healthy adults at rest. Trial registration EUDAMED No. CIV-21-03-036033.
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Affiliation(s)
- Catherina AB Bubb
- Technical University of Munich, School of Medicine and Health, Department of Anaesthesiology and Intensiv Care Medicine, Munich, Germany
- Ulm University, Faculty of Medicine, Department of Anaesthesiology and Intensiv Care Medicine, Ulm, Germany
| | | | - Nadine Kretsch
- Technical University of Munich, School of Medicine and Health, Department of Anaesthesiology and Intensiv Care Medicine, Munich, Germany
| | | | | | - Sebastian Schmid
- Technical University of Munich, School of Medicine and Health, Department of Anaesthesiology and Intensiv Care Medicine, Munich, Germany
- Ulm University, Faculty of Medicine, Department of Anaesthesiology and Intensiv Care Medicine, Ulm, Germany
| | - Simone M Kagerbauer
- Technical University of Munich, School of Medicine and Health, Department of Anaesthesiology and Intensiv Care Medicine, Munich, Germany
- Ulm University, Faculty of Medicine, Department of Anaesthesiology and Intensiv Care Medicine, Ulm, Germany
| | | | - Stefan J Schaller
- Technical University of Munich, School of Medicine and Health, Department of Anaesthesiology and Intensiv Care Medicine, Munich, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universitätzu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Manfred Blobner
- Technical University of Munich, School of Medicine and Health, Department of Anaesthesiology and Intensiv Care Medicine, Munich, Germany
- Ulm University, Faculty of Medicine, Department of Anaesthesiology and Intensiv Care Medicine, Ulm, Germany
| | - Bettina Jungwirth
- Ulm University, Faculty of Medicine, Department of Anaesthesiology and Intensiv Care Medicine, Ulm, Germany
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Value-based Care and Quality Improvement in Perioperative Neuroscience. J Neurosurg Anesthesiol 2022; 34:346-351. [PMID: 35917131 DOI: 10.1097/ana.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
Value-based care and quality improvement are related concepts used to measure and improve clinical care. Value-based care represents the relationship between the incremental gain in outcome for patients and cost efficiency. It is achieved by identifying outcomes that are important to patients, codesigning solutions using multidisciplinary teams, measuring both outcomes and costs to drive further improvements, and developing partnerships across the health system. Quality improvement is focused on process improvement and compliance with best practice, and often uses "Plan-Do-Study-Act" cycles to identify, test, and implement change. Validated, standardized core outcome sets for perioperative neuroscience are currently lacking, but neuroanesthesiologists can consider using traditional clinical indicators, patient-reported outcomes measures, and perioperative core outcome measures. Several examples of bundled care solutions have been successfully implemented in perioperative neuroscience to increase value; for example, enhanced recovery for spine surgery, delirium reduction pathways, and same-day discharge craniotomy. This review proposes potential individual- and system-based solutions to address barriers to value-based care and quality improvement in perioperative neuroscience.
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Postoperative recovery: DrEaMing as a wake-up call? Br J Anaesth 2022; 129:1-3. [DOI: 10.1016/j.bja.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
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