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Edwards T, Boerkamp A, Davis KJ, Craig S. Using an under-utilised rural hospital to reduce surgical waiting lists. AUST HEALTH REV 2024; 48:248-253. [PMID: 38522435 DOI: 10.1071/ah23191] [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: 09/28/2023] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
Objectives This study aimed to evaluate patient outcomes from a 12-month pilot program establishing specialist surgical services in a small rural (Modified Monash Model, MM4) hospital on the south coast of NSW. Methods Suitable patients for ambulatory surgery were selected based on strict anaesthetic, surgical and social criteria. Skills shortfalls among nursing staff, usually with emergency or inpatient experience, were addressed by appropriate re-training and in-service training in scrub, scout and anaesthetic duties. An anonymous post-operative patient survey was administered during the pilot program, which assessed patient experiences and outcomes. Of 162 patients undergoing surgery during the pilot, 50 consecutive participants completed the survey. Results Of the 161 procedures during the pilot program, 100 were performed under sedation and locoregional anaesthesia and 62 under general anaesthesia. Half (n = 86, 53.4%) were complex excisions of malignant skin lesions, and of these 63% also required either a skin graft or local flap repair. Survey respondents reported adequate information and pain relief upon discharge (n = 45, 96%) and 100% were satisfied with the care received. No respondents needed to see a doctor following discharge. There were no mortality events or major issues of morbidity during the study period or subsequently, no further overnight admissions or return to theatre and no re-presentations within 48 h of operating. Two superficial surgical site infections were reported. Conclusions There is merit in drawing on underutilised resources in small rural hospitals in support of initiatives to reduce surgical waitlists. Appropriate outpatient surgeries can be safely performed with high levels of patient satisfaction.
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Affiliation(s)
- Tracey Edwards
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Keiraville, NSW 2522, Australia
| | - Andrea Boerkamp
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Keiraville, NSW 2522, Australia; and Department of Surgery, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Scenic Drive, Nowra, NSW 2541, Australia
| | - Kimberley J Davis
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Keiraville, NSW 2522, Australia; and Research Operations, Illawarra Shoalhaven Local Health District, NSW, Australia
| | - Steven Craig
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Keiraville, NSW 2522, Australia; and Department of Surgery, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Scenic Drive, Nowra, NSW 2541, Australia
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2
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Ma W, Liu Y, Liu J, Qiu Y, Zuo Y. Prehabilitation of surgical patients: a bibliometric analysis from 2005 to 2023. Perioper Med (Lond) 2024; 13:48. [PMID: 38822436 PMCID: PMC11140917 DOI: 10.1186/s13741-024-00410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Good preoperative conditions help patients to counteract surgical injury. Prehabilitation is a multimodal preoperative management strategy, including physical, nutritional, psychological, and other interventions, which can improve the functional reserve of patients and enhance postoperative recovery. The purpose of this study is to show the evolution trend and future directions of research related to the prehabilitation of surgical patients. METHODS The global literature regarding prehabilitation was identified from The Web of Science Core Collection database. Bibliometric methods of the Bibliometrix package of R (version 4.2.1) and VOSviewer were used to analyze publication trends, cooperative networks, study themes, and co-citation relationships in the field. RESULTS A total of 638 publications were included and the number of publications increased rapidly since 2016, with an average annual growth rate of 41.0%. "Annals of Surgery", "British Journal of Surgery" and "British Journal of Anesthesia" were the most cited journals. Experts from the USA, Canada, the UK, and the Netherlands contributed the most in this field, and an initial cooperative network among different countries and clinical teams was formed. Malnutrition, older patients, frailty, and high-risk patients were the hotspots of recent studies. However, among the top 10 cited articles, the clinical effects of prehabilitation were conflicting. CONCLUSION This bibliometric review summarized the most influential publications as well as the publication trends and clarified the progress and future directions of prehabilitation, which could serve as a guide for developing evidence-based practices.
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Affiliation(s)
- Wei Ma
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yijun Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yanhua Qiu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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3
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Hines L, Mali K, Campbell T, Jain R, Quarrier SO. Advancing Holmium Laser Enucleation of the Prostate Outcomes Reporting: An Assessment of Patient-Reported Outcomes in the Literature. Urology 2024; 187:147-153. [PMID: 38442790 DOI: 10.1016/j.urology.2024.02.045] [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: 12/12/2023] [Revised: 01/22/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024]
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a size-independent option for benign prostatic hyperplasia surgical management. Since lower urinary tract symptoms (LUTS) are a quality-of-life issue, studies should prioritize patient-reported outcomes (PROs). This HoLEP review assesses PROs inclusion in the top 20 cited HoLEP studies and defines their limitations. PROs were categorized by domain: LUTS, incontinence, sexual function, pain, hematuria, and patient satisfaction. On review, no top-cited study included all PRO domains. The nuanced patient experience after HoLEP could be better defined via standardized utilization of validated PROs, while also improving comparability between HoLEP studies.
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Affiliation(s)
- Laena Hines
- Department of Urology, University of Rochester Medical Center, Rochester, NY.
| | - Kaela Mali
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Timothy Campbell
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Rajat Jain
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Scott O Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY
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4
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Gurunathan U, Roe A, Milligan C, Hay K, Ravichandran G, Chawla G. Preoperative Renin-Angiotensin System Antagonists Intake and Blood Pressure Responses During Ambulatory Surgical Procedures: A Prospective Cohort Study. Anesth Analg 2024; 138:763-774. [PMID: 38236756 DOI: 10.1213/ane.0000000000006728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND There is limited evidence to inform the association between the intake of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) and intraoperative blood pressure (BP) changes in an ambulatory surgery population. METHODS Adult patients who underwent ambulatory surgery and were discharged on the same day or within 24 hours of their procedure were enrolled in this prospective cohort study. The primary outcome of the study was early intraoperative hypotension (first 15 minutes of induction). Secondary outcomes included any hypotension, BP variability, and recovery. Hypotension was defined as a decrease in systolic BP of >30% from baseline for ≥5 minutes or a mean BP of <55 mm Hg. Four exposure groups were compared (no antihypertensives, ACEI/ARB intake <10 hours before surgery, ACEI/ARB intake ≥10 hours before surgery, and other antihypertensives). RESULTS Of the 537 participants, early hypotension was observed in 25% (n = 134), and any hypotension in 41.5% (n = 223). Early hypotension occurred in 30% (29 of 98) and 41% (17 of 41) with the intake of ACEI/ARBs <10 and ≥10 hours before surgery, respectively, compared to 30% (9 of 30) with other antihypertensives and 21% (79 of 368) with no antihypertensives ( P = .02). Those on antihypertensives also experienced any hypotension more frequently than those who were not on antihypertensives ( P < .001). After adjusting for age and baseline BP in a regression analysis, antihypertensive exposure groups were observed to be associated only with any intraoperative hypotension ( P = .012). In the ACEI/ARB subset, there was no evidence of an association between time since the last ACEI/ARB dose, and hypotension or minimum mean or systolic BP. Compared to normal baseline BP, BP ≥ 140/90 mm Hg increased the odds of early and any hypotension (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.1-7.1 and OR, 7.7; 95% CI, 3.7-14.9, respectively; P < .001). Intraoperative variability in systolic and diastolic BP demonstrated significant differences with age, baseline BP, and antihypertensive exposure group ( P < .001). CONCLUSIONS Early and any hypotension occurred more frequently in those on antihypertensives than those not on antihypertensives. Unadjusted associations between antihypertensive exposure and intraoperative hypotension were largely explained by baseline hypertension rather than the timing of ACEI/ARBs or type of antihypertensive exposure. Patients with hypertension and on treatment experience more intraoperative BP variability and should be monitored appropriately.
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Affiliation(s)
- Usha Gurunathan
- From the Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Roe
- Department of Urology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Caitlin Milligan
- From the Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Hay
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Gowri Ravichandran
- Department of Anaesthesia, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Gunjan Chawla
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesia, Caboolture Hospital, Caboolture, Queensland, Australia
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5
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Gratteri M, Marangi GF, Mirra C, Arcari L, Romano FD, Cimmino A, Cogliandro A, Cagli B, Segreto F, Persichetti P. Impact of Incisional Access Site in Primary Breast Augmentation: Evaluation of Patient Satisfaction with SCAR-Q. Aesthetic Plast Surg 2024; 48:1565-1570. [PMID: 37495729 DOI: 10.1007/s00266-023-03502-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. METHODS The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. RESULTS All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. CONCLUSION Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. LEVEL OF EVIDENCE IV Case series study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Marco Gratteri
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy.
| | - Lucrezia Arcari
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Fara Desiree Romano
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Andrea Cimmino
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
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6
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Ricker AB, Manning D, Smith KE, Warren YE, Matthews BD, Reinke CE. Preoperative intervention for smoking cessation: A systematic review. Am J Surg 2024; 227:175-182. [PMID: 37865545 DOI: 10.1016/j.amjsurg.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Smoking is associated with increased postoperative complications. Pre-surgical smoking cessation remains a challenge. Our aim was to summarize pre-hospital smoking cessation interventions and impact on smoking cessation rates. METHODS Independent review of English language articles identified from systematic searches of MEDLINE, PubMed, PsycInfo, Embase, Web of Science, and Cumulative Index to Nursing & Allied Health Literature databases from 1998 to 2019 was performed (PROSPERO registration number CRD42021247927). Studies of adult patients enrolled in a pre-hospital smoking cessation intervention were included. Studies with historical controls or only self-reported outcomes were excluded. RESULTS Nine articles including 1762 patients were identified. Exhaled CO was used to confirm cessation. Six studies reported smoking status day of surgery. Interventions included NRT, hand-held technology, e-cigarettes, decision aids/counseling and medications. Four studies demonstrated a difference in smoking cessation rates. Ethics and study appraisal were assessed using ROB2. CONCLUSIONS Based on the variability of interventions, settings, and outcomes, best practice for successful pre-hospital smoking cessation in surgery clinics would benefit from ongoing investigation.
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Affiliation(s)
- Ansley Beth Ricker
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Debra Manning
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Kaylee E Smith
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Yancey E Warren
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Brent D Matthews
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA
| | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28205, USA.
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7
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Bignami E, Celoria S, Bellini V. Surgical outcomes and patient-centred perioperative programs. J Clin Monit Comput 2023; 37:1641-1643. [PMID: 37460869 DOI: 10.1007/s10877-023-01057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 11/16/2023]
Abstract
Perioperative medicine is changing, and its goals are expanding. More and more attention is paid to the surgical experience and the patient's quality of life. Patient-reported data represent a useful tool in this context. Patient-reported outcomes measures (PROMs) and experience measures (PREMs) are among the most used categories. However, creating perioperative programs capable of integrating traditional perioperative data with these scales is not easy. New technologies, particularly artificial intelligence, thanks to their ability to recognise, interpret, process or simulate human feelings, emotions and moods, could provide the necessary tools to combine all perioperative aspects, placing the patients and their needs at the centre of the process.
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Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy.
| | - Serena Celoria
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
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8
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Chiche L, Yang HK, Abbassi F, Robles-Campos R, Stain SC, Ko CY, Neumayer LA, Pawlik TM, Barkun JS, Clavien PA. Quality and Outcome Assessment for Surgery. Ann Surg 2023; 278:647-654. [PMID: 37555327 DOI: 10.1097/sla.0000000000006077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
ABSTRACT This forum summarizes the proceedings of the joint European Surgical Association (ESA)/American Surgical Association (ASA) symposium on Quality and Outcome Assessment for Surgery that took place in Bordeaux, France, as part of the celebrations of the 30th anniversary of the ESA. Three presentations focused on a) the main messages from the Outcome4Medicine Consensus Conference, which took place in Zurich, Switzerland, in June 2022, b) the patient perspective, and c) benchmarking were hold by ESA members and discussed by ASA members in a symposium attended by members of both associations.
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Affiliation(s)
| | - Han-Kwang Yang
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Clifford Y Ko
- University of California at Los Angeles and the American College of Surgeons, Los Angeles, CA
| | - Leigh A Neumayer
- University of Florida, College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Jeffrey S Barkun
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
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9
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Liu Y, Qiu Y, Fu Y, Liu J. Evaluation of postoperative recovery: past, present and future. Postgrad Med J 2023; 99:808-814. [PMID: 37490361 DOI: 10.1136/postgradmedj-2022-141652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/02/2022] [Indexed: 02/05/2023]
Abstract
Postoperative recovery, as a window to observe perioperative treatment effect and patient prognosis, is a common outcome indicator in clinical research and has attracted more and more attention of surgeons and anaesthesiologists. Postoperative recovery is a subjective, multidimensional, long-term, complex process, so it is unreasonable to only use objective indicators to explain it. Currently, with the widespread use of patient-reported outcomes, various scales become the primary tools for assessing postoperative recovery. Through systematic search, we found 14 universal recovery scales, which have different structures, contents and measurement properties, as well as their own strengths and weaknesses. We also found that it is urgently necessary to perform further researches and develop a scale that can serve as the gold universal standard to evaluate postoperative recovery. In addition, with the rapid development of intelligent equipment, the establishment and validation of electronic scales is also an interesting direction.
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Affiliation(s)
- Yijun Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Yanhua Qiu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Fu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
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10
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Look in the Mirror, Not Out the Window. ANNALS OF SURGERY OPEN 2022; 3:e184. [PMID: 36199485 PMCID: PMC9508963 DOI: 10.1097/as9.0000000000000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Over the past few decades, institutions have developed complex systems to compare themselves to others with the goal of improving healthcare quality. This process of comparison to others, called external benchmarking, has become the standard approach for quality improvement. However, external benchmarking is resource intensive, may not be flexible enough to focus on problems unique to individual institutions, and may lead to complacency for institutions ranking near the top of the quality bell curve for the measured metrics. Our singular focus on external benchmarking could also divert resources from other approaches. Here, we describe how the use of internal benchmarking, in which an institution focuses on improving their own processes over time, can offer unique advantages as well as offset the limitations of external benchmarking. We advocate for investment in both internal and external benchmarking as complimentary tools to improve healthcare quality. Mini-abstract: External benchmarking, the most common approach to benchmarking today, compares outcomes across a group to improve performance. This article discusses internal benchmarking, a complementary approach with several strengths—including reduced data burden, selection of tailored metrics, motivation to improve for all performers, and incentive to look inward for solutions.
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11
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Corcoran TB, Martin C, O'Loughlin E, Ho KM, Coutts P, Chan MT, Forbes A, Leslie K, Myles P. Dexamethasone and clinically significant postoperative nausea and vomiting: a prespecified substudy of the randomised perioperative administration of dexamethasone and infection (PADDI) trial. Br J Anaesth 2022; 129:327-335. [DOI: 10.1016/j.bja.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022] Open
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Patient Judgement of Change with Elective Surgery Correlates with Patient Reported Outcomes and Quality of Life. Healthcare (Basel) 2022; 10:healthcare10060999. [PMID: 35742049 PMCID: PMC9222512 DOI: 10.3390/healthcare10060999] [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: 05/04/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
Obtaining pre-surgery PROM measures is not always feasible. The aim of this study was to examine if self-reports of change following elective surgery correlate with change scores from a validated PROM (15-item Quality of Recovery (QoR-15)). This cross-sectional study across 29 hospitals enrolled elective surgery patients. PROMs were collected one-week pre-surgery, as well as one- and four-weeks post-surgery via an electronic survey. We examined associations between patient “judgement of change” at one and four-weeks after surgery and the actual pre-to post-surgery PROM change scores. A total of 4177 surveys were received. The correlation between patient judgement of change, and the actual change score was moderately strong at one-week (n = 247, rs = 0.512, p < 0.001), yet low at four-weeks (n = 241, rs = 0.340, p < 0.001). Patient judgement was aligned to the direction of the PROM change score from pre- to post-surgery. We also examined the correlation between the QoR-15 (quality of recovery) and the EQ-5D-5L (QOL). There was a moderately strong positive correlation between the two PROMs (n = 356, rs = 0.666, p < 0.001), indicating that change in quality of recovery was related to change in QOL. These findings support the use of a single “judgement of change” recall question post-surgery.
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Jaensson M, Nilsson U, Dahlberg K. Postoperative recovery: how and when is it assessed: a scoping review. Br J Anaesth 2022; 129:92-103. [PMID: 35623904 DOI: 10.1016/j.bja.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no consensus about the type of instrument with which to assess postoperative recovery or the time points when assessments are most appropriate. It is also unclear whether instruments measure the four dimensions of postoperative recovery, that is physical, psychological, social, and habitual recovery. This scoping review had three objectives: (1) to identify and describe instruments used in clinical trials to assess postoperative recovery; (2) to determine how, when, and the number of times postoperative recovery was measured; and (3) to explore whether the four dimensions of postoperative recovery are represented in the identified instruments. METHODS A literature search was conducted in CINAHL, MEDLINE, and Web of Science. The search terms were related to three search strands: postoperative recovery, instrument, and clinical trials. The limits were English language and publication January 2010 to November 2021. In total, 5015 studies were identified. RESULTS A total of 198 studies were included in the results. We identified 20 instruments measuring postoperative recovery. Different versions of Quality of Recovery represented 81.8% of the included instruments. Postoperative recovery was often assessed at one time point (47.2%) and most often on postoperative day 1 (81.5%). Thirteen instruments had items covering all four dimensions of postoperative recovery. CONCLUSIONS Assessing recovery is important to evaluate and improve perioperative care. We emphasise the importance of choosing the right instrument for the concept studied and, if postoperative recovery is of interest, of assessing more than once. Ideally, instruments should include all four dimensions to cover the whole recovery process.
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Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
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Allar BG, Eruchalu CN, Rahman S, Mou D, Ortega G, Reich A, Pusic A, Brook CD, Sisodia R, Bergmark RW. Lost in translation: A qualitative analysis of facilitators and barriers to collecting patient reported outcome measures for surgical patients with limited English proficiency. Am J Surg 2022; 224:514-521. [DOI: 10.1016/j.amjsurg.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
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Abstract
PURPOSE OF REVIEW Ambulatory surgery is associated with improved patient experience while reducing overall costs without compromising patient safety. Patient-centered care is crucial for further expansion and success of ambulatory surgery because it is associated with superior patient experience and improved patient satisfaction. This article discusses the approach to improving patient-centered care and patient-reported outcomes (PROs). RECENT FINDINGS It is necessary to recognize that each patient is different and may have different needs and preferences. Patient education and shared decision-making are critical components of patient-centered care. Shared decision-making emphasizes patient engagement in an effort to improve PROs. Implementation of enhanced recovery after surgery principles in ambulatory surgery is necessary to improve PROs. SUMMARY Delivery of patient-centered care will require modification of the current approach to perioperative care. It is imperative to measure PROs by implementing a comprehensive continuous quality improvement program.
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Affiliation(s)
- Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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