Information technology-based joint preoperative assessment, risk stratification and its impact on patient management, perioperative outcome, and cost

Impact of Covid-19 Pandemic on Waitlisted Preoperative General Surgical Patients in a Tertiary Care Hospital in India - Problems and Probable Solutions: an Observational Study

INTRODUCTION

Among patients affected by Covid-19, a large subset included those who were on preoperative general surgical waiting list for elective operations. There are very few studies on the various factors that impacted these patients during the pandemic in India. The current study aimed to analyse the factors which hampered the surgical management of such patients and to suggest implementable solutions which can mitigate those factors in future pandemics.

MATERIALS AND METHODS

This was a cross sectional observational study conducted from March 2021 to February 2022. Patients from the surgical register who were placed on a waiting list for routine elective procedures like hernias, gallstone disease, benign thyroid swellings, etc were included, while those with malignancy and emergencies were excluded. We sought information about their current status regarding the planned surgery, the factors which have prevented or are preventing them from accessing suitable surgical service and the current status of individually experienced symptoms.

RESULTS

There were 38 respondents. Most of the patients belonged to the age group 40-60 years and had an average waiting period of more than six months. In 20/38 patients, surgery was postponed because of Covid-19 pandemic, seven patients were admitted but operation was postponed for various reasons, while a few others suffered due to financial difficulty or lockdown restrictions. In 23/38 patients' symptoms progressed and nine patients had unbearable symptoms at the time of the study. Two of the 38 respondents underwent emergency surgery outside the institute. All subjects knew that Covid-19 patients were being treated in the institute, where most of them were still willing to continue their treatment. Three patients refused to continue treatment because of apprehension about getting Covid-19.

CONCLUSION

Although the World Health Organization (WHO) declared the Covid-19 pandemic over, experts opine that there might be more such incidents in not-too-distant future. Our study is among the few of its kind that provides some analytical data regarding the factors which prevented the general surgical patients access to surgical service in India during the Covid-19 pandemic and to suggest some implementable strategies to mitigate the effect of those factors in future pandemics.

Educating Family Physician Residents for Anesthetic Preoperative Evaluation and Assessment

Introduction

Encounters for preoperative assessments are common within primary care offices, so it is imperative that family medicine residents learn how to perform preoperative evaluations. We assessed family medicine residents' knowledge of preoperative evaluation in preparation for surgery by providing a pre- and post-test alongside a didactic seminar.

Methods

A didactic seminar on preoperative evaluations was presented at a family medicine resident didactics session by two senior anesthesiology residents. A 16-question, multiple choice test was used as both a pre-test and post-test to assess family medicine residents' knowledge.

Results

A total of 31 participants took the pre-test (residents = 24; medical students = 7), and 30 participants took the post-test (residents = 23; medical students = 7). Mean scores and standard deviations were calculated for both tests with an average score of 37.50% ± 10.58% and 45.42% ± 11.12% on the pre- and post-test, respectively. Using the Kruskal-Wallis test, residents showed a significant improvement in test scores following the didactic presentation (p = 0.041), while overall results (residents and medical students) also reported a significant difference (p = 0.004).

Conclusions

Our results demonstrated that educating family medicine residents and medical students on preoperative evaluation showed significant, quantifiable gains in knowledge following a brief didactic presentation. Given the current gap between guidelines and practice, our results emphasize the need for a formal medical school and residency-based curriculum related to preoperative patient evaluation.

Epidemiology of primary and revision total knee arthroplasty: analysis of demographics, comorbidities and outcomes from the national inpatient sample

INTRODUCTION

Primary total knee arthroplasty (TKA) is a preferred treatment for end-stage knee osteoarthritis. In the setting of a failed TKA, revision total knee arthroplasty (rTKA) acts as a salvage procedure and carries a higher risk compared to primary TKA. Given increased interest in postoperative outcomes from these procedures, a thorough understanding of the demographics, comorbidities, and inpatient outcomes is warranted. This study aimed to report the epidemiological data of demographics, comorbidity profiles and outcomes of patients undergoing TKA and rTKA.

METHODS

A retrospective review of NIS registry discharge data from 2006 to 2015 third quarter was performed. This study included adults aged 40 and older who underwent TKA or rTKA. A total of 5,901,057 TKA patients and 465,968 rTKA patients were included in this study. Simple descriptive statistics were used to present variables on demographics, medical comorbidities, and postoperative complications.

RESULTS

A total of 5,901,057 TKA and 465,968 rTKA discharges were included in this study, with an average age of 66.30 and 66.56 years, and the major payor being Medicare, accounting for 55.34% and 59.88% of TKA and rTKA cases, respectively. Infection (24.62%) was the most frequent reason for rTKA, and was followed by mechanical complications (18.62%) and dislocation (7.67%). The most common medical comorbidities for both groups were hypertension, obesity, and diabetes. All types of inpatient complications were reported in 22.21% TKA and 28.78% of rTKA cases. Postoperative anemia was the most common complication in both groups (20.34% vs. 25.05%).

CONCLUSIONS

Our data demonstrated a 41.9% increase in patients receiving TKA and 28.8% increase in rTKA from the years 2006 to 2014. The data showed a 22.21% and a 28.78% "complication" rate with TKA and rTKA, with postoperative anemia being the most common complication. The top 3 medical comorbidities were hypertension, obesity, and diabetes for both groups and with increased focus on perioperative optimization, future analyses into preoperative medical optimization, and improved primary arthroplasty protocol may result in improved postoperative outcomes.

Effectiveness of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies

OBJECTIVES

The aim of this systematic review was to examine the effectiveness of pre-anaesthesia assessment clinics (PACs) in improving the quality and safety of perioperative patient care.

DESIGN

Systematic review.

DATA SOURCES

The electronic databases CINAHL Plus with Full Text (EBSCOhost), Medline and Embase (OvidSP) were systematically searched on 11 September 2018 and updated on 3 February 2020 and 4 February 2021.

ELIGIBILITY CRITERIA

The inclusion criteria for this study were studies published in English or Scandinavian language and scientific original research that included randomised or non-randomised prospective controlled studies. Additionally, studies that reported the outcomes from a PAC consultation with the patient present were included.

DATA EXTRACTION AND SYNTHESIS

Titles, abstracts and full texts were screened by a team of three authors. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies. Data extraction was performed by one author and checked by four other authors. Results were synthesised narratively owing to the heterogeneity of the included studies.

RESULTS

Seven prospective controlled studies on the effectiveness of PACs were included. Three studies reported a significant reduction in the length of hospital stay and two studies reported a significant reduction in cancellation of surgery for medical reasons when patients were seen in the PAC. In addition, the included studies presented mixed results regarding anxiety in patients. Most studies had a high risk of bias.

CONCLUSION

This systematic review demonstrated a reduction in the length of hospital stay and cancellation of surgery when the patients had been assessed in the PAC. There is a need for high-quality prospective studies to gain a deeper understanding of the effectiveness of PACs.

PROSPERO REGISTRATION NUMBER

CRD42019137724.