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Yip SWS, Weinberg L, Gooi J, Sivenayagam S, Coulson TG, Barnett SA, Knight SR, Ludski J, Lee DK. Anaesthetic and perioperative considerations for extrapleural pneumonectomy and extended pleurectomy/decortication: a scoping review protocol. BMJ Open 2024; 14:e078125. [PMID: 38760041 PMCID: PMC11103232 DOI: 10.1136/bmjopen-2023-078125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 05/05/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (ePD) are surgical cytoreductive techniques aimed at achieving macroscopic resection in malignant pleural tumours such as pleural mesothelioma, non-mesothelioma pleural malignancies such as thymoma and sarcoma, and rarely for pleural tuberculosis, in a more limited fashion. Despite extensive studies on both surgical techniques and consequences, a significant knowledge gap remains regarding how best to approach the perioperative anaesthesia challenges for EPP and ePD.It is unknown if the risk stratification processes for such surgeries are standardised or what types of functional and dynamic cardiac and pulmonary tests are employed preoperatively to assist in the perioperative risk stratification. Further, it is unknown whether the types of anaesthesia and analgesia techniques employed, and the types of haemodynamic monitoring tools used, impact on outcomes. It is also unknown whether individualised haemodynamic protocols are used to guide the rational use of fluids, vasoactive drugs and inotropes.Finally, there is a dearth of evidence regarding how best to monitor these patients postoperatively or what the most effective enhanced recovery protocols are to best mitigate postoperative complications and accelerate hospital discharge. To increase our knowledge of the perioperative and anaesthetic treatment for patients undergoing EPP/ePD, this scoping review attempts to synthesise the literature and identify these knowledge gaps. METHODS AND ANALYSIS This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review Protocols methodology. Electronic databases, OVID Medline, EMBASE and the Cochrane Library, will be systematically searched for relevant literature corresponding to EPP or ePD and perioperative or anaesthetic management. Data will be analysed and summarised descriptively and organised according to the three perioperative stages: preoperative, intraoperative and postoperative factors in clinical care. ETHICS AND DISSEMINATION Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.
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Affiliation(s)
- Sui Wah Sean Yip
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Julian Gooi
- Department of Cardiothoracic Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Siven Sivenayagam
- Department of Cardiothoracic Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Tim G Coulson
- Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, Victoria, Australia
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Stephen A Barnett
- Department of Thoracic Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Simon R Knight
- Department of Thoracic Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Jarryd Ludski
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea (the Republic of)
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Syversen A, Dosis A, Jayne D, Zhang Z. Wearable Sensors as a Preoperative Assessment Tool: A Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:482. [PMID: 38257579 PMCID: PMC10820534 DOI: 10.3390/s24020482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Surgery is a common first-line treatment for many types of disease, including cancer. Mortality rates after general elective surgery have seen significant decreases whilst postoperative complications remain a frequent occurrence. Preoperative assessment tools are used to support patient risk stratification but do not always provide a precise and accessible assessment. Wearable sensors (WS) provide an accessible alternative that offers continuous monitoring in a non-clinical setting. They have shown consistent uptake across the perioperative period but there has been no review of WS as a preoperative assessment tool. This paper reviews the developments in WS research that have application to the preoperative period. Accelerometers were consistently employed as sensors in research and were frequently combined with photoplethysmography or electrocardiography sensors. Pre-processing methods were discussed and missing data was a common theme; this was dealt with in several ways, commonly by employing an extraction threshold or using imputation techniques. Research rarely processed raw data; commercial devices that employ internal proprietary algorithms with pre-calculated heart rate and step count were most commonly employed limiting further feature extraction. A range of machine learning models were used to predict outcomes including support vector machines, random forests and regression models. No individual model clearly outperformed others. Deep learning proved successful for predicting exercise testing outcomes but only within large sample-size studies. This review outlines the challenges of WS and provides recommendations for future research to develop WS as a viable preoperative assessment tool.
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Affiliation(s)
- Aron Syversen
- School of Computing, University of Leeds, Leeds LS2 9JT, UK
| | - Alexios Dosis
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.D.); (D.J.)
| | - David Jayne
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.D.); (D.J.)
| | - Zhiqiang Zhang
- School of Electrical Engineering, University of Leeds, Leeds LS2 9JT, UK;
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Arina P, Kaczorek MR, Hofmaenner DA, Pisciotta W, Refinetti P, Singer M, Mazomenos EB, Whittle J. Prediction of Complications and Prognostication in Perioperative Medicine: A Systematic Review and PROBAST Assessment of Machine Learning Tools. Anesthesiology 2024; 140:85-101. [PMID: 37944114 PMCID: PMC11146190 DOI: 10.1097/aln.0000000000004764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The utilization of artificial intelligence and machine learning as diagnostic and predictive tools in perioperative medicine holds great promise. Indeed, many studies have been performed in recent years to explore the potential. The purpose of this systematic review is to assess the current state of machine learning in perioperative medicine, its utility in prediction of complications and prognostication, and limitations related to bias and validation. METHODS A multidisciplinary team of clinicians and engineers conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Multiple databases were searched, including Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Medline, Embase, and Web of Science. The systematic review focused on study design, type of machine learning model used, validation techniques applied, and reported model performance on prediction of complications and prognostication. This review further classified outcomes and machine learning applications using an ad hoc classification system. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability of the studies. RESULTS A total of 103 studies were identified. The models reported in the literature were primarily based on single-center validations (75%), with only 13% being externally validated across multiple centers. Most of the mortality models demonstrated a limited ability to discriminate and classify effectively. The PROBAST assessment indicated a high risk of systematic errors in predicted outcomes and artificial intelligence or machine learning applications. CONCLUSIONS The findings indicate that the development of this field is still in its early stages. This systematic review indicates that application of machine learning in perioperative medicine is still at an early stage. While many studies suggest potential utility, several key challenges must be first overcome before their introduction into clinical practice. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Pietro Arina
- Bloomsbury Institute of Intensive Care Medicine and Human Physiology and Performance Laboratory, Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, United Kingdom
| | - Maciej R. Kaczorek
- Wellcome/EPSRC Centre of Interventional and Surgical Sciences and Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Daniel A. Hofmaenner
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom; and Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Walter Pisciotta
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Patricia Refinetti
- Human Physiology and Performance Laboratory, Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, United Kingdom
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Evangelos B. Mazomenos
- Wellcome/EPSRC Centre of Interventional and Surgical Sciences and Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - John Whittle
- Human Physiology and Performance Laboratory, Centre for Perioperative Medicine, Department of Targeted Intervention, University College London, London, United Kingdom
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Bougeard AM, Nair A, Santhirapala R. Perioperative shared decision making - How do we train clinicians? PEC INNOVATION 2023; 3:100181. [PMID: 37416622 PMCID: PMC10320377 DOI: 10.1016/j.pecinn.2023.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Abstract
Objective Decision making about high-risk surgery can be complex, particularly when outcomes may be uncertain. Clinicians have a legal and ethical responsibility to support decision making which fits with patients' values and preferences. In the UK, preoperative assessment and optimisation is led by Anaesthetists in clinic several weeks prior to planned surgery. Training in supporting shared decision making (SDM) has been identified as an area of need among UK anaesthetists with leadership roles in perioperative care. Methods We describe adaptation of a generic SDM workshop to perioperative care, in particular to decisions on high-risk surgery, and its delivery to UK healthcare professionals over a two-year period. Feedback from workshops were thematically analysed. We explored further improvements to the workshop and ideas for development and dissemination. Results The workshops were well received, with high satisfaction for techniques used, including video demonstrations, role-play and discussions. Thematic analysis identified a desire for multidisciplinary training and training in using patient aids. Conclusion Qualitative findings suggest workshops were considered useful with perceived improvement in SDM awareness, skills and reflective practice. Innovation This pilot introduces a new modality of training in the perioperative setting providing physicians, particularly Anaesthetists, with previously unavailable training needed to facilitate complex discussions.
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Affiliation(s)
| | - Ashwati Nair
- Fifth Year Medical Student, GKT School of Medical Education, King's College London, UK
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Wallace SK, Bucknall TK, Forbes A, Myles PS. A mixed methods study protocol to identify research priorities for perioperative medicine in Australia. BJA OPEN 2023; 8:100235. [PMID: 37927381 PMCID: PMC10624594 DOI: 10.1016/j.bjao.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
Background Clinical research in perioperative medicine requires the perspectives of patients and caregivers to increase its relevance and quality, benefiting both researchers and the community. Identifying these priorities will enable researchers, funders, and governing bodies to efficiently use scarce funding and resources. We aim to identify the top 10 research priorities in perioperative medical research in Australia. Methods A mixed-methods, exploratory-sequential design will be conducted. The study will include five phases. Initially, a published open-ended survey gathered responses from the population (researchers, healthcare workers, and consumers) regarding uncertainties/questions relevant to the population about perioperative medical research. We collected 544 questions and quantitatively analysed and grouped them according to the Standardised Endpoints in Perioperative Medicine-Core Outcomes Measures in Perioperative and Anaesthetic Care (StEP-COMPAC) endpoints. Using multicriteria decision-making software, workshops combining the population will be conducted to determine the top 10 priorities for perioperative medicine research for the Australian population. Ethics and dissemination Ethical approval to conduct the study was obtained from the Alfred Health (Australia) Human Research Ethics Committee (ID: 171/19). The findings will be disseminated in peer review publications, conferences, and dissemination across perioperative research networks. The top 10 priorities will be available to inform research funders, grant submissions, guidelines, and the population.
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Affiliation(s)
- Sophie K.A. Wallace
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tracey K. Bucknall
- Centre for Quality and Patient Safety- Alfred Health Partnership, Institute for Health Transformation, Deakin University, Geelong, Australia
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Andrew Forbes
- Biostatistics Unit, Department of Epidemiology and Perioperative Medicine, Monash University, Melbourne, Australia
| | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Tong SX, Li RS, Wang D, Xie XM, Ruan Y, Huang L. Artificial intelligence technology and ultrasound-guided nerve block for analgesia in total knee arthroplasty. World J Clin Cases 2023; 11:7026-7033. [PMID: 37946775 PMCID: PMC10631398 DOI: 10.12998/wjcc.v11.i29.7026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Knee diseases are more common in middle-aged and elderly people, so artificial knee replacement is also more used in middle-aged and elderly people. Although the patient's pain can be reduced through surgery, often accompanied by moderate pain after surgery and neutralization, which not only increases the psychological burden of the patient, but also greatly reduces the postoperative recovery effect, and may also lead to the occurrence of postoperative adverse events in severe cases. AIM To investigate the analgesic effect of artificial intelligence (AI) and ultrasound-guided nerve block in total knee arthroplasty (TKA). METHODS A total of 92 patients with TKA admitted to our hospital from January 2021 to January 2022 were opted and divided into two groups according to the treatment regimen. The control group received combined spinal-epidural anesthesia. The research group received AI technique combined with ultrasound-guided nerve block anesthesia. The sensory block time, motor block time, visual analogue scale (VAS) at different time points and complications were contrasted between the two groups. RESULTS The time of sensory block onset and sensory block perfection in the research group was shorter than those in the control group, but the results had no significant difference (P > 0.05). Duration of sensory block in the research group was significantly longer than those in the control group (P < 0.05). The time of motor block onset and motor block perfection in the research group was shorter than those in the control group, but the results had no significant difference (P > 0.05). Duration of motor block in the research group was significantly longer than those in the control group. The VAS scales of the research group were significantly lower than that of the control group at different time points (P < 0.05). The postoperative hip flexion and abduction range of motion in the research group were significantly better than those in the control group at different time points (P < 0.05). The incidence of complications was significantly lower in the research group than in the control group (P = 0.049). CONCLUSION In TKA, the combination of AI technology and ultrasound-guided nerve block has a significantly effect, with fewer postoperative complications and significantly analgesic effect, which is worthy of application.
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Affiliation(s)
- Sheng-Xiong Tong
- Department of Pain Management, Wuhan First Hospital, Wuhan 430033, Hubei Province, China
| | - Ren-Song Li
- Department of Orthopaedics, Wuhan Wuchang Hospital, Wuhan 430063, Hubei Province, China
| | - Dan Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xiao-Meng Xie
- Department of Nursing, Huanggang Central Hospital, Huanggang 438000, Hubei Province, China
| | - Yuan Ruan
- Department of Orthopaedics, Huanggang Central Hospital, Huanggang 438000, Hubei Province, China
| | - Lin Huang
- Department of Orthopaedics, Huanggang Central Hospital, Huanggang 438000, Hubei Province, China
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Kalt F, Mayr H, Gero D. Classification of Adverse Events in Adult Surgery. Eur J Pediatr Surg 2023; 33:120-128. [PMID: 36720250 DOI: 10.1055/s-0043-1760821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Successful surgery combines quality (achievement of a positive outcome) with safety (avoidance of a negative outcome). Outcome assessment serves the purpose of quality improvement in health care by establishing performance indicators and allowing the identification of performance gaps. Novel surgical quality metric tools (benchmark cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes in a subgroup of well-defined low-risk patients, with the aim of setting realistic and best achievable goals for surgeons and centers, as well as supporting unbiased comparison of surgical quality between centers and periods of time. Validated classification systems have been deployed to grade adverse events during the surgical journey: (1) the ClassIntra classification for the intraoperative period; (2) the Clavien-Dindo classification for the gravity of single adverse events; and the (3) Comprehensive Complication Index (CCI) for the sum of adverse events over a defined postoperative period. The failure to rescue rate refers to the death of a patient following one or more potentially treatable postoperative adverse event(s) and is a reliable proxy of the institutional safety culture and infrastructure. Complication assessment is undergoing digital transformation to decrease resource-intensity and provide surgeons with real-time pre- or intraoperative decision support. Standardized reporting of complications informs patients on their chances to realize favorable postoperative outcomes and assists surgical centers in the prioritization of quality improvement initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the enhancement of clinical standards.
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Affiliation(s)
- Fabian Kalt
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
| | - Hemma Mayr
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
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Gottumukkala V, Vetter TR, Gan TJ. Perioperative Medicine: What the Future Can Hold for Anesthesiology. Anesth Analg 2023; 136:628-635. [PMID: 36928147 DOI: 10.1213/ane.0000000000006412] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Vijaya Gottumukkala
- From the Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Tong J Gan
- Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Nicholson JJ, Reilly J, Shulman MA, Ferguson M, Burke JA, Lehane DN, Liaw CM, Mahoney A, Stark P, Myles PS. Perioperative outcomes in intermediate and high-risk patients after major surgery following introduction of a dedicated perioperative medicine team: A single centre cohort study. Anaesth Intensive Care 2023; 51:120-129. [PMID: 36523257 DOI: 10.1177/0310057x221119814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Intermediate and high-risk patients undergoing surgery are often managed on a surgical ward in the absence of haemodynamic or ventilatory support requirements necessitating intensive care unit or high dependency unit admission. We describe a model of care for the multidisciplinary management of selected postoperative patients and the epidemiology of patients managed using this model at a tertiary Australian hospital.Of 25,139 patients undergoing inpatient surgery at our institution over a two-year period, 506 (2%) were referred to the Perioperative Medicine team. The median age of patients referred was 74 years; 85% had an American Society of Anesthesiologists physical status ≥3, and 44% underwent emergency surgery. Major complication or death within 30 days was 44.2% (213/482). The most common complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program were transfusion within 72 h (17.4%), pneumonia/aspiration pneumonitis (11.3%), and acute renal failure (10.6%); median time to Medical Emergency Team call was 146 (interquartile range 77-279) h.Sixty-six percent of referred patients (280/423) required an intervention during their time under the service. This high incidence indicates that this population of patients merits closer attention, including routine measurement and reporting of postoperative outcomes to monitor and improve quality of care at our institution as part of an integrated perioperative service. We believe that with so much current focus on perioperative medicine, it is important we translate this to clinical care by evolving traditional models of management into more innovative strategies to meet the complex demands of today's surgical patients.
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Affiliation(s)
- Jonathan J Nicholson
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Jennifer Reilly
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Marissa Ferguson
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Justin A Burke
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Daragh N Lehane
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
| | - Chen-Mei Liaw
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
| | - Adam Mahoney
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
| | - Peter Stark
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
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Goth A, Karim HMR, Yunus M, Chakraborty R, Dey S, Bhattacharyya P. Effect of Postoperative Anesthesiologists' Single Visit on Patient Satisfaction: A Hospital-Based Non-Randomized Study. Cureus 2023; 15:e34518. [PMID: 36879720 PMCID: PMC9984279 DOI: 10.7759/cureus.34518] [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] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Background Continuity of personal care by the anesthesiologist is crucial for patient satisfaction. Over and above the consultation and service in the preoperative area, intraoperative care, and post-anesthesia care unit, anesthesia services frequently incorporate a pre-anesthesia evaluation clinic and a preoperative visit in the inpatient ward for their services, which helps with rapport building. However, routine post-anesthesia visits in the inpatient ward by the anesthesiologist are infrequent, causing a break in the continuity of care. The effect of such a routine post-operative visit by anesthesiologists has been tested only rarely in the Indian population. The present study aimed to evaluate the impact of a single postoperative visit by the same anesthesiologist (continuity of care) on patient satisfaction and compare it with a postoperative visit by another anesthesiologist and no postoperative visit. Methods After institutional ethical committee approval, 276 American Society of Anesthesiologists physical status (ASA PS) I and II, consenting, elective surgical inpatients older than 16 years were enrolled in a tertiary care teaching hospital from January 2015- September 2016. Consecutive patients were allocated into three groups based on the postoperative visit (i.e., group A: by the same anesthesiologist; group B: another anesthesiologist; and group C: no visit). Data related to patients' satisfaction were collected in a pretested questionnaire. Chi-Square and Analysis of Variance (ANOVA) were applied to analyze the data and compare among the groups; a p < 0.05 was considered statistically significant. Results The mean age of the entire cohort was 38.1 years, comprising 39.9% men. Demographic, socioeconomic, and educational statuses were similar in all groups (p >0.05). The percentages of patient satisfaction were 61.47%, 51.52%, and 38.5% in groups A, B, and C, respectively (p=0.0001). Satisfaction with the fulfillment of "continuity of personal care" was the highest for group A (69.35%), which was significantly higher than group B (43.69%) and group C (35.65%). Group C had the lowest fulfillment of patient expectations and was significantly less satisfied than even group B (p=0.02). Conclusion Continuity of anesthesia care with the addition of routine postoperative visits had the highest positive impact on patient satisfaction. Even a single postoperative visit by the anesthesiologist significantly increased the patients' satisfaction.
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Affiliation(s)
- Anjum Goth
- Anesthesiology, University Hospital of North Tees, Stockton-On-Tees, GBR
| | - Habib Md R Karim
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Mohd Yunus
- Emergency Medicine and Trauma, All India Institute of Medical Sciences, Bhopal, IND
| | - Raunaq Chakraborty
- Anesthesiology, University Hospital of North Tees, Stockton-On-Tees, GBR
| | - Samarjit Dey
- Anesthesiology, All India Institute of Medical Sciences, Mangalagiri, IND
| | - Prithwis Bhattacharyya
- Anesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, IND
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Michard F, Thiele RH, Saugel B, Joosten A, Flick M, Khanna AK. Wireless wearables for postoperative surveillance on surgical wards: a survey of 1158 anaesthesiologists in Western Europe and the USA. BJA OPEN 2022; 1:100002. [PMID: 37588692 PMCID: PMC10430871 DOI: 10.1016/j.bjao.2022.100002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 08/18/2023]
Abstract
Background Several continuous monitoring solutions, including wireless wearable sensors, are available or being developed to improve patient surveillance on surgical wards. We designed a survey to understand the current perception and expectations of anaesthesiologists who, as perioperative physicians, are increasingly involved in postoperative care. Methods The survey was shared in 40 university hospitals from Western Europe and the USA. Results From 5744 anaesthesiologists who received the survey link, there were 1158 valid questionnaires available for analysis. Current postoperative surveillance was mainly based on intermittent spot-checks of vital signs every 4-6 h in the USA (72%) and every 8-12 h in Europe (53%). A majority of respondents (91%) considered that continuous monitoring of vital signs should be available on surgical wards and that wireless sensors are preferable to tethered systems (86%). Most respondents indicated that oxygen saturation (93%), heart rate (80%), and blood pressure (71%) should be continuously monitored with wrist devices (71%) or skin adhesive patches (54%). They believed it may help detect clinical deterioration earlier (90%), decrease rescue interventions (59%), and decrease hospital mortality (54%). Opinions diverged regarding the impact on nurse workload (increase 46%, decrease 39%), and most respondents considered that the biggest implementation challenges are economic (79%) and connectivity issues (64%). Conclusion Continuous monitoring of vital signs with wireless sensors is wanted by most anaesthesiologists from university hospitals in Western Europe and in the USA. They believe it may improve patient safety and outcome, but may also be challenging to implement because of cost and connectivity issues.
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Affiliation(s)
| | - Robert H. Thiele
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Alexandre Joosten
- Department of Anesthesiology, University Paris Saclay, Paul Brousse Hospital, Villejuif, France
| | - Moritz Flick
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
| | - Ashish K. Khanna
- Outcomes Research Consortium, Cleveland, OH, USA
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Lan L, Chen F, Luo J, Li M, Hao X, Hu Y, Yin J, Zhu T, Zhou X. Prediction of intensive care unit admission (>24h) after surgery in elective noncardiac surgical patients using machine learning algorithms. Digit Health 2022; 8:20552076221110543. [PMID: 35910815 PMCID: PMC9326842 DOI: 10.1177/20552076221110543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/28/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Background To develop a highly discriminative machine learning model for the prediction of intensive care unit admission (>24h) using the easily available preoperative information from electronic health records. An accurate prediction model for ICU admission after surgery is of great importance for surgical risk assessment and appropriate utilization of ICU resources. Method Data were collected retrospectively from a large hospital, comprising 135,442 adult patients who underwent surgery except for cardiac surgery between 1 January 2014, and 31 July 2018 in China. Multiple existing predictive machine learning algorithms were explored to construct the prediction model, including logistic regression, random forest, adaptive boosting, and gradient boosting machine. Four secondary analyses were conducted to improve the interpretability of the results. Results A total of 2702 (2.0%) patients were admitted to the intensive care unit postoperatively. The gradient boosting machine model attained the highest area under the receiver operating characteristic curve of 0.90. The machine learning models predicted intensive care unit admission better than the American Society of Anesthesiologists Physical Status (area under the receiver operating characteristic curve: 0.68). The gradient boosting machine recognized several features as highly significant predictors for postoperatively intensive care unit admission. By applying subgroup analysis and secondary analysis, we found that patients with operations on the digestive, respiratory, and vascular systems had higher probabilities for intensive care unit admission. Conclusion Compared with conventional American Society of Anesthesiologists Physical Status and logistic regression model, the gradient boosting machine could improve the performance in the prediction of intensive care unit admission. Machine learning models could be used to improve the discrimination and identify the need for intensive care unit admission after surgery in elective noncardiac surgical patients, which could help manage the surgical risk.
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Affiliation(s)
- Lan Lan
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,IT Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Fangwei Chen
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jiawei Luo
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Mengjiao Li
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital/ West China School of Medicine, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jin Yin
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China.,School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital/ West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaobo Zhou
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
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13
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Gisselbaek M, Hudelson P, Savoldelli GL. A systematic scoping review of published qualitative research pertaining to the field of perioperative anesthesiology. Can J Anaesth 2021; 68:1811-1821. [PMID: 34608588 PMCID: PMC8563559 DOI: 10.1007/s12630-021-02106-y] [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: 02/20/2021] [Revised: 05/18/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Qualitative research (QR) take advantage of a wide range of methods and theoretical frameworks to explore people’s beliefs, perspectives, experiences, and behaviours and has been applied to many areas of healthcare. The aim of this review was to explore how QR has contributed to the field of perioperative anesthesiology. Source We performed a systematic scoping review of published QR studies pertaining to the field of perioperative anesthesiology in three databases (CINAHL, Pubmed, and Embase), published between January 2000 and June 2018. We extracted data regarding publication and researchers’ characteristics, main study objectives, and methodological details. Descriptive statistics were generated for each data extraction category. Principal findings A total of 107 articles fulfilled our inclusion criteria. We identified 13 main research topics addressed by the included studies. Topics such as “patient safety,” “barriers to evidence-base medicine,” “patient experiences under local/regional anesthesia,” “training in practice,” “experiences of care,” and “implementation of changes in clinical practice” were commonly tackled. Others, such as “interprofessional communication”, “work environment,” and “patients’/healthcare professionals’ interactions” were less common. Qualitative research was often poorly reported and methodological details were frequently missing. Conclusion Qualitative research has been used to explore an array of issues in perioperative anesthesiology. Some areas may benefit from further primary research, such as interprofessional communication or patient-centred care, while other areas may deserve a detailed systematic knowledge synthesis. We identified suboptimal reporting of qualitative methods and their link to study findings. Increased attention to quality criteria and reporting standards in QR is called for. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-021-02106-y.
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Affiliation(s)
- Mia Gisselbaek
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Patricia Hudelson
- Department of Primary Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L Savoldelli
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.,Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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14
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Sneyd JR. What we do, what we call ourselves, and how we spell it. Br J Anaesth 2021; 127:505-508. [PMID: 34548151 DOI: 10.1016/j.bja.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- J Robert Sneyd
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
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15
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Goonasekera C, Gammon N, Found P, Sheikh A, Fleming I, Amoako D, Nanavati N. Enhancing the utility of virtual surgical pre-assessment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1032-1038. [PMID: 34605255 DOI: 10.12968/bjon.2021.30.17.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
During the COVID-19 pandemic, virtual pre-assessment was introduced for all elective and semi-urgent surgeries to maintain surgical clinical services in the authors' Trust. This mainly involved telephone pre-assessments, although occasionally video technology was used. This had to be managed and maintained at a distance with little or no training or established method. This article includes experiences of staff involved in a single tertiary centre, an assessment of the pros and cons of virtual pre-assessment and concludes with a set of recommendations to enhance the utility of the service for the future.
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Affiliation(s)
- Chulananda Goonasekera
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Nicola Gammon
- Neurosurgical Pre-assessment Sister-in-Charge, King's College Hospital NHS Foundation Trust, London
| | - Phil Found
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Asme Sheikh
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Ian Fleming
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Derek Amoako
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
| | - Nilesh Nanavati
- Consultant Anaesthetist, Department of Anaesthetics, King's College Hospital NHS Foundation Trust, London
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16
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Harrison TG, Ronksley PE, James MT, Brindle ME, Ruzycki SM, Graham MM, McRae AD, Zarnke KB, McCaughey D, Ball CG, Dixon E, Hemmelgarn BR. The Perioperative Surgical Home, Enhanced Recovery After Surgery and how integration of these models may improve care for medically complex patients. Can J Surg 2021; 64:E381-E390. [PMID: 34296705 PMCID: PMC8410465 DOI: 10.1503/cjs.002020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Perioperative medicine is changing rapidly, and with this change comes the opportunity to improve upon current models of care delivery and integration within the health care system. Perioperative models of care are structured or conceptual arrangements for surgical patients before, during and after their surgery. Models of care such as the Perioperative Surgical Home and Enhanced Recovery After Surgery pathways are increasingly used to guide the structure of perioperative care delivery with an aim to improve patient outcomes and experience in Canadian settings. In this narrative review, we summarize the origins of these perioperative models of care. They are fundamentally different in scope and level of evidence. Both models have potential benefits and limitations to their broad implementation in our health care system. As currently developed, both models are limited in their application to patients with chronic disease. We discuss how these models of care can be used to develop integrated horizontal and vertical perioperative pathways in a Canadian setting. Such integration is a potential solution that will improve their applicability to patients with medically complex conditions and in times when health care systems are under pressure. We describe this approach using the example of patients with kidney failure receiving dialysis.
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Affiliation(s)
- Tyrone G Harrison
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Paul E Ronksley
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Matthew T James
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Mary E Brindle
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Shannon M Ruzycki
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Michelle M Graham
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Andrew D McRae
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Kelly B Zarnke
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Deirdre McCaughey
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Chad G Ball
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Elijah Dixon
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
| | - Brenda R Hemmelgarn
- From the Department of Medicine, University of Calgary, Calgary, Alta. (Harrison, James, Ruzycki, Zarnke, Hemmelgarn); the Department of Community Health Sciences, University of Calgary, Calgary, Alta. (Harrison, James, Ronksley, Ruzycki, McRae, McCaughey, Dixon); the O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ronksley, Zarnke, McCaughey, James); the Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alta. (James); the Department of Surgery, University of Calgary, Calgary, Alta. (Brindle, Ball, Dixon); the Department of Emergency Medicine, University of Calgary, Calgary, Alta. (McRae); the Mazankowski Alberta Heart Institute, Edmonton, Alta. (Graham); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Graham, Hemmelgarn)
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17
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Yuan V, Cowie BS. Appropriateness of transthoracic echocardiography in preoperative elective joint arthroplasty patients. J Perioper Pract 2021; 32:196-201. [PMID: 34176351 DOI: 10.1177/1750458921996920] [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: 11/16/2022]
Abstract
Elective joint arthroplasty is a commonly performed procedure with postoperative cardiovascular complications occurring in up to 3% of elderly patients. Preoperative cardiac evaluation, including transthoracic echocardiography, may improve risk stratification and optimise perioperative outcomes in patients having non-cardiac surgery.This study aimed to investigate the frequency, indications, appropriateness and consequences of preoperative transthoracic echocardiography in elective joint arthroplasty patients. A one-year retrospective audit was conducted for patients who had elective joint arthroplasties performed at St Vincent's Hospital Melbourne. Patient demographics, transthoracic echocardiography indication, time between transthoracic echocardiography being ordered, performed and its impact on date of surgery were obtained via database and manual chart review. Appropriateness of transthoracic echocardiography was determined in accordance with international guidelines. This study analysed 609 elective joint arthroplasties. Of these, 116 (19%) already had a recent transthoracic echocardiography. Of the remaining 493 patients, 192 (39%) received a resting transthoracic echocardiography. Only 92 (48%) of the transthoracic echocardiography's ordered were deemed appropriate. Transthoracic echocardiography resulted in a significant delay of 31 days in time to surgery.This study indicates that almost 40% of elective joint arthroplasty patients with no recent echocardiogram are having a resting transthoracic echocardiography as part of their preoperative assessment. In 52% of cases, these are not clearly appropriate and result in delays to surgery.
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Affiliation(s)
- Victor Yuan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Brian S Cowie
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Melbourne, Australia
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18
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Takla A, Savulescu J, Wilkinson DJC, Pandit JJ. General anaesthesia in end-of-life care: extending the indications for anaesthesia beyond surgery. Anaesthesia 2021; 76:1308-1315. [PMID: 33878803 PMCID: PMC8581983 DOI: 10.1111/anae.15459] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
In this article, we describe an extension of general anaesthesia – beyond facilitating surgery – to the relief of suffering during dying. Some refractory symptoms at the end of life (pain, delirium, distress, dyspnoea) might be managed by analgesia, but in high doses, adverse effects (e.g. respiratory depression) can hasten death. Sedation may be needed for agitation or distress and can be administered as continuous deep sedation (also referred to as terminal or palliative sedation) generally using benzodiazepines. However, for some patients these interventions are not enough, and others may express a clear desire to be completely unconscious as they die. We summarise the historical background of an established practice that we refer to as ‘general anaesthesia in end‐of‐life care’. We discuss its contexts and some ethical and legal issues that it raises, arguing that these are largely similar issues to those already raised by continuous deep sedation. To be a valid option, general anaesthesia in end‐of‐life care will require a clear multidisciplinary framework and consensus practice guidelines. We see these as an impending development for which the specialty should prepare. General anaesthesia in end‐of‐life care raises an important debate about the possible role of anaesthesia in the relief of suffering beyond the context of surgical/diagnostic interventions.
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Affiliation(s)
- A Takla
- Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - J Savulescu
- Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - D J C Wilkinson
- Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of Neonatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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19
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Sood J, Bhatia P, Johnson JE, Lalwani J, Sethi N. Career as a general speciality anaesthesiologist. Indian J Anaesth 2021; 65:6-11. [PMID: 33767496 PMCID: PMC7980248 DOI: 10.4103/ija.ija_1452_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/17/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022] Open
Abstract
The growth in anaesthesia speciality has been contemporaneous with the advancement in surgical techniques. Although various anaesthesia subspecialities have developed over the years, the value of a general speciality anaesthesiologist cannot be undermined as skills and techniques acquired during basic anaesthesia training are major determinants of efficiency of an anaesthesiologist. A general speciality anaesthesiologist performs multiple roles: that of a perioperative physician, intensivist and acute pain management expert. Anaesthesia also offers a multitude of avenues in teaching and research. A successful anaesthesiologist not only requires having good clinical skills but also needs to adhere to basic medical ethics principles. Anaesthesiologists have also been in the forefront in the management of the current COVID pandemic.
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Affiliation(s)
- Jayashree Sood
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - J Edward Johnson
- Department of Anaesthesiology, Kanyakumari Government Medical College, Asaripallam, Kanyakumari, Tamil Nadu, India
| | - Jaya Lalwani
- Department of Anaesthesiology and Critical Care, Pt. JNM Medical College and Dr. BRAM Hospital, Raipur, Chhattisgarh, India
| | - Nitin Sethi
- Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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20
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Kim K, Churilov L, Tan CO, Phan T, Geertsema J, Krieser R, Mehra R, Stewart PA, Rachbuch C, Huang A, Weinberg L. Anaesthetists' attitudes towards attending the funerals of their patients: A cross-sectional study among Australian and New Zealand anaesthetists. PLoS One 2020; 15:e0239996. [PMID: 33151958 PMCID: PMC7643987 DOI: 10.1371/journal.pone.0239996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
A patient’s death can pose significant stress on the family and the treating anaesthetist. Anaesthetists’ attitudes about the benefits of and barriers to attending a patient’s funeral are unknown. Therefore, we performed a prospective, cross-sectional study to ascertain the frequency of anaesthetists’ attendance at a patient’s funeral and their perceptions about the benefits and barriers. The primary aim was to investigate the attitudes of anaesthetists towards attending the funeral of a patient. The secondary aims were to examine the perceived benefits of and barriers to attending the funeral and to explore the rate of bonds being formed between anaesthetists, patients and families. Of the 424 anaesthetists who completed the survey (response rate 21.2%), 25 (5.9%) had attended a patient’s funeral. Of the participants, 364 (85.9%) rarely formed special bonds with patients or their families; 233 (55%) believed that forming a special bond would increase the likelihood of their attendance. Showing respect to patients or their families was the most commonly perceived benefit of attending a funeral. Participants found expression of personal grief and caring for the patient at the end-of-life and beyond beneficial to themselves and the family. Fear of their attendance being misinterpreted or perceived as not warranted by the family as well as time restraints were barriers for their attendance. Most anaesthetists had never attended a patient’s funeral. Few anaesthetists form close relationships with patients or their families. Respect, expression of grief and caring beyond life were perceived benefits of attendance. Families misinterpreting the purpose of attendance or not expecting their attendance and time restraints were commonly perceived barriers. Trial registration:ACTRN 12618000503224.
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Affiliation(s)
- Kwangtaek Kim
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) & Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, Victoria, Australia
| | - Chong Oon Tan
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tuong Phan
- Department of Anaesthesia, St Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - Jake Geertsema
- Department of Anaesthesia, The Northern Hospital, Epping, Victoria, Australia
| | - Roni Krieser
- Department of Anaesthesia, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rishi Mehra
- Department of Anaesthesia, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Anthony Stewart
- Department of Anaesthesia, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia
| | - Clive Rachbuch
- Department of Anaesthesia, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Andrew Huang
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Victoria, Australia
- * E-mail:
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21
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Dziadzko M, Aubrun F. Management of postdischarge nausea and vomiting. Best Pract Res Clin Anaesthesiol 2020; 34:771-778. [PMID: 33288126 DOI: 10.1016/j.bpa.2020.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
Postdischarge nausea and vomiting (PDNV) occurs in at least 30% of patients leaving hospital, especially after day-case surgery. A significant number of ambulatory patients may develop PDNV associated with the use of analgesics for postsurgical pain. A validated PDNV prediction score and international evidence-based consensus guidelines for PONV/PDNV management are available. High-risk patients benefit from a predischarge PDNV risk assessment and the use of adapted pharmacological intervention (combination of long- and short-acting antiemetics and access to antiemetics at home). Patient education is often overlooked in this context. All clinicians involved in the ambulatory surgery care process should participate in the development of institutional protocol for PONV/PDNV management. Constant quality control and patients' feedback should be integrated as part of an efficient implementation strategy.
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Affiliation(s)
- Mikhail Dziadzko
- Service Anesthésie Réanimation Douleur, Université Lyon 1, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 LYON Cédex 04, France.
| | - Frédéric Aubrun
- Service Anesthésie Réanimation Douleur, Université Lyon 1, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 LYON Cédex 04, France.
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22
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Preoperative Risk Management in Perioperative Medicine and Value-based Care: What the United States Needs to Understand, What the United Kingdom Knows. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Ratcliffe F, Rothwell PM. The case for statin use to reduce perioperative adverse cardiovascular and cerebrovascular events. Br J Anaesth 2020; 124:525-534. [PMID: 32111371 DOI: 10.1016/j.bja.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/12/2020] [Accepted: 01/24/2020] [Indexed: 12/11/2022] Open
Abstract
Ischaemic heart disease and stroke are the leading causes of death worldwide at 119 per 100,000 and 85 per 100,000 population. For the USA, heart disease is leading cause of death at 165 per 100,000 population. In developed countries, strokes and acute myocardial infarction in the general population have fallen from smoking reduction, lifestyle modifications and therapeutic interventions including statins. In a population-based stroke study in the UK involving primary care practices, of in-hospital strokes 90% were ischaemic, and 37% occurred within 1 week of an operation. Approximately 50% of the patients were not on a statin. In the UK, there is a national screening initiative for the prevention of atherosclerotic cardiovascular disease (ASCVD) offered to people aged 40-74 yr old. The QRISK3 tool calculates the risk of developing heart disease or stroke over 10 yr, from which recommendations are made on interventions for the prevention of ASCVD up to age 84 yr, with similar screening and assessment tools in Europe and the US. If the QRISK3 score tool for calculating cardiovascular risk is considered sufficiently robust for population screening in primary care, should anaesthetists not use the same screening for secondary care? We present a case for statin use over the perioperative period, to reduce early vascular adverse events based on statins' early pleiotropic actions, using the primary care QRISK tool for screening of ASCVD risk.
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Affiliation(s)
- Fiona Ratcliffe
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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MySurgeryRisk: Development and Validation of a Machine-learning Risk Algorithm for Major Complications and Death After Surgery. Ann Surg 2020; 269:652-662. [PMID: 29489489 DOI: 10.1097/sla.0000000000002706] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To accurately calculate the risk for postoperative complications and death after surgery in the preoperative period using machine-learning modeling of clinical data. BACKGROUND Postoperative complications cause a 2-fold increase in the 30-day mortality and cost, and are associated with long-term consequences. The ability to precisely forecast the risk for major complications before surgery is limited. METHODS In a single-center cohort of 51,457 surgical patients undergoing major inpatient surgery, we have developed and validated an automated analytics framework for a preoperative risk algorithm (MySurgeryRisk) that uses existing clinical data in electronic health records to forecast patient-level probabilistic risk scores for 8 major postoperative complications (acute kidney injury, sepsis, venous thromboembolism, intensive care unit admission >48 hours, mechanical ventilation >48 hours, wound, neurologic, and cardiovascular complications) and death up to 24 months after surgery. We used the area under the receiver characteristic curve (AUC) and predictiveness curves to evaluate model performance. RESULTS MySurgeryRisk calculates probabilistic risk scores for 8 postoperative complications with AUC values ranging between 0.82 and 0.94 [99% confidence intervals (CIs) 0.81-0.94]. The model predicts the risk for death at 1, 3, 6, 12, and 24 months with AUC values ranging between 0.77 and 0.83 (99% CI 0.76-0.85). CONCLUSIONS We constructed an automated predictive analytics framework for machine-learning algorithm with high discriminatory ability for assessing the risk of surgical complications and death using readily available preoperative electronic health records data. The feasibility of this novel algorithm implemented in real time clinical workflow requires further testing.
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25
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Nilsson U, Gruen R, Myles PS. Postoperative recovery: the importance of the team. Anaesthesia 2020; 75 Suppl 1:e158-e164. [DOI: 10.1111/anae.14869] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- U. Nilsson
- Division of Nursing Department of Neurobiology, Care Sciences and Society Karolinska Institute and Peri‐operative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
| | - R. Gruen
- College of Health and Medicine Australian National University Canberra Australian Capital Territory Australia
| | - P. S. Myles
- Department of Anaesthesiology and Peri‐operative Medicine Alfred Hospital and Monash University Melbourne Vic. Australia
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26
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Aronson S, Grocott MPW, Mythen MMG. Preoperative Patient Preparation, Programs, and Education in the United States: State of the Art, State of the Science, and State of Affairs. Adv Anesth 2019; 37:127-143. [PMID: 31677653 DOI: 10.1016/j.aan.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Solomon Aronson
- Anesthesiology and Population Health Science, Duke University School of Medicine, DUMC 3094, MS 33, 103 Baker House, Durham, NC 27710, USA.
| | - Mike P W Grocott
- University Southampton, University Road, South Hampton SO17 1BJ, UK
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Yang L, Wan L, Huang H, Qi X. Uterine hypertonus and fetal bradycardia occurred after combined spinal-epidural analgesia during induction of labor with oxytocin infusion: A case report. Medicine (Baltimore) 2019; 98:e16282. [PMID: 31305411 PMCID: PMC6641829 DOI: 10.1097/md.0000000000016282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pain management is an essential part of good obstetrical care. The rapid onset of pain relief after combined spinal-epidural (CSE) analgesia may cause a transient imbalance in maternal catecholamine level, leading to uterine hyperactivity and fetal heart rate (FHR) abnormalities. How to manage the uterine basal tone and FHR abnormalities after labor analgesia still remains controversial. PATIENT CONCERNS A 33-year-old nulliparous woman at 40 weeks' gestation underwent induction of labor after premature rupture of membranes. CSE analgesia was provided when the patient described her pain as the top on a scale of 10 during induction of labor with oxytocin infusion. DIAGNOSES Uterine hypertonus and fetal bradycardia were diagnosed within 10 minutes after CSE analgesia. INTERVENTIONS Oxytocin infusion and CSE analgesia were immediately suspended, and measures of staying in left lateral decubitus position and giving supplemental oxygen were attempted to resuscitating the baby. Because of suspicious fetal distress, the baby was rapidly delivered by emergency cesarean section. OUTCOMES The Apgar score of the baby was 8 and 10 at 1 and 5 minutes after birth. Subsequent follow-up confirmed that both mother and baby were in good condition. LESSONS The loss of the tocolytic effect of epinephrine after CSE analgesia and continuous oxytocin infusion may work together to form a totally synergistic function, finally leading to inevitable uterine hypertonus and fetal bradycardia. Both the obstetrical provider and anesthesiologist should carefully monitor all patients in the first 15 minutes after CES analgesia induction. Oxytocin administration in this critical period deserves attention. Additionally, intraprofessional collaboration is also necessary to ensure high quality and safe delivery for all childbearing women.
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Affiliation(s)
- Lingyun Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
| | - Li Wan
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
| | - Han Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
- Department of Anaesthesiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
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28
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Engel D, Furrer MA, Wuethrich PY, Löffel LM. Surgical safety in radical cystectomy: the anesthetist's point of view-how to make a safe procedure safer. World J Urol 2019; 38:1359-1368. [PMID: 31201522 DOI: 10.1007/s00345-019-02839-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this review is to present an anesthesiological overview on surgical safety for radical cystectomy implementing the cornerstones of today's rapidly evolving field of perioperative medicine. METHODS This is a narrative review of current perioperative medicine and surgical safety concepts for major surgery in general with special focus on radical cystectomy. RESULTS The tendency for perioperative care and surgical safety is to consider it a continuous proactive pathway rather than a single surgical intervention. It starts at indication for surgery and lasts until full functional recovery. Preoperative optimization leads to superior outcome by mobilizing and/or increasing physiological reserve. Multidisciplinary teamwork involving all the relevant parties from the beginning of the pathway is crucial for outcome rather than an isolated specialist approach. This fact has gained importance in times of an ageing frail population and rising health care cost. We also present our 2019 Cystectomy Enhanced Recovery Approach for optimization of perioperative care for open radical cystectomy in a high caseload center. CONCLUSIONS With the implementation of in itself simple but crucial steps in perioperative medicine such as multimodal prehabilitation, safety checks, better perioperative monitoring and enhanced recovery concepts, even complex surgical procedures such as radical cystectomy can be performed safer. Emphasis has to be laid on a more global view of the patients' path through the perioperative process than on the surgical procedure alone.
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Affiliation(s)
- Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, CH 3010, Bern, Switzerland
| | - Marc A Furrer
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, CH 3010, Bern, Switzerland
| | - Lukas M Löffel
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, CH 3010, Bern, Switzerland.
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29
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Shah SB, Hariharan U, Chawla R. Integrating perioperative medicine with anaesthesia in India: Can the best be achieved? A review. Indian J Anaesth 2019; 63:338-349. [PMID: 31142876 PMCID: PMC6530285 DOI: 10.4103/0019-5049.258058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Integrating perioperative medicine with anaesthesia is the need of the hour. Evolution of a new superspeciality called perioperative anaesthesia can improve surgical outcomes by quality perioperative care and guarantee imminent escalation of influence and power for anaesthesiologists. All original peer-reviewed manuscripts pertaining to surgery-specific perioperative surgical home models involving preoperative, intraoperative and postoperative initiatives spanning the past 5 years have been reviewed using PubMed and Google Scholar. Whether the perioperative surgical home model is feasible or still a distant dream in the Indian perspective has been analysed.
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Affiliation(s)
- SB Shah
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - U Hariharan
- Department of Anaesthesia and Intensive Care, Dr. Ram Manohar Lohia Hospital and PGIMER, CHS, New Delhi, India
| | - R Chawla
- Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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30
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A cross-sectional survey of Australian anesthetists’ and surgeons’ perceptions of preoperative risk stratification and prehabilitation. Can J Anaesth 2019; 66:388-405. [DOI: 10.1007/s12630-019-01297-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/17/2018] [Accepted: 12/03/2018] [Indexed: 12/17/2022] Open
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31
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Kaptain K, Ulsøe ML, Dreyer P. Surgical perioperative pathways-Patient experiences of unmet needs show that a person-centred approach is needed. J Clin Nurs 2019; 28:2214-2224. [PMID: 30786078 DOI: 10.1111/jocn.14817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 11/30/2022]
Abstract
AIM To explore patients' and healthcare professionals' experiences of patients' surgical pathways in a perioperative setting. BACKGROUND Elective surgical pathways have improved over the past decades due to fast-track programmes, but patients desire more personalised and coordinated care and treatment. There is little knowledge of how healthcare professionals' collaboration and communication affect patients' pathways. DESIGN The overall framework was complex intervention method. A phenomenological-hermeneutic approach was used for data analyses. COREQ checklist was used as a guideline to secure accurate and complete reporting of the study. METHODS Field observations (120 hr) and semi-structured interviews (24 patients) were undertaken during 2016-2017. Healthcare professionals involved in the pathways were interviewed: (a) 13 single interviews and (b) 13 focus group interviews (37 healthcare professionals) were conducted. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS Patients asked for individualised information adapted to their life and illness experiences. Furthermore, healthcare professionals need access to a quick overview of individual patients and their perioperative pathway in the electronic patient journal (EPJ). Agreements made with patients did not always reach the right receiver, there was poor interpersonal communication and the complex teamwork between many healthcare professionals made pathways incoherent and uncoordinated. Healthcare professionals who had the time to talk about other subjects than the disease with smiles and good humour gave patients a feeling of security. CONCLUSION Patients wanted to be treated as individuals, but often they received standard treatment. Healthcare professionals had the intention of treating patients individually, but the EPJ and information provided to patients were not easy to access. RELEVANCE TO CLINICAL PRACTICE Visible information about the patient's whole pathway could improve healthcare professionals' care and treatment. In addition, systematic feedback from patients' could make it possible to adjust information, care and treatment to achieve a more coherent pathway. Particular attention needs to be paid to how electronic healthcare systems can underpin relational coordination in pathways.
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Affiliation(s)
- Kirsten Kaptain
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Marie-Louise Ulsøe
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.,Institute of Public Health, Section of Nursing, University of Aarhus, Aarhus C, Denmark
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32
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Affiliation(s)
- Simon Trundle
- ST7 in anaesthesia and intensive care medicine, Royal London Hospital, Bart's Health NHS Trust, London, UK
- Royal London Hospital, Bart's Health NHS Trust, London, UK
| | - Helen Drewery
- ST7 in anaesthesia and intensive care medicine, Royal London Hospital, Bart's Health NHS Trust, London, UK
- Royal London Hospital, Bart's Health NHS Trust, London, UK
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33
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Grocott MPW, Edwards M, Mythen MG, Aronson S. Peri-operative care pathways: re-engineering care to achieve the ‘triple aim’. Anaesthesia 2019; 74 Suppl 1:90-99. [DOI: 10.1111/anae.14513] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2018] [Indexed: 12/11/2022]
Affiliation(s)
- M. P. W. Grocott
- Peri-operative Medicine and Critical Care Research Group; Southampton NIHR Biomedical Research Centre; University Hospital Southampton/University of Southampton; UK
- Duke University Medical Centre; North Carolina USA
| | - M. Edwards
- Peri-operative Medicine and Critical Care Research Group; Southampton NIHR Biomedical Research Centre; University Hospital Southampton/University of Southampton; UK
- Duke University Medical Centre; North Carolina USA
| | - M. G. Mythen
- Duke University Medical Centre; North Carolina USA
- UCLH/UCL NIHR Biomedical Research Centre; London UK
| | - S. Aronson
- Duke University Medical Centre; North Carolina USA
- Department of Anaesthesiology; Duke University Medical School; North Carolina USA
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Abstract
The rising prominence of value-based health care and population health management supports evolving perioperative surgical home (PSH) models that rely on continuously evolving evidence-based best practice and telemedicine and telehealth, including mobile technologies and connectivity. To successfully deliver greater perioperative valued-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing perioperative management and its associated services and care provider skills must be expanded. This article focuses on the PSH model as continued opportunity and mechanism for delivering greater value-based, comprehensive perioperative assessment and global optimization of surgical patients.
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Affiliation(s)
- Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA; Department of Population Health, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
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35
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Affiliation(s)
- David R Hillman
- From the Centre for Sleep Science, University of Western Australia, Crawley, Western Australia, Australia; and Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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36
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Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Valsamis EM, Sadler J, Kennedy T, Thornhill C, Carey C, Ricketts D. Anaesthesia: what a surgeon needs to know. Br J Hosp Med (Lond) 2018; 79:270-278. [PMID: 29727235 DOI: 10.12968/hmed.2018.79.5.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgeons and anaesthetists work closely together, sometimes in challenging circumstances. To help surgeons cooperate with anaesthetists to deliver high quality care for patients, a working knowledge of modern anaesthetic practice is useful. The specialty of anaesthetics is developing rapidly, and periodic updating of this knowledge is likely to be required. This article provides an update of anaesthetic practice for surgeons, covering the varied roles of anaesthetists, preoperative assessment, management on the day of surgery (induction, maintenance and reversal of anaesthetic), general anaesthesia, the role of regional blocks and sedation. It also discusses safety issues, the management of frail patients and future challenges.
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Affiliation(s)
- E M Valsamis
- Core Surgical Trainee, Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE
| | - J Sadler
- Clinical Fellow in Anaesthesia, Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - T Kennedy
- Anaesthetic Trainee, Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - C Thornhill
- Medical Student, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - C Carey
- Consultant in Anaesthetics, Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - D Ricketts
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton
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38
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Kwon MA. Perioperative surgical home: a new scope for future anesthesiology. Korean J Anesthesiol 2018; 71:175-181. [PMID: 29690755 PMCID: PMC5995011 DOI: 10.4097/kja.d.18.27182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/23/2017] [Accepted: 12/10/2017] [Indexed: 01/08/2023] Open
Abstract
The health care system is changing from ‘pay for volume’ to ‘pay for value.’ These changes are turning health care delivery into a more cost-effective and coordinated care setup that drives hospitals to lower costs and greater quality gains. The present perioperative care service in Korea has proven to be costly, fragmented, and neither evidence-based nor patient-centered. Recently, a new concept of a perioperative care model termed perioperative surgical home (PSH) has been proposed. The PSH is a patient-centered, team-based, and coordinated perioperative care setup, composed of the head anesthesiologist-perioperativist in tandem with dedicated nurse practitioners and other PSH team doctors. All pre-, intra-, and postoperative patient care functions are performed by a single PSH team, not several different departments. The PSH care extends from the decision to operate till 30 days post-discharge. Several evidence-driven perioperative strategies for reducing postoperative complications and shortening hospital stay can be adapted to each specific hospital situation, rather than strictly applying any given strategies. With the PSH, patients are more satisfied and experience better outcomes. It is also a good hospital business model. The expanded role of anesthesiologists in the PSH has the potential to invigorate the specialty.
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Affiliation(s)
- Min A Kwon
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
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39
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Yeung J, Gillies MA, Pearse RM. Pragmatic trials in peri-operative medicine: why, when and how? Anaesthesia 2018; 73:803-807. [PMID: 29577235 DOI: 10.1111/anae.14252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Yeung
- Warwick Medical School, University of Warwick, Warwick, UK
| | - M A Gillies
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R M Pearse
- Intensive Care, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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40
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Howell S. Abdominal aortic aneurysm repair in the United Kingdom: an exemplar for the role of anaesthetists in perioperative medicine. Br J Anaesth 2017; 119:i15-i22. [DOI: 10.1093/bja/aex360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cooper AE. The future United Kingdom anaesthetic workforce: training, education, and role boundaries for anaesthetists and others. Br J Anaesth 2017; 119:i99-i105. [PMID: 29161392 DOI: 10.1093/bja/aex345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/14/2022] Open
Abstract
Anaesthesia is the largest hospital-based specialty in the UK, and the activities of the anaesthesia workforce underpin the care of all patients in the hospital sector. Changes in the way care will be delivered in the future will impact on the workforce as a consequence of patient requirements and funding issues. This article considers these and other factors in the context of the current and future workforce.
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Affiliation(s)
- A E Cooper
- Department of Anaesthetics, Rotherham General Hospital, Rotherham S60 2UD, UK
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Abbott TEF, Gooneratne M, McNeill J, Lee A, Levett DZH, Grocott MPW, Swart M, MacDonald N. Inter-observer reliability of preoperative cardiopulmonary exercise test interpretation: a cross-sectional study. Br J Anaesth 2017; 120:475-483. [PMID: 29452804 DOI: 10.1016/j.bja.2017.11.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the increasing importance of cardiopulmonary exercise testing (CPET) for preoperative risk assessment, the reliability of CPET interpretation is unclear. We aimed to assess inter-observer reliability of preoperative CPET. METHODS We conducted a prospective, multi-centre, observational study of preoperative CPET interpretation. Participants were professionals with previous experience or training in CPET, assessed by a standardized questionnaire. Each participant interpreted 100 tests using standardized software. The CPET variables of interest were oxygen consumption at the anaerobic threshold (AT) and peak oxygen consumption (VO2 peak). Inter-observer reliability was measured using intra-class correlation coefficient (ICC) with a random effects model. Results are presented as ICC with 95% confidence interval, where ICC of 1 represents perfect agreement and ICC of 0 represents no agreement. RESULTS Participants included 8/28 (28.6%) clinical physiologists, 10 (35.7%) junior doctors, and 10 (35.7%) consultant doctors. The median previous experience was 140 (inter-quartile range 55-700) CPETs. After excluding the first 10 tests (acclimatization) for each participant and missing data, the primary analysis of AT and VO2 peak included 2125 and 2414 tests, respectively. Inter-observer agreement for numerical values of AT [ICC 0.83 (0.75-0.90)] and VO2 peak [ICC 0.88 (0.84-0.92)] was good. In a post hoc analysis, inter-observer agreement for identification of the presence of a reportable AT was excellent [ICC 0.93 (0.91-0.95)] and a reportable VO2 peak was moderate [0.73 (0.64-0.80)]. CONCLUSIONS Inter-observer reliability of interpretation of numerical values of two commonly used CPET variables was good (>80%). However, inter-observer agreement regarding the presence of a reportable value was less consistent.
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Affiliation(s)
- T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
| | | | | | - A Lee
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - D Z H Levett
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M P W Grocott
- Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - M Swart
- South Devon Healthcare NHS Trust, Torbay, UK
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Al-Shammari L, Douglas D, Gunaratnam G, Jones C. Perioperative medicine: a new model of care? Br J Hosp Med (Lond) 2017; 78:628-632. [DOI: 10.12968/hmed.2017.78.11.628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lena Al-Shammari
- Perioperative Medicine Fellow, Department of Anaesthesia, UCLH, London NW1 2BU
| | - Deborah Douglas
- Perioperative Medicine Fellow, Department of Anaesthesia, UCLH, London
| | - Geetha Gunaratnam
- Perioperative Medicine Fellow, Department of Anaesthesia, UCLH, London
| | - Chris Jones
- Consultant Anaesthetist, Department of Anaesthesia, Royal Surrey County Hospital, Guildford
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Groves C, Whiteman A, Kumar G, Stephens R, Walker D. Early adopters of perioperative medicine: who are they and what motivates them? Br J Hosp Med (Lond) 2017; 78:642-646. [DOI: 10.12968/hmed.2017.78.11.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Groves
- CT2 in Anaesthesia, Department of Anaesthesia, Barking Havering and Redbridge University Hospitals, Romford
| | - A Whiteman
- Consultant in Anaesthesia, Department of Anaesthesia, University College London Hospitals, London
| | - G Kumar
- Consultant in Anaesthesia, Department of Anaesthesia, University College London Hospitals, London
| | - R Stephens
- Consultant in Anaesthesia, Department of Anaesthesia, University College London Hospitals, London
| | - D Walker
- Consultant in Anaesthesia, Department of Anaesthesia, University College London Hospitals, London
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Role of the Perioperative Surgical Home in Optimizing the Perioperative Use of Opioids. Anesth Analg 2017; 125:1653-1657. [DOI: 10.1213/ane.0000000000002280] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bustamante R. ¿QUÉ HACEMOS LOS ANESTESIÓLOGOS? DESDE LA VIGILANCIA ANESTÉSICA MONITORIZADA HASTA LA ANESTESIA GENERAL. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Curriculum for the administration of sedation outside the operating room in patients over 12 years of age☆,☆☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rubiano-Pinzón AM, Burbano-Paredes CC, Hernández-Caicedo ÁC, Rincón-Valenzuela DA, Benavides-Caro CA, Restrepo-Palacio S, Grillo-Ardila CF, Amaya-Guio J, Cañón-Muñoz M, Rincón-Aguilar JE, Moreno LÁ, Rey-Tovar MH, Hernández-Restrepo FJ, Martínez-Rebolledo CP, Grillo-Ardila EK, Cortés-Díaz D. Curriculum for the administration of sedation outside the operating room in patients over 12 years of age. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Currículo para la administración de sedación fuera del quirófano en pacientes mayores de 12 años. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Preoperative Evaluation Clinic Visit Is Associated with Decreased Risk of In-hospital Postoperative Mortality. Anesthesiology 2017; 125:280-94. [PMID: 27433746 DOI: 10.1097/aln.0000000000001193] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND As specialists in perioperative medicine, anesthesiologists are well equipped to design and oversee the preoperative patient preparation process; however, the impact of an anesthesiologist-led preoperative evaluation clinic (PEC) on clinical outcomes has yet to be fully elucidated. The authors compared the incidence of in-hospital postoperative mortality in patients who had been evaluated in their institution's PEC before elective surgery to the incidence in patients who had elective surgery without being seen in the PEC. METHODS A retrospective review of an administrative database was performed. There were 46 deaths from 64,418 patients (0.07%): 22 from 35,535 patients (0.06%) seen in PEC and 24 from 28,883 patients (0.08%) not seen in PEC. After propensity score matching, there were 13,964 patients within each matched set; there were 34 deaths (0.1%). There were 11 deaths from 13,964 (0.08%) patients seen in PEC and 23 deaths from 13,964 (0.16%) patients not seen in PEC. A subanalysis to assess the effect of a PEC visit on deaths as a result of failure to rescue (FTR) was also performed. RESULTS A visit to PEC was associated with a reduction in mortality (odds ratio, 0.48; 95% CI, 0.22 to 0.96, P = 0.04) by comparison of the matched cohorts. The FTR subanalysis suggested that the proportion of deaths attributable to an unanticipated surgical complication was not significantly different between the two groups (P = 0.141). CONCLUSIONS An in-person assessment at the PEC was associated with a reduction in in-hospital mortality. It was difficult to draw conclusions about whether a difference exists in the proportion of FTR deaths between the two cohorts due to small sample size.
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