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Hu Y, Xie M. Exploring the benefits of mind mapping in teaching pre-anesthetic evaluation to anesthesia residents. Asian J Surg 2024:S1015-9584(24)01286-7. [PMID: 38964965 DOI: 10.1016/j.asjsur.2024.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Affiliation(s)
- Yunxia Hu
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Xie
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Dixit AA, Sun EC. Improving patient care and enhancing surgical efficiency: strategies to reduce same-day surgical cancellations. Anaesthesia 2024; 79:573-575. [PMID: 38489835 PMCID: PMC11087192 DOI: 10.1111/anae.16282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Affiliation(s)
- A. A. Dixit
- Postdoctoral Scholar, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - E. C. Sun
- Assistant Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Cammarota G, De Robertis E, Simonte R. Unexpected intensive care unit admission after surgery: impact on clinical outcome. Curr Opin Anaesthesiol 2024; 37:192-198. [PMID: 38390879 DOI: 10.1097/aco.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review is focused on providing insights into unplanned admission to the intensive care unit (ICU) after surgery, including its causes, effects on clinical outcome, and potential strategies to mitigate the strain on healthcare systems. RECENT FINDINGS Postoperative unplanned ICU admission results from a combination of several factors including patient's clinical status, the type of surgical procedure, the level of supportive care and clinical monitoring outside the ICU, and the unexpected occurrence of major perioperative and postoperative complications. The actual impact of unplanned admission to ICU after surgery on clinical outcome remains uncertain, given the conflicting results from several observational studies and recent randomized clinical trials. Nonetheless, unplanned ICU admission after surgery results a significant strain on hospital resources. Consequently, this issue should be addressed in hospital policy with the aim of implementing preoperative risk assessment and patient evaluation, effective communication, vigilant supervision, and the promotion of cooperative healthcare. SUMMARY Unplanned ICU admission after surgery is a multifactorial phenomenon that imposes a significant burden on healthcare systems without a clear impact on clinical outcome. Thus, the early identification of patient necessitating ICU interventions is imperative.
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Affiliation(s)
- Gianmaria Cammarota
- Department of Translational Medicine, Università del Piemonte Orientale, Novara
| | - Edoardo De Robertis
- Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
| | - Rachele Simonte
- Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
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Wangrattanapranee P, Jensen DM, Khrucharoen U, Jensen ME. Patient Outcomes of Definitive Diverticular Hemorrhage After Colonoscopic, Medical, Surgical, or Embolization Treatment. Dig Dis Sci 2024; 69:538-551. [PMID: 38091175 DOI: 10.1007/s10620-023-08199-3] [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: 07/23/2023] [Accepted: 11/15/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND There are few reports of clinical outcomes or the natural history of definitive diverticular hemorrhage (DDH). AIMS To describe 1-year clinical outcomes of patients with documented DDH treated with colonoscopic hemostasis, angioembolization, surgery, or medical treatment. METHODS DDH was diagnosed when active bleeding or other stigmata of hemorrhage were found in a colonic diverticulum during urgent colonoscopy or extravasation on angiography or red blood cell (RBC) scanning. This was a retrospective analysis of prospectively collected data of DDH patients from two referral centers between 1993 and 2022. Outcomes were compared for the four treatment groups. The Kaplan-Meier analysis was for time-to-first diverticular rebleed. RESULTS 162 patients with DDH were stratified based on their final treatment before discharge-104 colonoscopic hemostasis, 24 medical treatment alone, 19 colon surgery, and 15 angioembolization. There were no differences in baseline characteristics, except for a higher Glasgow-Blatchford score in the angioembolization group vs. the colonoscopic group. Post-treatment, the colonoscopic hemostasis group had the lowest rate of RBC transfusions and fewer hospital and ICU days compared to surgical and embolization groups. The medical group had significantly higher rates of rebleeding and reintervention. The surgical group had the highest postoperative complications. CONCLUSIONS Medically treated DDH patients had significantly higher 1-year rebleed and reintervention rates than the three other treatments. Those with colonoscopic hemostasis had significantly better clinical outcomes during the index hospitalization. Surgery and embolization are recommended as salvage therapies in case of failure of colonoscopic and medical treatments.
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Affiliation(s)
- Peerapol Wangrattanapranee
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Dennis M Jensen
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
- Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
- VA Hemostasis GI Research Unit, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA.
| | - Usah Khrucharoen
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- VA Hemostasis GI Research Unit, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA
| | - Mary Ellen Jensen
- VA Hemostasis Research Unit and Division of Digestive Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Vatche and Tamar Manoukian Division of Digestive Diseases and Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
- VA Hemostasis GI Research Unit, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA
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Van Wicklin SA. Preoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures. PLASTIC AND AESTHETIC NURSING 2023; 43:174-186. [PMID: 37774162 DOI: 10.1097/psn.0000000000000525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Sharon Ann Van Wicklin
- Sharon Ann Van Wicklin, PhD, RN, CNOR, CRNFA(E), CPSN-R, PLNC, ISPAN-F, FAAN, is the Editor-in-Chief, Plastic and Aesthetic Nursing, and a Perioperative and Legal Nurse Consultant from Aurora, CO
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Network prediction of surgical complication clusters: a prospective multicenter cohort study. SCIENCE CHINA. LIFE SCIENCES 2023:10.1007/s11427-022-2200-1. [PMID: 36881319 DOI: 10.1007/s11427-022-2200-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/11/2022] [Indexed: 03/08/2023]
Abstract
Complicated relationships exist in both occurrence and progression of surgical complications, which are difficult to account for using a separate quantitative method such as prediction or grading. Data of 51,030 surgical inpatients were collected from four academic/teaching hospitals in a prospective cohort study in China. The relationship between preoperative factors, 22 common complications, and death was analyzed. With input from 54 senior clinicians and following a Bayesian network approach, a complication grading, cluster-visualization, and prediction (GCP) system was designed to model pathways between grades of complication and preoperative risk factor clusters. In the GCP system, there were 11 nodes representing six grades of complication and five preoperative risk factor clusters, and 32 arcs representing a direct association. Several critical targets were pinpointed on the pathway. Malnourished status was a fundamental cause widely associated (7/32 arcs) with other risk factor clusters and complications. American Society of Anesthesiologists (ASA) score ⩾3 was directly dependent on all other risk factor clusters and influenced all severe complications. Grade III complications (mainly pneumonia) were directly dependent on 4/5 risk factor clusters and affected all other grades of complication. Irrespective of grade, complication occurrence was more likely to increase the risk of other grades of complication than risk factor clusters.
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Surgical Emergencies in the Pregnant Patient. Curr Probl Surg 2023; 60:101304. [PMID: 37169419 DOI: 10.1016/j.cpsurg.2023.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Pai SL, Haehn DA, Pitruzzello NE, Rao SN, Meek SE, Irizarry Alvarado JM. Reducing Infection Rates with Enhanced Preoperative Diabetes Mellitus Diagnosis and Optimization Processes. South Med J 2023; 116:215-219. [PMID: 36724538 DOI: 10.14423/smj.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Hyperglycemia and increased preoperative hemoglobin A1c (HbA1c) are associated with perioperative morbidity and death. For nonurgent operations, adequate glycemic control before surgery is recommended. Our surgical practice needed a process for preoperative diabetes mellitus (DM) diagnosis and glycemic optimization. METHODS Our review of the existing preoperative evaluation process found that patients without a DM diagnosis but with random plasma glucose ≥200 mg/dL received no additional screening. Patients with DM routinely receive neither preoperative HbA1c screening nor DM management when HbA1c is ≥8.0%. RESULTS A new preoperative evaluation process was designed. HbA1c screening was automatically performed for patients with random plasma glucose ≥200 mg/dL. For patients with a DM diagnosis, an HbA1c test was performed. Specialty consultation was prompted for patients with known DM and HbA1c ≥8.0% and those with no DM diagnosis but HbA1c ≥6.5%. In the first year postimplementation, 9320 patients received a basic metabolic panel; 263 had random plasma glucose ≥200 mg/dL that triggered an HbA1c check. In total, 123 patients (99 with and 24 without a DM diagnosis) were referred to endocrinology; 13 received a new DM diagnosis. Twenty patients had surgery delayed for DM treatment. All of the patients received individualized medication instructions for the perioperative period. Among patients with random plasma glucose ≥200 mg/dL, incidence rates for surgical site infection pre- and postimplementation were 47.8/1000 and 3.8/1000 population. CONCLUSIONS The implemented process benefited patients scheduled for nonurgent procedures by optimizing glucose control and lowering infection rates through earlier preoperative DM diagnosis, glycemic management, and standardized patient medication instruction.
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Affiliation(s)
- Sher-Lu Pai
- From the Department of Anesthesiology and Perioperative Medicine
| | - Daniela A Haehn
- the Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
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Beilstein CM, Krutkyte G, Vetsch T, Eser P, Wilhelm M, Stanga Z, Bally L, Verra M, Huber M, Wuethrich PY, Engel D. Multimodal prehabilitation for major surgery in elderly patients to lower complications: protocol of a randomised, prospective, multicentre, multidisciplinary trial (PREHABIL Trial). BMJ Open 2023; 13:e070253. [PMID: 36596634 PMCID: PMC9815025 DOI: 10.1136/bmjopen-2022-070253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The global volume of surgery is growing and the population ageing, and economic pressure is rising. Major surgery is associated with relevant morbidity and mortality. Postoperative reduction in physiological and functional capacity is especially marked in the elderly, multimorbid patient with low fitness level, sarcopenia and malnutrition. Interventions aiming to optimise the patient prior to surgery (prehabilitation) may reduce postoperative complications and consequently reduce health costs. METHODS AND ANALYSIS This is a multicentre, multidisciplinary, prospective, 2-arm parallel-group, randomised, controlled trial with blinded outcome assessment. Primary outcome is the Comprehensive Complications Index at 30 days. Within 3 years, we aim to include 2×233 patients with a proven fitness deficit undergoing major surgery to be randomised using a computer-generated random numbers and a minimisation technique. The study intervention consists of a structured, multimodal, multidisciplinary prehabilitation programme over 2-4 weeks addressing deficits in physical fitness and nutrition, diabetes control, correction of anaemia and smoking cessation versus standard of care. ETHICS AND DISSEMINATION The PREHABIL trial has been approved by the responsible ethics committee (Kantonale Ethikkomission Bern, project ID 2020-01690). All participants provide written informed consent prior to participation. Participant recruitment began in February 2022 (10 and 8 patients analysed at time of submission), with anticipated completion in 2025. Publication of the results in peer-reviewed scientific journals are expected in late 2025. TRIAL REGISTRATION NUMBER NCT04461301.
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Affiliation(s)
- Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Gabija Krutkyte
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Vetsch
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Medical Division Rehabilitation & Sports Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital University Hospital, Bern, Switzerland
| | - Martin Verra
- Institute of Physiotherapy, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital University Hospital, University of Bern, Bern, Switzerland
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Abstract
PURPOSE OF REVIEW Ambulatory surgery is increasingly performed in medically complex patients. This dynamic environment requires new approaches to ensure cost-effective, efficient, and ultimately safe preoperative evaluation of the patient. This review investigates recent advances in the assessment of ambulatory patients, with a special focus on patient screening, digital communication, and multidisciplinary team evaluation. RECENT FINDINGS Identifying suitable candidates for ambulatory surgery relies on a variety of medical, surgical, and institutional factors. Identification of high-risk patients and optimization of their treatment can be achieved through multidisciplinary protocols specific to the local institution and in line with current guidelines. Virtual assessment may be sufficient for most patients and provide an efficient evaluation strategy and high patient satisfaction. Prescreening can be supported by preoperative nursing teams. SUMMARY The increasing complexity of treatment provided in day surgery offers a unique opportunity to highlight the importance of anesthesiology staff as perioperative caregivers. Preoperative evaluation serves as a central junction to integrate a variety of surgical, medical, and institutional factors to provide safe, satisfactory, and efficient care for patients. Implementing technological innovation to streamline and facilitate this process is paramount.
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Fleming C, Shin E, Powell R, Poznyak D, Javadi A, Burkhart C, Ghosh A, Rich EC. Updating a Claims-Based Measure of Low-Value Services Applicable to Medicare Fee-for-Service Beneficiaries. J Gen Intern Med 2022; 37:3453-3461. [PMID: 35668238 PMCID: PMC9550936 DOI: 10.1007/s11606-022-07654-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
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Meyer M, Grifka J, Kappenschneider T. [Preoperative screening for risk factors]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:684-692. [PMID: 35925284 DOI: 10.1007/s00132-022-04258-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 06/15/2023]
Abstract
The demographic change and continuously improving healthcare lead to increasing numbers of older, comorbid patients in elective orthopedic surgery. Perioperative risk assessment is crucial for patient counseling and preoperative planning. Risk factors, such as heart failure, chronic obstructive pulmonary disease, peripheral arterial occlusive disease, anemia, malnutrition, obesity, smoking and insufficiently controlled diabetes mellitus are common in patients undergoing elective orthopedic surgery. A thorough and early screening not only enables the individual assessment of the risk profile but in an elective setting also enables the chance for modification of certain risk factors in order to reduce the individual perioperative risk. Meanwhile, recommendations regarding risk stratification and adjustment of modifiable risk factors are included in national guidelines on the indications for elective total hip arthroplasty.
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Affiliation(s)
- Matthias Meyer
- Orthopädische Klinik für die Universität Regensburg im Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Joachim Grifka
- Orthopädische Klinik für die Universität Regensburg im Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Tobias Kappenschneider
- Orthopädische Klinik für die Universität Regensburg im Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
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Zhou Y, Wang L, Cao A, Luo W, Xu Z, Sheng Z, Wang J, Zhu B. Modified Frailty Index Combined with a Prognostic Nutritional Index for Predicting Postoperative Complications of Hip Fracture Surgery in Elderly. J INVEST SURG 2022; 35:1739-1746. [PMID: 35906737 DOI: 10.1080/08941939.2022.2101166] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Aim: There is currently no consensus on the best risk assessment technique for predicting complications after hip surgery in the elderly, which is hindering the accuracy of surgical risk assessment. The goal of this study was to build a risk assessment model and evaluate its predictive value using the modified frailty index (5-mFI) and the prognostic nutritional index (PNI).Methods: A retrospective investigation was undertaken on 150 patients (aged ≥60 years) who had hip fracture surgery. Using univariate and multivariate logistic regression models, the relationship between combined 5-mFI and PNI and the evaluation of postoperative unfavorable outcomes such as infection and unscheduled intensive care unit (ICU) admission was investigated. Finally, utilizing receiver operating characteristic (ROC) curve analysis, the model's predictive value for adverse outcomes following hip fracture surgery in elderly patients was assessed.Results: Univariate and multivariate logistic analyses revealed that preoperative PNI, 5-mFI, ASA, and gender acted as independent predictors of adverse outcomes after hip fracture surgery in the elderly. According to the ROC curve analysis, the predictive model demonstrated a high predictive value for total postoperative complications (AUC: 0.788; 95%CI: 0.715-0.860; p<0.01), infectious complications (AUC: 0.798; 95% CI: 0.727-0.868; P<0.001), and unplanned ICU admission (AUC: 0.783; 95% CI: 0.705-0.861; P<0.001).Conclusions: The multivariable evaluation model, which included 5-mFI and PNI, showed a high predictive value and can hence be applied to predict the adverse outcomes in elderly patients undergoing hip fracture surgery.
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Affiliation(s)
- Yanling Zhou
- Department of anesthesiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Long Wang
- Department of Nephrology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Angyang Cao
- Department of anesthesiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Wenjun Luo
- Department of anesthesiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Zhipeng Xu
- Department of anesthesiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Zhiren Sheng
- Nursing department, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Jianhua Wang
- Department of Radiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Binbin Zhu
- Department of anesthesiology, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
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Chotisukarat H, Akavipat P, Suchartwatnachai P, Sookplung P, Eiamcharoenwit J. Incidence and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery. F1000Res 2022; 11:15. [PMID: 35388339 PMCID: PMC8943344 DOI: 10.12688/f1000research.75245.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background: An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods: This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results: Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (odds ratios (OR): 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (OR: 120.97; 95% CI: 2.12-6898.80). Conclusion: The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.
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Affiliation(s)
- Haruthai Chotisukarat
- Department of Anesthesiology, Neurological Institute of Thailand, Bangkok, 10400, Thailand
| | - Phuping Akavipat
- Department of Anesthesiology, Neurological Institute of Thailand, Bangkok, 10400, Thailand
| | | | - Pimwan Sookplung
- Department of Anesthesiology, Neurological Institute of Thailand, Bangkok, 10400, Thailand
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Jensen JH, Sørensen L, Mosegaard SB, Mechlenburg I. Risk Stratification for Postoperative Pulmonary Complications following Major Cardiothoracic and Abdominal Surgery - development of the PPC Risk Prediction Score for Physiotherapists Clinical Decision-making. Physiother Theory Pract 2022; 39:1305-1316. [PMID: 35232331 DOI: 10.1080/09593985.2022.2037795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Major cardiothoracic or abdominal surgery can lead to the development of postoperative pulmonary complications (PPC), associated with increased morbidity and prolonged length of hospital stay. Preventive chest physiotherapy is routinely provided, but optimization of treatment strategies is needed to improve patient outcome and resource utilization. OBJECTIVE To develop a preoperative risk prediction scorelr to assist clinical decision-making regarding physiotherapy interventions. METHODS A prospective observational single-center study included 339 of 577 eligible patients admitted for major elective cardiothoracic or abdominal surgery. Primary outcome measure was PPC amendable to chest physiotherapy. RESULTS A total of 113 patients (33.3%) developed a PPC. Logistic regression modeling identified four independent predictors of PPC presented with odds ratio (OR) and 95% confidence interval. Reduced lung function (FEV1 > 50% to <75% OR 2.4 (1.4; 4.3) and FEV1 ≤ 50% OR 4.7 (1.4;16.0)), Recent unintended weight loss OR 4.5 (1.1; 18.7), Sternotomy OR 3.5 (2.0; 6.0) and Thoraco-abdominal incision OR 4.5 (2.1; 10.1). Based on assigned point values, a score dividing patients into three risk groups was developed. The score had moderate discrimination (c-statistic 0.70). CONCLUSION By following recommended guidelines (TRIPOD) a preoperative risk prediction score including four predictors of PPC was developed. External validation of the score is currently being investigated.
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Affiliation(s)
- Janne Hastrup Jensen
- Department of Physical and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
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Silva Dutra H, Arreguy-Sena C, Cordeiro Ribeiro F, Muniz Braga L, Krempser P, Deleon de Melo L. Representações sociais de mulheres sobre cateterização venosa para procedimento anestésico-cirúrgico. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: A cateterização venosa é essencial para procedimentos anestésico-cirúrgicos, com características compatíveis com estabilidade, volume de fluxo em curtos espaços de tempo e grosso calibre a fim de evitar trauma vascular. Objetivo: Identificar as representações sociais de mulheres sobre punção venosa para fins anestésico-cirúrgicos à luz dos estressores de Neuman. Materiais e métodos: Estudo qualitativo por abordagem estrutural das representações sociais realizada em um serviço de cirurgia, Brasil. Amostra de seleção completa (n=180) com delineamento temporal composta por mulheres (idade ≥18 anos) submetidas à punção venosa durante procedimentos anestésico-cirúrgicos. Utilizou-se técnica de evocação livre de palavras com o termo indutor “pegar veia para anestesia e cirurgia”. Realizou-se análise prototípica empregando o software EVOC2003. Os requisitos ético-legais foram atendidos. Resultados: As mulheres tinham de 20 a 39 anos (63%) e 10 a 13 anos de escolaridade (56,1%). No possível núcleo central constam sentimentos (“dor” e “medo-sem-medo”) em oposição à área de contraste “(in)certeza-habilidade-profissional” e “tranquila-fácil” e com elementos objetivados superativados alocados na primeira periferia, retratando estressores intrapessoais, interpessoais e extrapessoais. Discussões: A dor, enquanto objeto representacional, remeteu à função justificadora quando aproximada da agulha, reafirmando o surgimento de medo, nervosismo e da ansiedade (estressores). Conclusões: Dor, medo, ansiedade e nervosismo foram estressores identificados nas representações sociais que necessitam ser monitorados terapeuticamente por meio de relações interpessoais de confiança entre profissional-usuário, aliando a performance do desempenho, sendo necessário inserir a educação permanente para profissionais que puncionam vasos.
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Disparities in cardiac arrest and failure to rescue after major elective noncardiac operations. Surgery 2022; 171:1358-1364. [DOI: 10.1016/j.surg.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 01/30/2023]
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Karim HMR, Singha SK, Neema PK, Baruah TD, Ray R, Mohanty D, Siddiqui MS, Nanda R, Bodhey NK. Information technology-based joint preoperative assessment, risk stratification and its impact on patient management, perioperative outcome, and cost. Discoveries (Craiova) 2021; 9:e130. [PMID: 34849397 PMCID: PMC8627278 DOI: 10.15190/d.2021.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/23/2021] [Accepted: 05/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Despite negative recommendations, routine preoperative testing practice is nearly universal. Our aim is to bring the healthcare providers on one platform by using information-technology based preanaesthetic assessment and evaluate the routine preoperative testing’s impact on patient outcome and cost.
Methods: A prospective, non-randomised study was conducted in a teaching hospital during January 2019-August 2020. A locally developed software and cloud-computing were used as a tool to modify preanaesthesia evaluation. The number of investigations ordered, time taken, cost incurred, were compared with the routine practice. Further data were matched as per surgical invasiveness and the patient's physical status. Appropriate tests compared intergroup differences and p-value <0.05 was considered significant.
Results: Data from 114 patients (58 in routine and 56 in patient and surgery specific) were analysed. Patient and surgery specific investigation led to a reduction in the investigations by 80-90%, hospital visit by 50%, and the total cost by 80%, without increasing the day of surgery cancellation or complications.
Conclusion: Information technology-based joint preoperative assessment and risk stratification are feasible through locally developed software with minimal cost. It helps in applying patient and surgery specific investigation, reducing the number of tests, hospital visit, and cost, without adversely affecting the perioperative outcome. The application of the modified method will help in cost-effective, yet quality and safe perioperative healthcare delivery. It will also benefit the public from both service and economic perspective.
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Affiliation(s)
| | - Subrata Kumar Singha
- Department of Anaesthesiology, India Institute of Medical Sciences, Raipur, India
| | - Praveen Kumar Neema
- Department of Anaesthesiology, India Institute of Medical Sciences, Raipur, India
| | - Tridip Dutta Baruah
- Department of General Surgery, India Institute of Medical Sciences, Raipur, India
| | - Rubik Ray
- Department of General Surgery, India Institute of Medical Sciences, Raipur, India
| | - Debajyoti Mohanty
- Department of General Surgery, India Institute of Medical Sciences, Raipur, India
| | - Md Sabah Siddiqui
- Department of General Medicine, India Institute of Medical Sciences, Raipur, India
| | - Rachita Nanda
- Department of Clinical Biochemistry, India Institute of Medical Sciences, Raipur, India
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19
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Grigorescu BL, Săplăcan I, Petrișor M, Bordea IR, Fodor R, Lazăr A. Perioperative Risk Stratification: A Need for an Improved Assessment in Surgery and Anesthesia-A Pilot Study. MEDICINA-LITHUANIA 2021; 57:medicina57101132. [PMID: 34684169 PMCID: PMC8538842 DOI: 10.3390/medicina57101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/03/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive correlations: ASA score–P-POSSUM (p < 0.01, r = 0.465); ASA score–SAS, (p < 0.01, r = −0.446); ASA score–APACHE II, (p < 0.01 r = 0.519); predicted LOS and ASA score (p < 0.01, r = 0.676); predicted LOS and p-POSSUM (p < 0.01, r = 0.433); and predicted LOS and APACHE II (p < 0.01, r = 0.454). A significant negative correlation between predicted LOS, real LOS, ASA class, and SAS (p < 0.05) was observed. We found a statistically significant difference between the predicted and actual LOS (p < 001). Conclusions: Anesthetic, surgical, and severity scores, used together, provide clearer information about mortality, morbidity, and LOS. ASA scale, associated with surgical scores and severity scores, presents a better image of the patient’s progress in the perioperative period. In our study, APACHE II is the best predictor of mortality, followed by P-POSSUM and SAS. P-POSSUM score and ASA scale may be complementary in terms of preoperative physiological factors, providing valuable information for postoperative outcomes.
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Affiliation(s)
- Bianca-Liana Grigorescu
- Department of Pathophysiology, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania;
| | - Irina Săplăcan
- Department of Anesthesiology and Intensive Care, Emergency County Hospital, 540136 Târgu-Mureș, Romania
- Correspondence: (I.S.); (I.R.B.); Tel.: +40-787691256 (I.S.); +40-744919391 (I.R.B.)
| | - Marius Petrișor
- Department of Simulation Applied in Medicine, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania;
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, University of Medicine and Pharmacy Iuliu Hațieganu, 400012 Cluj-Napoca, Romania
- Correspondence: (I.S.); (I.R.B.); Tel.: +40-787691256 (I.S.); +40-744919391 (I.R.B.)
| | - Raluca Fodor
- Department of Anesthesiology and Intensive Care, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania; (R.F.); (A.L.)
| | - Alexandra Lazăr
- Department of Anesthesiology and Intensive Care, University of Medicine, Pharmacology, Sciences and Technology, 540142 Târgu-Mureș, Romania; (R.F.); (A.L.)
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20
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Jorge AJL, Mesquita ET, Martins WDA. Myocardial Injury after Non-cardiac Surgery - State of the Art. Arq Bras Cardiol 2021; 117:544-553. [PMID: 34550241 PMCID: PMC8462967 DOI: 10.36660/abc.20200317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
Aproximadamente 300 milhões de cirurgias não cardíacas são realizadas anualmente no mundo, e eventos cardiovasculares adversos são as principais causas de morbimortalidade no período perioperatório e pós-operatório. A lesão miocárdica após cirurgia não cardíaca (MINS, do inglês myocardial injury after non-cardiac surgery) é uma nova entidade clínica associada com desfechos cardiovasculares adversos. MINS é definida como uma lesão miocárdica que pode resultar em necrose secundária à isquemia, com elevação dos biomarcadores. A lesão tem importância prognóstica e ocorre em até 30 dias após a cirurgia não cardíaca. Os critérios diagnósticos para MINS são: níveis elevados de troponina durante ou em até 30 dias após a cirurgia não cardíaca, sem evidência de etiologia não isquêmica, sem que haja necessariamente sintomas isquêmicos ou achados eletrocardiográficos de isquemia. Recentemente, pacientes com maior risco para MINS têm sido identificados por variáveis clínicas e biomarcadores, bem como por protocolos de vigilância quanto ao monitoramento eletrocardiográfico e dosagem de troponina cardíaca. Pacientes idosos com doença aterosclerótica prévia necessitam medir troponina diariamente no período pós-operatório. O objetivo deste trabalho é descrever este novo problema de saúde pública, seu impacto clínico e a abordagem terapêutica contemporânea.
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Affiliation(s)
| | - Evandro Tinoco Mesquita
- Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, Rio de Janeiro, RJ - Brasil.,UNIALFA / Colégio Brasileiro de Executivos em Saúde CBEXs, São Paulo, SP - Brasil.,Sociedad Interamericana de Cardiología (SIAC), Cidade do México - México.,DASA Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
| | - Wolney de Andrade Martins
- Universidade Federal Fluminense (UFF), Niterói, RJ - Brasil.,DASA Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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21
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Metzger L, Teitelbaum M, Weber G, Kumaraswami S. Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist. Cureus 2021; 13:e17196. [PMID: 34540424 PMCID: PMC8439398 DOI: 10.7759/cureus.17196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/20/2022] Open
Abstract
Pregnant patients may present with multiple complex comorbidities that can affect peripartum management and anesthetic care. The preanesthesia clinic is the ideal setting for early evaluation of high-risk pregnant patients. Comorbidities may include cardiovascular pathology such as valvular abnormalities, septal defects, aortopathies, arrythmias and cardiomyopathies. Additional comorbidities include pulmonary conditions such as obstructive sleep apnea as well as preexisting neuromuscular and skeletal disorders that may impact anesthetic management. Hematologic conditions involving both bleeding diathesis and thrombophilias may present unique challenges for the anesthesiologist. Patients may also present with endocrinopathies including diabetes and obesity. While not as common, high-risk patients may also have preexisting gastrointestinal conditions such as liver dysfunction, renal failure, and even post-transplant status. Ongoing and prior substance abuse, obstetric conditions such as placenta accreta spectrum disorders, and fetal conditions needing ex utero Intrapartum treatment also require advanced planning. Preanesthesia evaluations also help address important ethical and cultural considerations. Counseling patients regarding anesthetic considerations as well as addressing concerns will play a role in reducing racial and ethnic disparities. Anticipatory guidance by means of pre-anesthetic planning can facilitate multidisciplinary communication and planning. This can allow for an impactful and meaningful role in the care provided, allowing for safe maternal care and optimal outcomes.
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Affiliation(s)
- Lia Metzger
- Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Garret Weber
- Anesthesiology, New York Medical College, Valhalla, USA
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22
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Lema G. Risk Prediction Models: Can They Be Applied in All Situations? Mayo Clin Proc 2021; 96:1095. [PMID: 33814082 DOI: 10.1016/j.mayocp.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Guillermo Lema
- Pontificia Universidad Catolica de Chile, Santiago, Chile
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23
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Perioperative Assessment of High-Risk Abdominal Surgery: A Case Study. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:374-382. [PMID: 32775620 PMCID: PMC7413206 DOI: 10.12691/ajmcr-8-10-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives • To outline the key components of a pre-operative cardiac risk assessment. • To review the major guidelines utilized to assess patients' surgical risks. • To discuss the perioperative management of surgical patients to prevent cardiac and pulmonary complications. • To review the utility of biomarkers in the pre- and post-operative period.
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