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Dias IR, Ghefter MC, Andrade Filho PHDE, Morais LLS, Marchetti Filho MA, Himuro HS, Feichas RLP. The impact of the COVID-19 pandemic on the decrease in the use of intensive care units in the postoperative period of anatomic lung resections. A retrospective analysis. Rev Col Bras Cir 2022; 49:e20223140. [PMID: 35792804 PMCID: PMC10578854 DOI: 10.1590/0100-6991e-20223140-en] [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: 07/30/2021] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE COVID-19 pandemic required optimization of hospital institutional flow, especially regarding the use of intensive care unit (ICU) beds. The aim of this study was to assess whether the individualization of the indication for postoperative recovery from pulmonary surgery in ICU beds was associated with more perioperative complications. METHOD retrospective analysis of medical records of patients undergoing anatomic lung resections for cancer in a tertiary hospital. The sample was divided into: Group-I, composed of surgeries performed between March/2019 and February/2020, pre-pandemic, and Group-II, composed of surgeries performed between March/2020 and February/2021, pandemic period in Brazil. We analyzed demographic data, surgical risks, surgeries performed, postoperative complications, length of stay in the ICU and hospital stay. Preventive measures of COVID-19 were adopted in group-II. RESULTS 43 patients were included, 20 in group-I and 23 in group-II. The groups did not show statistical differences regarding baseline demographic variables. In group-I, 80% of the patients underwent a postoperative period in the ICU, compared to 21% in group-II. There was a significant difference when comparing the average length of stay in an ICU bed (46 hours in group-I versus 14 hours in group-II - p<0.001). There was no statistical difference regarding postoperative complications (p=0.44). CONCLUSIONS the individualization of the need for ICU use in the immediate postoperative period resulted in an improvement in the institutional care flow during the COVID-19 pandemic, in a safe way, without an increase in surgical morbidity and mortality, favoring the maintenance of essential cancer treatment.
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Affiliation(s)
- Ismael Rodrigo Dias
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Mario Claudio Ghefter
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Pedro Hilton DE Andrade Filho
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Anestesiologia - São Paulo - SP - Brasil
| | - Lilianne Louise Silva Morais
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Marco Aurelio Marchetti Filho
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Hebert Santos Himuro
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Rafael Lacerda Pereira Feichas
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
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DIAS ISMAELRODRIGO, GHEFTER MARIOCLAUDIO, ANDRADE FILHO PEDROHILTONDE, MORAIS LILIANNELOUISESILVA, MARCHETTI FILHO MARCOAURELIO, HIMURO HEBERTSANTOS, FEICHAS RAFAELLACERDAPEREIRA. O impacto da Pandemia de COVID-19 na diminuição do uso de Unidade de Terapia Intensiva em pós-operatório de ressecções pulmonares anatômicas. Uma análise retrospectiva. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução: a pandemia de COVID-19 exigiu otimização dos fluxos institucionais hospitalares, especialmente quanto ao uso de leitos de unidade de terapia intensiva (UTI). O objetivo deste estudo foi avaliar se a individualização da indicação de recuperação pós-operatória de cirurgias pulmonares em leitos de UTI associou-se a mais complicações perioperatórias. Método: análise retrospectiva de prontuários dos pacientes submetidos a ressecções pulmonares anatômicas por câncer em hospital terciário. A amostra foi dividida em dois grupos: Grupo-I, composto pelas cirurgias realizadas entre março/2019 e fevereiro/2020, pré-pandemia, e Grupo-II, composto pelas cirurgias realizadas entre março/2020 e fevereiro/2021, período de pandemia no Brasil. Analisamos dados demográficos, riscos cirúrgicos, cirurgias realizadas, complicações pós-operatórias, tempo de UTI e de internação hospitalar. Foram adotadas medidas preventivas de COVID-19 no grupo-II. Resultados: foram incluídos 43 pacientes, 20 no grupo-I e 23 no grupo-II. Os grupos não apresentaram diferenças estatísticas quanto às variáveis demográficas basais. No grupo-I 80% dos pacientes fizeram pós-operatório em UTI, comparados a 21% do grupo-II. Houve diferença significativa na comparação de tempo médio de permanência em leito de UTI (46 horas no grupo-I versus 14 horas no grupo-II - p<0,001). Não houve diferença estatística quanto a complicações pós-operatórias entre grupos (p=0,44). Conclusões: a individualização da necessidade do uso de UTI no pós-operatório imediato de cirurgias pulmonares resultou em melhora no fluxo assistencial institucional durante a pandemia de COVID-19, de maneira segura, sem aumento na morbimortalidade cirúrgica, favorecendo a manutenção do tratamento oncológico essencial.
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Chino K, Ganzberg S, Mendoza K. Office-Based Sedation/General Anesthesia for COPD Patients, Part II. Anesth Prog 2019; 66:44-51. [PMID: 30883229 DOI: 10.2344/anpr-66-02-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office office-based settings can be quite complex without a current understanding of the etiology, course, severity, and current treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other co-morbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article covered the epidemiology, etiology, and pathophysiology of COPD. Patient considerations in the preoperative period were also reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office-based setting as well as sedation/general anesthesia techniques that may be considered. Postoperative care will also be reviewed.
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Affiliation(s)
- Kristin Chino
- Private Practice, Anesthesia for Dentistry, Las Vegas, Nevada
| | - Steven Ganzberg
- Clinical Professor of Anesthesiology, UCLA School of Dentistry, Los Angeles, California
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Burton BN, Abudu B, Bhat P, Gabriel RA, Schmidt UH. Thirty-Day Unplanned Reintubation Following Pleurodesis: A Retrospective National Registry Analysis. J Cardiothorac Vasc Anesth 2019; 33:2465-2470. [PMID: 30852091 DOI: 10.1053/j.jvca.2019.01.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/26/2019] [Accepted: 01/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine risk factors associated with 30-day unplanned reintubation after pleurodesis. DESIGN A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program surgical outcomes registry. SETTING United States hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. PARTICIPANTS The study comprised 2,358 patients who underwent video-assisted thorascopic surgery for pleurodesis from 2007 to 2016. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The final sample included 2,358 cases, of which 93 (3.9%) required 30-day unplanned reintubation. Cases with 30-day unplanned reintubation, compared to those without, had higher unadjusted rates of American Society of Anesthesiologists physical status (ASA PS) score ≥4 (54.8% v 27.2%), preoperative dyspnea (71% v 57%), congestive heart failure (14% v 5.4%), functional dependence (28% v 10.3%), and diabetes mellitus (29% v 17.8%) (all p < 0.05). Patients with 30-day reintubation experienced higher unadjusted rates of 30-day outcomes including mortality (50.5% v 10.1%), pneumonia (28% v 4.9%), ventilator dependence (50.5% v 10.1%), sepsis (7.5% v 1.9%), myocardial infarction (5.4% v 0.1%), cardiac arrest (18.3% v 0.6%), transfusion (14% v 4.5%), and reoperation (15.1% v 3.2%) (all p < 0.05). The odds of 30-day unplanned reintubation were increased significantly on multivariable analysis for patients with ASA PS score ≥4, functional dependence, disseminated cancer, renal dialysis, and weight loss (all p < 0.05). CONCLUSION Given the dearth of population-based studies addressing risk factors of reintubation after pleurodesis, this study suggests further review of preoperative optimization, which is required to improve patient outcomes and safety.
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Affiliation(s)
- Brittany N Burton
- School of Medicine, University of California San Diego, La Jolla, CA.
| | - Boya Abudu
- School of Medicine, University of California San Diego, La Jolla, CA
| | - Pradhan Bhat
- College of Medicine, University of Illinois, Chicago, IL
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, La Jolla, CA; Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, CA
| | - Ulrich H Schmidt
- Department of Anesthesiology, University of California San Diego, La Jolla, CA
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Garg R. Elderly patients for cancer surgeries: How much to investigate! J Anaesthesiol Clin Pharmacol 2018; 34:539-541. [PMID: 30774238 PMCID: PMC6360899 DOI: 10.4103/joacp.joacp_103_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
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6
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Chino K, Ganzberg S, Mendoza K. Office-Based Sedation/General Anesthesia for COPD Patients, Part I. Anesth Prog 2018; 65:261-268. [PMID: 30715953 PMCID: PMC6318726 DOI: 10.2344/anpr-65-04-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/10/2018] [Indexed: 11/11/2022] Open
Abstract
The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office-based settings can be quite complex without a current understanding of the etiology, course, severity, and treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other comorbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article will cover the epidemiology, etiology, and pathophysiology of COPD. Patient evaluation in the preoperative period will also be reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office-based setting as well as sedation/general anesthesia techniques that may be considered.
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Affiliation(s)
- Kristin Chino
- Private Practice, Anesthesia for Dentistry, Las Vegas, Nevada
| | - Steven Ganzberg
- Clinical Professor of Anesthesiology, UCLA School of Dentistry, Los Angeles, California
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Diaz-Fuentes G, Hashmi HRT, Venkatram S. Perioperative Evaluation of Patients with Pulmonary Conditions Undergoing Non-Cardiothoracic Surgery. Health Serv Insights 2016; 9:9-23. [PMID: 27867301 PMCID: PMC5104294 DOI: 10.4137/hsi.s40541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 02/07/2023] Open
Abstract
This review describes the perioperative management of patients with suspected or established pulmonary conditions undergoing non-cardiothoracic surgery, with a focus on common pulmonary conditions such as obstructive airway disease, pulmonary hypertension, obstructive sleep apnea, and chronic hypoxic respiratory conditions. Considering that postoperative pulmonary complications are common and given the increasing number of surgical procedures and the size of the aging population, familiarity with current guidelines for preoperative risk assessment and intra- and postoperative patient management is recommended to decrease the morbidity and mortality. In particular, smoking cessation and pulmonary rehabilitation are perioperative strategies for improving patients’ short- and long-term outcomes. Understanding the potential risk for pulmonary complications allows the medical team to appropriately plan the intra- and postoperative care of each patient.
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Affiliation(s)
- Gilda Diaz-Fuentes
- Chief, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA.; Associate Professor
| | - Hafiz Rizwan Talib Hashmi
- Fellow, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
| | - Sindhaghatta Venkatram
- Assistant Professor, Clinical Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Attending, Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA
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Swann MC, Hoes KS, Aoun SG, McDonagh DL. Postoperative complications of spine surgery. Best Pract Res Clin Anaesthesiol 2016; 30:103-20. [PMID: 27036607 DOI: 10.1016/j.bpa.2016.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 12/20/2022]
Abstract
A variety of surgical approaches are available for the treatment of spine diseases. Complications can arise intraoperatively, in the immediate postoperative period, or in a delayed fashion. These complications may lead to severe or even permanent morbidity if left unrecognized and untreated [1-4]. Here we review a range of complications in the early postoperative period from more benign complications such as postoperative nausea and vomiting (PONV) to more feared complications leading to permanent loss of neurological function or death [5]. Perioperative pain management is covered in a separate review (Chapter 8).
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Affiliation(s)
- Matthew C Swann
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kathryn S Hoes
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - David L McDonagh
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Abstract
The chronic obstructive pulmonary disease has become a disease of public health importance. Among the various risk factors, smoking remains the main culprit. In addition to airway obstruction, the presence of intrinsic positive end expiratory pressure, respiratory muscle dysfunction contributes to the symptoms of the patient. Perioperative management of these patients includes identification of modifiable risk factors and their optimisation. Use of regional anaesthesia alone or in combination with general anaesthesia improves pulmonary functions and reduces the incidence of post-operative pulmonary complications.
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Affiliation(s)
- Devika Rani Duggappa
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - G Venkateswara Rao
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India
| | - Sudheesh Kannan
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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