1
|
Kahl U, Brodersen K, Kaiser S, Krause L, Klinger R, Plümer L, Zöllner C, Fischer M. Psychometric evaluation of a quality of recovery score for the postanesthesia care unit-A preliminary validation study. PLoS One 2023; 18:e0289685. [PMID: 37582085 PMCID: PMC10426991 DOI: 10.1371/journal.pone.0289685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/24/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Patients' perception of postoperative recovery is a key aspect of perioperative care. Self-reported quality of recovery (QoR) has evolved as a relevant endpoint in perioperative research. Several psychometric instruments have been introduced to assess self-reported recovery 24 hours after surgery. However, there is no questionnaire suitable for use in the postanesthesia care unit (PACU). We aimed to develop and psychometrically evaluate a QoR questionnaire for the PACU (QoR-PACU). METHODS The QoR-PACU was developed in German language based on the 40-item QoR-40 questionnaire. Between March and November 2020, adult patients scheduled for elective urologic surgery completed the QoR-PACU preoperatively and during the PACU stay. We evaluated feasibility, validity, reliability, and responsiveness. RESULTS We included 375 patients. After two piloting phases including 72 and 48 patients, respectively, we administered the final version of the QoR-PACU to 255 patients, with a completion rate of 96.5%. Patients completed the QoR-PACU at a median of 125.0 (83.0; 156.8) min after arrival in the PACU. Construct validity was good with postoperative QoR-PACU sum scores correlating with age (r = 0.23, 95% CI: 0.11 to 0.35, p < 0.001), length of PACU stay (r = -0.15, 95%CI: -0.27 to -0.03, p = 0.02), pain in the PACU (r = -0.48, 95% CI: -0.57 to -0.37, p < 0.001) and piritramide dose administered (r = -0.29, 95% CI: -0.40 to -0.17, p < 0.001). Cronbach's alpha was 0.67 (95% CI: 0.61-0.73) with moderate test-retest reliability (ICC of 0.67, 95% CI: 0.38 to 0.83). Cohen's effect size was 3.08 and the standardized response mean was 1.65 indicating adequate responsiveness. CONCLUSION The assessment of QoR in the early postoperative period is feasible. We found high acceptability, good validity, adequate responsiveness, and moderate reliability. Future studies should evaluate the psychometric properties of the QoR-PACU in more heterogeneous patient populations including female and gender-diverse patients with varying degress of perioperative risk.
Collapse
Affiliation(s)
- Ursula Kahl
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Brodersen
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Kaiser
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lili Plümer
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Wu A, Fahey MT, Cui D, El‐Behesy B, Story DA. An evaluation of the outcome metric 'days alive and at home' in older patients after hip fracture surgery. Anaesthesia 2022; 77:901-909. [PMID: 35489814 PMCID: PMC9543156 DOI: 10.1111/anae.15742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/11/2023]
Abstract
'Days alive and at home' is a validated measure that estimates the time spent at home, defined as the place of residence before admission to hospital. We evaluated this metric in older adults after hip fracture surgery and assessed two follow-up durations, 30 and 90 days. Patients aged ≥ 70 years who underwent hip fracture surgery were identified retrospectively via hospital admission and government mortality records. Patients who successfully returned home and were still alive within 90 days of surgery were distinguished from those who were not. Regression models were used to examine which variables were associated with failure to return home and number of days at home among those who did return, within 90 days of surgery. We analysed the records of 825 patients. Median (IQR [range]) number of days at home within 90 days (n = 788) was 54 (0-76 [0-88]) days and within 30 days (n = 797) it was 2 (0-21 [0-28]) days. Out of these, 274 (35%) patients did not return home within 90 days and 374 (47%) within 30 days after surgery. Known peri-operative risk-factors such as older age, pre-operative anaemia and postoperative acute renal impairment were associated with failure to return home. This study supports days alive and at home as a useful patient-centred outcome measure in older adults after hip fracture surgery. We recommend that this metric should be used in clinical trials and measured at 90, rather than 30, postoperative days. As nearly half of this patient population did not return home within 30 days, the shorter time-period catches fewer meaningful events.
Collapse
Affiliation(s)
- A. Wu
- Department of AnaestheticsMaroondah Hospital, Eastern HealthMelbourneAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
| | - M. T. Fahey
- Department of Health Sciences and BiostatisticsSwinburne University of TechnologyMelbourneAustralia,Department of Biostatistics and Clinical TrialsPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - D. Cui
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia,Department of AnaestheticsMaroondah Hospital, Eastern HealthMelbourneAustralia
| | - B. El‐Behesy
- Department of AnaestheticsMaroondah Hospital, Eastern HealthMelbourneAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
| | - D. A. Story
- Department of Critical CareUniversity of Melbourne and Melbourne Academic Centre for HealthMelbourneAustralia
| |
Collapse
|
3
|
Boney O, Moonesinghe SR, Myles PS, Grocott MPW. Core Outcome Measures for Perioperative and Anaesthetic Care (COMPAC): a modified Delphi process to develop a core outcome set for trials in perioperative care and anaesthesia. Br J Anaesth 2021; 128:174-185. [PMID: 34740438 DOI: 10.1016/j.bja.2021.09.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/20/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Outcome selection underpins clinical trial interpretation. Inconsistency in outcome selection and reporting hinders comparison of different trials' results, reducing the utility of research findings. METHODS We conducted an iterative consensus process to develop a set of Core Outcome Measures for Perioperative and Anaesthetic Care (COMPAC), following the established Core Outcome Measures for Effectiveness Trials (COMET) methodology. First, we undertook a systematic review of RCTs in high-impact journals to describe current outcome reporting trends. We then surveyed patients, carers, researchers, and perioperative clinicians about important outcomes after surgery. Finally, a purposive stakeholder sample participated in a modified Delphi process to develop a core outcome set for perioperative and anaesthesia trials. RESULTS Our systematic review revealed widespread inconsistency in outcome reporting, with variable or absent definitions, levels of detail, and temporal criteria. In the survey, almost all patients, carers, and clinicians rated clinical outcome measures critically important, but clinicians rated patient-centred outcomes less highly than patients and carers. The final core outcome set was: (i) mortality/survival (postoperative mortality, long-term survival); (ii) perioperative complications (major postoperative complications/adverse events; complications/adverse events causing permanent harm); (iii) resource use (length of hospital stay, unplanned readmission within 30 days); (iv) short-term recovery (discharge destination, level of dependence, or both); and (v) longer-term recovery (overall health-related quality of life). CONCLUSIONS This core set, incorporating important outcomes for both clinicians and patients, should guide outcome selection in future perioperative medicine or anaesthesia trials. Mapping these alongside standardised endpoint definitions will yield a comprehensive perioperative outcome framework.
Collapse
Affiliation(s)
- Oliver Boney
- Surgical Outcomes Research Centre, University College Hospital, London, UK; Health Services Research Centre, National Institute of Academic Anaesthesia, Royal College of Anaesthetists, London, UK.
| | - S Ramani Moonesinghe
- Surgical Outcomes Research Centre, University College Hospital, London, UK; Health Services Research Centre, National Institute of Academic Anaesthesia, Royal College of Anaesthetists, London, UK
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Michael P W Grocott
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Perioperative and Critical Care Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | | |
Collapse
|
4
|
Kluyts HL, Becker PJ. Development of a clinical prediction model for high hospital cost in patients admitted for elective non-cardiac surgery to a private hospital in South Africa. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.5.2448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- HL Kluyts
- Department of Anaesthesiology, University of Pretoria,
South Africa
| | - PJ Becker
- Research Unit, Faculty of Health Sciences, University of Pretoria,
South Africa
| |
Collapse
|
5
|
Canıtez A, Kozanhan B, Aksoy N, Yildiz M, Tutar MS. Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy a prospective double-blind study. Br J Anaesth 2021; 127:629-635. [PMID: 34340839 DOI: 10.1016/j.bja.2021.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/31/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is a common surgical procedure that frequently results in substantial postoperative pain. Erector spinae plane block (ESPB) has been shown to have beneficial postoperative analgesic effects when used as a part of multimodal analgesia. The aim of this study was to determine whether ESPB improves postoperative recovery quality in patients undergoing laparoscopic cholecystectomy. Evaluation of the effects of ESPB on postoperative pain, opioid consumption, and nausea and vomiting was the secondary objective. METHODS In this prospective double-blind study, 82 patients undergoing laparoscopic cholecystectomy were randomised into one of two groups: a standard multimodal analgesic regimen in Group N (control) or an ESPB was performed in Group E. Preoperative and postoperative recovery quality was measured using the 40-item quality of recovery (QoR-40) questionnaire; postoperative pain was evaluated using the numerical rating scale scores. RESULTS Postoperative mean (standard deviation) QoR-40 scores were higher in Group E (181 [7.3]) than in Group N (167 [11.4]); P<0.01. With repeated measures, a significant effect of group and time was demonstrated for the global QoR-40 score, P<0.01, indicating better quality of recovery in Group E. Pain scores were significantly lower in Group E than in Group N, both during resting and motion at T1-T8 times (P<0.01 at each time). The total amount of tramadol consumed in the first 24 h was lower in Group E [median 0 mg, inter-quartile range (IQR) (0-140)], than in Group N [median 180 mg, IQR (150-240); P<0.01]. CONCLUSIONS ESPB improved postoperative quality of recovery in patients undergoing laparoscopic cholecystectomy. Moreover, ESPB reduced pain scores and cumulative opioid consumption. CLINICAL TRIAL REGISTRATION NCT04112394.
Collapse
Affiliation(s)
- Ahmet Canıtez
- Department of Anaesthesiology and Reanimation, Abdulkadir Yuksel City Hospital, Gaziantep, Turkey
| | - Betul Kozanhan
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey.
| | - Nergis Aksoy
- Department of General Surgery, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Munise Yildiz
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Mahmut S Tutar
- Department of Anaesthesiology and Reanimation, Konya Numune State Hospital, Konya, Turkey
| |
Collapse
|
6
|
Abstract
BACKGROUND Textbook outcome (TBO) is a patient-oriented composite criterion achieved when all desired main health outcomes are realized. The aim was to assess the incidence and the independent factors associated with TBO following LT. METHODS This bicentric study included all patients who underwent their first elective liver-only LT between 2011 and 2015. TBO occurred when all the following criteria were fulfilled: no mortality within 90 days, no major complications within 90 days, no reintervention within 90 days (liver graft biopsy, radiological, endoscopic or surgical interventions, or retransplantation), no prolonged intensive care unit stay, and no prolonged hospital stay. Univariable and multivariable analyses were performed to identify factors associated with TBO and to assess whether TBO is an independent factor associated with patient and graft survival. RESULTS The study population included 530 patients. TBO occurred in 176/530 (33%) patients. Independent factors associated with TBO included the balance of risk score, the use of an intraoperative temporary portacaval shunt, and duration of the operation. TBO was identified as an independent factor associated with graft survival but not patient survival. CONCLUSIONS TBO might be implemented in the patient-doctor decision-making regarding whether to proceed with LT and in the reporting of patient-level hospital performance related to LT.
Collapse
|
7
|
Quality of Recovery of Patients Who Underwent Curative Pancreatectomy: Comparison of Total Intravenous Anesthesia Versus Inhalation Anesthesia Using the QOR-40 Questionnaire. World J Surg 2021; 45:2581-2590. [PMID: 33881579 DOI: 10.1007/s00268-021-06117-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There has been increasing attention on the subjective recovery of patients undergoing cancer surgery. Total intravenous anesthesia (TIVA) and inhaled anesthesia with volatile anesthetics (INHA) are safe and common anesthetic techniques. Currently, TIVA and INHA have only been compared for less invasive and less complex surgeries. This prospective randomized trial aimed to compare the quality of recovery between TIVA and INHA in patients undergoing pancreatoduodenectomy (PD) or distal pancreatectomy (DP) using the Quality of Recovery (QOR)-40 questionnaire. METHODS We enrolled 132 patients who were randomly assigned to either the desflurane (DES) (INHA, balanced anesthesia with DES and remifentanil infusion) or TIVA (effect-site target-controlled infusion of propofol and remifentanil) groups and completed the QOR-40 questionnaire postoperatively. RESULTS The mean global QOR-40 score on postoperative day 3 was significantly higher in the TIVA group than in the DES group. In the PD group, the total QOR-40 score was significantly higher in the TIVA group than in the DES group. Moreover, the TIVA group had significantly higher scores in the physical comfort and psychological support QOR-40 dimensions than the DES group. CONCLUSION TIVA provides better quality of recovery scores on POD 3 for patients undergoing curative pancreatectomy. CLINICAL TRIAL REGISTRATION NUMBER NCT03447691.
Collapse
|
8
|
Azoulay D, Ramos E, Casellas-Robert M, Salloum C, Lladó L, Nadler R, Busquets J, Caula-Freixa C, Mils K, Lopez-Ben S, Figueras J, Lim C. Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. JHEP Rep 2020; 3:100190. [PMID: 33294830 PMCID: PMC7689549 DOI: 10.1016/j.jhepr.2020.100190] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023] Open
Abstract
Background & Aims Liver resection (LR) in patients with hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg is not encouraged. Here, we reappraised the outcomes of patients with cirrhosis and CSPH who underwent LR for HCC in highly specialised liver centres. Methods This was a retrospective multicentre study from 1999 to 2019. Predictors for postoperative liver decompensation and textbook outcomes were identified. Results In total, 79 patients with a median age of 65 years were included. The Child-Pugh grade was A in 99% of patients, and the median model for end-stage liver disease (MELD) score was 8. The median HVPG was 12 mmHg. Major hepatectomies and laparoscopies were performed in 28% and 34% of patients, respectively. Ninety-day mortality and severe morbidity rates were 6% and 27%, respectively. Postoperative and persistent liver decompensation occurred in 35% and 10% of patients at 3 months. Predictors of liver decompensation included increased preoperative HVPG (p = 0.004), increased serum total bilirubin (p = 0.02), and open approach (p = 0.03). Of the patients, 34% achieved a textbook outcome, of which the laparoscopic approach was the sole predictor (p = 0.004). The 5-year overall survival and recurrence-free survival rates were 55% and 43%, respectively. Conclusions Patients with cirrhosis, HCC and HVPG ≥10 mmHg can undergo LR with acceptable mortality, morbidity, and liver decompensation rates. The laparoscopic approach was the sole predictor of a textbook outcome. Lay summary Patients with cirrhosis, hepatocellular carcinoma, and clinically significant portal hypertension (defined as a hepatic venous pressure gradient ≥10 mmHg) can undergo resection with acceptable mortality, morbidity, liver decompensation rates, and a textbook outcome. These results can be achieved in selected patients with preserved liver function, good general status, and sufficient remnant liver volume. Patients with HCC and CSPH can undergo resection, with mortality of 6% and severe morbidity of 27%. Postoperative and persistent liver decompensation occurred in 35% and 10% of patients, respectively. Textbook outcome was achieved in 34% of patients. The laparoscopic approach was identified as a predictor of postoperative liver decompensation and textbook outcome.
Collapse
Key Words
- AFP, alpha-fetoprotein
- ASA, American Society of Anesthesiologists
- BCLC, Barcelona-Clinic Liver Cancer
- CCI, Comprehensive Complication Index
- CSPH, clinically significant portal hypertension
- CT, computed tomography
- Clinically significant portal hypertension
- EASL, European Association for the Study of the Liver
- HVPG, hepatic venous pressure gradient
- Hepatectomy
- Hepatic venous pressure gradient
- LLR, laparoscopic liver resection
- LR, liver resection
- MELD, model for end-stage liver disease
- PHT, portal hypertension
- PVE, portal vein embolisation
- Postoperative liver decompensation
- TACE, transarterial chemoembolisation
- Textbook outcome
Collapse
Affiliation(s)
- Daniel Azoulay
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France.,Department of Hepato-Biliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Emilio Ramos
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Margarida Casellas-Robert
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari Dr Josep Trueta, Girona, Catalonia, Spain
| | - Chady Salloum
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Laura Lladó
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Roy Nadler
- Department of Hepato-Biliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Juli Busquets
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Celia Caula-Freixa
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari Dr Josep Trueta, Girona, Catalonia, Spain
| | - Kristel Mils
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Santiago Lopez-Ben
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari Dr Josep Trueta, Girona, Catalonia, Spain
| | - Joan Figueras
- Hepato-Biliary and Pancreatic Surgery, Department of Surgery, "Sagrat Cor" Hospital University of Barcelona, Barcelona, Spain
| | - Chetana Lim
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
9
|
Defining the Minimal Clinically Important Difference and Patient-acceptable Symptom State Score for Disability Assessment in Surgical Patients. Anesthesiology 2020; 132:1362-1370. [DOI: 10.1097/aln.0000000000003240] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
The World Health Organization Disability Assessment Schedule 2.0 has been used to measure postoperative disability in several clinical trials and cohort studies. It is uncertain what the minimal clinically important difference or patient-acceptable symptom state scores are for this scale in patients recovering from surgery.
Methods
The authors analyzed prospectively collected data from three studies that measured disability 3 and 6 months after surgery. Three distribution-based methods (0.3 multiplied by SD, standard error of the measurement, and 5% range) and two anchor-based methods (anchored to two patient-rated health status questions and separately to unplanned hospital readmission) were averaged to estimate the minimal clinically important difference for the World Health Organization Disability Assessment Schedule 2.0 score converted to a percentage scale. Scores consistent with a patient-acceptable symptom state and clinically significant disability were determined by an anchored 75th centile method.
Results
Data from 4,361 patients were analyzed. The average minimal clinically important difference estimate for the World Health Organization Disability Assessment Schedule 2.0 was 5%, with similar estimates in patients with or without preoperative disability. The patient-acceptable symptom state score was 16%, and the score consistent with at least moderate clinically significant disability was 35%. Using these estimates, between baseline and 6 months after surgery, 21% of patients had a significant increase in disability, and 73% achieved a patient-acceptable symptom state.
Conclusions
A change in World Health Organization Disability Assessment Schedule 2.0 score of 5% or more after surgery is consistent with a clinically important change in disability. Patients with a score less than 16% after surgery have an acceptable symptom state and can be considered as disability-free, whereas patients with a score of 35% or more can be considered as having at least moderate clinically significant disability.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Collapse
|
10
|
Liu Q, Lin JY, Zhang YF, Zhu N, Wang GQ, Wang S, Gao PF. Effects of epidural combined with general anesthesia versus general anesthesia on quality of recovery of elderly patients undergoing laparoscopic radical resection of colorectal cancer: A prospective randomized trial. J Clin Anesth 2020; 62:109742. [PMID: 32088534 DOI: 10.1016/j.jclinane.2020.109742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/02/2020] [Accepted: 02/13/2020] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVES The aim of the present study was to assess the quality of recovery from anesthesia on patients subjected to laparoscopic radical resection of colorectal cancer under epidural block combined with general anesthesia or general anesthesia by means of Quality of Recovery-15 (QoR-15) questionnaire. DESIGN Prospective randomized trial. SETTING The setting is at an operating room, a post-anesthesia care unit, and a hospital ward. PATIENTS Seventy patients, aging from 65 to 79 years with an American Society of Anesthesiologists physical status II or III, were scheduled to undergo laparoscopic radical resection of colorectal cancer. INTERVENTIONS Epidural block combined with general anesthesia or general anesthesia. MEASUREMENTS The QoR-15 was administered by an investigator blind to group allocation before surgery (T0), at 24 and 72h after surgery (T1 and T2), and on postoperative day 7 (T3). The quality of recovery, as assessed by the score on the QoR-15, was compared between the groups. Besides, the consumption of anesthetics, respiratory recovery time, response time, extubation time, flatus time, the incidence of nausea or vomiting, the consumption of antiemetic and analgesic agents, and the duration of the hospital stay were also recorded. MAIN RESULTS The QoR-15 scores at T1 and T2 were significantly higher in the E + G group compared with the G group (P < 0.05). Among the five dimensions of the QoR-15, physiological comfort, physiological independence, pain, and emotional dimension were significantly better at T1 in the E + G group, and physiological comfort and pain were significantly better at T2 in the E + G group. CONCLUSION This study demonstrates that epidural block combined with general anesthesia can improve the early recovery of elderly patients after laparoscopic radical resection of colorectal cancer from the perspective of patients.
Collapse
Affiliation(s)
- Qin Liu
- Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000,Sichuan,China; Department of Anesthesiology, Suining Central Hospital, Suining 629000, Sichuan, China
| | - Jing-Yan Lin
- Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000,Sichuan,China; Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College,Nanchong, 637000,Sichuan,China.
| | - Yun-Feng Zhang
- Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000,Sichuan,China
| | - Na Zhu
- Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000,Sichuan,China
| | - Guo-Qiang Wang
- Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000,Sichuan,China
| | - Shun Wang
- Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000,Sichuan,China
| | - Peng-Fei Gao
- Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000,Sichuan,China
| |
Collapse
|
11
|
Regional anesthesia for vascular surgery: does the anesthetic choice influence outcome? Curr Opin Anaesthesiol 2020; 32:690-696. [PMID: 31415047 DOI: 10.1097/aco.0000000000000781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Outcomes following surgery are of major importance to clinicians, institutions and most importantly patients. This review examines whether regional anesthesia and analgesia influence outcome after vascular surgery. RECENT FINDINGS Large database analyses of contemporary practice suggest that utilizing regional anesthesia for both open and endovascular aortic aneurysm repair, lower limb revascularization and carotid endarterectomy reduces morbidity, length of stay and possibly even mortality. Results from such analyses are limited by an inherent risk of bias but are nevertheless important given the number of patients required in randomized trials to detect differences in rare outcomes. There is minimal evidence that regional anesthesia influences longer term outcomes except for arteriovenous fistula surgery where brachial plexus blocks appear to improve 3-month fistula patency. SUMMARY Patients undergoing vascular surgery often have multiple comorbidities and it is important to be able to outline both benefits and risks of regional anesthesia techniques. Regional anesthesia in vascular surgery allows avoidance of general anesthesia and does provide short-term benefits beyond superior analgesia. Evidence of long-term benefits is lacking in most procedures. Further work is required on newer patient centered outcomes.
Collapse
|
12
|
Myles PS. More than just morbidity and mortality – quality of recovery and long‐term functional recovery after surgery. Anaesthesia 2020; 75 Suppl 1:e143-e150. [DOI: 10.1111/anae.14786] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2019] [Indexed: 12/23/2022]
Affiliation(s)
- P. S. Myles
- Department of Anaesthesiology and Peri‐operative Medicine Alfred Hospital and Monash University Melbourne Vic. Australia
| |
Collapse
|
13
|
Fernandes A, Rodrigues J, Lages P, Lança S, Mendes P, Antunes L, Santos CS, Castro C, Costa RS, Lopes CS, da Costa PM, Santos LL. Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study. Patient Saf Surg 2019; 13:40. [PMID: 31827617 PMCID: PMC6889593 DOI: 10.1186/s13037-019-0221-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit. Methods From January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs. Results Sixty patients (75% male) with a median age of 64.5 [47-81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality. Conclusion PPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.
Collapse
Affiliation(s)
- Antero Fernandes
- 1Experimental Pathology and Therapeutics Group, Instituto Português de Oncologia, Porto, Portugal.,2Polyvalent Intensive Care Unit of Intensive Medicine Service, Hospital Garcia de Orta, E.P.E, Almada, Portugal
| | - Jéssica Rodrigues
- 3Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Instituto Português de Oncologia, Porto, Portugal
| | - Patrícia Lages
- 4General Surgery Service, Hospital Garcia de Orta, E.P.E, Portugal and Faculdade de Medicina da Universidade de Lisboa, Almada, Portugal
| | - Sara Lança
- 2Polyvalent Intensive Care Unit of Intensive Medicine Service, Hospital Garcia de Orta, E.P.E, Almada, Portugal
| | - Paula Mendes
- Polyvalent Intensive Care Unit, Hospital Santo Espírito ilha Terceira, E.P.R, Angra do Heroísmo, Açores Portugal
| | - Luís Antunes
- 3Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Instituto Português de Oncologia, Porto, Portugal
| | - Carla Salomé Santos
- 6Surgical Oncology Department of Portuguese Instituto Português de Oncologia, Porto, Portugal
| | - Clara Castro
- 3Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Instituto Português de Oncologia, Porto, Portugal.,7EPIUnit - Institute of Public Health, Universidade do Porto, Porto, Portugal
| | - Rafael S Costa
- 8IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,9REQUIMTE/LAQV, Department of Chemistry, Faculty of Science and Technology, Universidade Nova de Lisboa, Caparica, Portugal
| | - Carlos Silva Lopes
- 10Biomedical Sciences Institute Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Paulo Matos da Costa
- 4General Surgery Service, Hospital Garcia de Orta, E.P.E, Portugal and Faculdade de Medicina da Universidade de Lisboa, Almada, Portugal
| | - Lúcio Lara Santos
- 1Experimental Pathology and Therapeutics Group, Instituto Português de Oncologia, Porto, Portugal.,6Surgical Oncology Department of Portuguese Instituto Português de Oncologia, Porto, Portugal.,10Biomedical Sciences Institute Abel Salazar, Universidade do Porto, Porto, Portugal
| |
Collapse
|
14
|
Dennis AT, Sheridan N. Sex, suffering and silence – why peri‐operative medicine must prioritise pregnant women. Anaesthesia 2019; 74:1504-1508. [DOI: 10.1111/anae.14702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/19/2022]
Affiliation(s)
- A. T. Dennis
- Department of Anaesthesia Royal Women's Hospital Parkville Vic. Australia
- Departments of Pharmacology Obstetrics and Gynaecology, and Radiology and Medicine University of Melbourne Parkville Vic. Australia
| | - N. Sheridan
- Department of Anaesthesia Western Health, Joan Kirner Women's and Children's Hospital St Albans Vic. Australia
| |
Collapse
|
15
|
Miles LF, Sandhu RNS, Grobler AC, Heritier S, Burgess A, Burbury KL, Story DA. Associations between non-anaemic iron deficiency and outcomes following surgery for colorectal cancer: An exploratory study of outcomes relevant to prospective observational studies. Anaesth Intensive Care 2019; 47:152-159. [DOI: 10.1177/0310057x19838899] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Iron deficiency is common in colorectal cancer. Despite perioperative guidelines advocating for the correction of non-anaemic iron deficiency prior to major surgery, the impact of this pathology on postoperative outcome is unclear. We conducted a single-centre, historical cohort study of 141 elective resections for colorectal cancer. We stratified non-anaemic patients into iron deficient and iron replete groups, and collected data on baseline characteristics, preoperative laboratory results, intraoperative events and postoperative outcomes. As this study was an exploratory work for future research, a P-value of 0.25 was considered relevant. Patients in the deficient group demonstrated lower baseline ferritin (median (interquartile range, IQR) 76 (41–141) µg/L versus 207 (140–334) µg/L, P < 0.001) and transferrin saturation (mean (standard deviation, SD) 18% (8%) versus 32% (12%), P < 0.001) than those in the replete group, and lower starting haemoglobin (mean (SD) 138 (10) g/L versus 144 (12) g/L, P = 0.01). The deficient group had increased re-admission (25% (24%) versus 4% (11%), P = 0.15) and all-cause infection (25% (24%) versus 5% (14%), P = 0.24). A decrease of two days in days alive and out of hospital at postoperative day 90 was seen in the deficient group on univariate analysis (median (IQR) 81 (75–84) versus 83 (78–84), P = 0.25). This reduced to 1.24 days in multivariate adjusted quantile regression analysis ( P = 0.22). Days alive and out of hospital at day 90, postoperative re-admission and postoperative infection may be meaningful outcome measures for future prospective observational work examining non-anaemic iron deficiency in patients undergoing major surgery for colorectal cancer.
Collapse
Affiliation(s)
- Lachlan F Miles
- Department of Anaesthesia, Austin Health, Melbourne, Australia
- Centre for Integrated Critical Care, Melbourne Medical School, University of Melbourne, Australia
| | | | | | - Stephane Heritier
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Adele Burgess
- Department of Colorectal Surgery, Austin Health, Melbourne, Australia
| | - Kate L Burbury
- Division of Haematology, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - David A Story
- Department of Anaesthesia, Austin Health, Melbourne, Australia
- Centre for Integrated Critical Care, Melbourne Medical School, University of Melbourne, Australia
| |
Collapse
|
16
|
Shulman M, Cuthbertson B, Wijeysundera D, Pearse R, Thompson B, Torres E, Ambosta A, Wallace S, Farrington C, Myles P, Wallace S, Thompson B, Ellis M, Borg B, Kerridge R, Douglas J, Brannan J, Pretto J, Godsall M, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter T, Macklin S, Elliott A, Carrera A, Terblanche N, Pitt S, Samuels J, Wilde C, MacCormick A, Leslie K, Bramley D, Southcott A, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney C, Choi S, Somascanthan P, Flores K, Beattie W, Karkouti K, Clarke H, Jerath A, McCluskey S, Wasowicz M, Granton J, Day L, Pazmino-Canizares J, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, Mcallister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G, Melo M, Mamdani M, Hillis G, Wijeysundera H. Using the 6-minute walk test to predict disability-free survival after major surgery. Br J Anaesth 2019; 122:111-119. [DOI: 10.1016/j.bja.2018.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
|
17
|
Boet S, Etherington C, Nicola D, Beck A, Bragg S, Carrigan ID, Larrigan S, Mendonca CT, Miao I, Postonogova T, Walker B, De Wit J, Mohamed K, Balaa N, Lalu MM, McIsaac DI, Moher D, Stevens A, Miller D. Anesthesia interventions that alter perioperative mortality: a scoping review. Syst Rev 2018; 7:218. [PMID: 30497505 PMCID: PMC6267894 DOI: 10.1186/s13643-018-0863-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/30/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With over 230 million surgical procedures performed annually worldwide, better application of evidence in anesthesia and perioperative medicine may reduce widespread variation in clinical practice and improve patient care. However, a comprehensive summary of the complete available evidence has yet to be conducted. This scoping review aims to map the existing literature investigating perioperative anesthesia interventions and their potential impact on patient mortality, to inform future knowledge translation and ultimately improve perioperative clinical practice. METHODS Searches were conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library databases from inception to March 2015. Study inclusion criteria were adult patients, surgical procedures requiring anesthesia, perioperative intervention conducted/organized by a professional with training in anesthesia, randomized controlled trials (RCTs), and patient mortality as an outcome. Studies were screened for inclusion, and data was extracted in duplicate by pairs of independent reviewers. Data were extracted, tabulated, and reported thematically. RESULTS Among the 10,505 publications identified, 369 RCTs (n = 147,326 patients) met the eligibility criteria. While 15 intervention themes were identified, only 7 themes (39 studies) had a significant impact on mortality: pharmacotherapy (n = 23), nutritional (n = 3), transfusion (n = 4), ventilation (n = 5), glucose control (n = 1), medical device (n = 2), and dialysis (n = 1). CONCLUSIONS By mapping intervention themes, this scoping review has identified areas requiring further systematic investigation given their potential value for reducing patient mortality as well as areas where continued investment may not be cost-effective given limited evidence for improving survival. This is a key starting point for future knowledge translation to optimize anesthesia practice.
Collapse
Affiliation(s)
- Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - David Nicola
- Family Medicine, McGill University, Montreal, Canada
| | - Andrew Beck
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Susan Bragg
- Department of Anesthesia, University of Toronto, Toronto, Canada
| | - Ian D Carrigan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sarah Larrigan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,University of Ottawa, Ottawa, Canada
| | - Cassandra T Mendonca
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Isaac Miao
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | | | - Benjamin Walker
- Department of Anesthesia, University of Utah, Salt Lake City, UT, 84132, USA
| | - José De Wit
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Karim Mohamed
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Nadia Balaa
- Department of Family Medicine, Montfort Hospital, University of Ottawa, Ottawa, Canada
| | - Manoj Mathew Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada.,Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, K1G 5Z3, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Adrienne Stevens
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Donald Miller
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | | |
Collapse
|
18
|
Carli F, Feldman LS. From preoperative risk assessment and prediction to risk attenuation: a case for prehabilitation. Br J Anaesth 2018; 122:11-13. [PMID: 30579388 DOI: 10.1016/j.bja.2018.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada.
| | - L S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
19
|
|
20
|
Lönnqvist PA. The potential implications of using disability-free survival and number needed to suffer as outcome measures for neonatal intensive care. Acta Paediatr 2018; 107:200-202. [PMID: 28437598 DOI: 10.1111/apa.13888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/20/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Per-Arne Lönnqvist
- Section of Anaesthesiology & Intensive Care; Department of Physiology & Pharmacology; Karolinska Institutet; Stockholm Sweden
- Paediatric Anaesthesia; Intensive Care and ECMO Services; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
21
|
Abstract
Purpose of Review The central question of preoperative assessment is not “What can be done?” but “What should be done and how?” Predicting a patient’s risk of unwanted outcomes is vital to answering this question. This review discusses risk prediction tools currently available and anticipates future developments. Recent Findings Simple, parsimonious risk scales and scores are being replaced by complex risk prediction models as high-capacity information systems become ubiquitous. The accuracy of risk estimation will be further increased by improved assessment of physical fitness, frailty, and incorporation of existing and novel biomarkers. However, the limitations of risk prediction for individual patient care must be recognized. Summary Risk prediction is transforming from clinical estimation to statistical science. Predictions should be used within the context of a patient’s baseline risk (life expectancy independent of surgery), personal circumstances, quality of life, their expectations and values, and consideration of outcomes that are meaningful for the patient.
Collapse
Affiliation(s)
- Pragya Ajitsaria
- 1Department of Anaesthesia & Perioperative Medicine, John Hunter Hospital, Locked Bag 1 HRMC, Newcastle, NSW 2310 Australia.,2University of Newcastle, Newcastle, NSW Australia
| | - Sabry Z Eissa
- 1Department of Anaesthesia & Perioperative Medicine, John Hunter Hospital, Locked Bag 1 HRMC, Newcastle, NSW 2310 Australia.,2University of Newcastle, Newcastle, NSW Australia
| | - Ross K Kerridge
- 1Department of Anaesthesia & Perioperative Medicine, John Hunter Hospital, Locked Bag 1 HRMC, Newcastle, NSW 2310 Australia.,2University of Newcastle, Newcastle, NSW Australia
| |
Collapse
|
22
|
Teunkens A, Vanhaecht K, Vermeulen K, Fieuws S, Van de Velde M, Rex S, Bruyneel L. Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study. J Clin Anesth 2017; 43:15-23. [PMID: 28964960 DOI: 10.1016/j.jclinane.2017.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To evaluate patient satisfaction and patient reported anaesthesia related outcome parameters after outpatient surgery. DESIGN A three-year (2013-2016) observational study. SETTING A surgical day care centre embedded in a tertiary care, university hospital. PATIENTS Adult Dutch-speaking patients who underwent surgery under general or regional anaesthesia on an outpatient basis (n=5424). INTERVENTIONS A questionnaire was developed to evaluate patients' satisfaction with care during their hospitalisation in the surgical day centre, as well as to assess their reports of anaesthesia related outcomes. MEASUREMENTS Various aspects of care were measured, including care by nurses, care by doctors, organisational and safety items. Variation in satisfaction and surgery and anaesthesia related outcomes as a function of different categories (gender, age, education, type of anaesthesia, discipline and era) were also investigated. MAIN RESULTS Confirmatory factor analysis showed an excellent fit to the hypothesized factors of the survey. Satisfaction scores were very high for different aspects of care, resulting in 98% of patients being (very) satisfied (59.1% very satisfied, 38.9% satisfied). Male (p=0.0003), higher educated (p<0.0001) and older patients (p<0.0001) were more likely to be very satisfied. Postoperative nausea and vomiting (PONV) were frequent (nausea: 13.9%, vomiting: 3.3%), and more present in female than in male patients (p<0.0001). Pain scores at the PACU differed among disciplines (p<0.0001) were higher in female patients compared to male patients (3.41% versus 2.54%, p<0.0001) and after general anaesthesia compared to regional anaesthesia (3.25% versus 0.39%, p<0.0001) and decreased with higher age (p=0.0001) and education level (p=0.0033). CONCLUSIONS Whereas satisfaction with all aspects of care is generally high, the results regarding pain and PONV should inspire quality improvement initiatives. The questionnaire developed in this study can be a vehicle to assess and improve the quality of care in surgical day care centres.
Collapse
Affiliation(s)
- An Teunkens
- Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Kristien Vermeulen
- Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Steffen Fieuws
- I-Biostat, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Marc Van de Velde
- Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Steffen Rex
- Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Anaesthesiology, University Hospitals of the KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| |
Collapse
|
23
|
Medical research and the ethics of medical treatments: disability-free survival. Br J Anaesth 2017; 118:286-288. [DOI: 10.1093/bja/aew474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|