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Iaquinandi F, Mongelli F, Christoforidis D, Cianfarani A, Pini R, Saporito A, Popeskou SG, La Regina D. Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials. Surg Endosc 2024; 38:1119-1130. [PMID: 38253697 DOI: 10.1007/s00464-023-10658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The transversus abdominis plane block (TAPB) is effective for postoperative pain management in patients undergoing colorectal surgery. However, evidence regarding the optimal delivery method, either laparoscopic (L-TAPB) or ultrasound-guided (U-TAPB) is lacking. Our study aimed to compare the effectiveness of these delivery methods. METHODS We carried out a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar databases to include randomized studies comparing patients receiving either L-TAPB or U-TAPB during minimally invasive colorectal surgery. The primary endpoint was opioid consumption in the first 24 h after surgery. Risk of bias was assessed with the RoB-2 tool. Effect size was estimated for each study with 95% confidence interval and overall effect measure was estimated with a random effect model. RESULTS The literature search revealed 294 articles, of which four randomized trials were eligible. A total of 359 patients were included, 176 received a L-TAPB and 183 received a U-TAPB. We established the non-inferiority of L-TAPB, as the absolute difference of - 2.6 morphine-mg (95%CI - 8.3 to 3.0) was below the pooled non-inferiority threshold of 8.1 morphine-mg (low certainty level). No difference in opioid consumption was noted at 2, 6, 12, and 48 h (low to very low certainty level). Postoperative pain, nausea and vomiting were similar between groups at different timepoints (low to very low certainty level). No TAPB-related complications were recorded. Finally, the length of hospital stay was similar between groups. CONCLUSION For postoperative multimodal analgesia both L-TAPB and U-TAPB may result in little to no difference in outcome in patients undergoing colorectal surgery. Registration Prospero CRD42023421141.
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Affiliation(s)
- Fabiano Iaquinandi
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland.
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Dimitri Christoforidis
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Agnese Cianfarani
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Sotirios Georgios Popeskou
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
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Ghielmini EM, Greco L, Spampatti S, Kubli R, Saporito A, La Regina D. Erector Spinae Plane Block versus Transversus Abdominis Plane Block for Robotic Inguinal Hernia Repair: A Blinded, Active-Controlled, Randomized Trial. Pain Physician 2024; 27:27-34. [PMID: 38285028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Regional anesthetic nerve blocks are widely used in the treatment of pain after outpatient surgery to reduce opioid consumption. Erector spinae plane (ESP) block is a recently described technique with promising results in different scenarios. OBJECTIVES To compare ESP block efficacy with the commonly used transversus abdominis plane (TAP) block in patients undergoing robot-assisted inguinal hernia repair. STUDY DESIGN This was a randomized, blinded, active controlled, superiority trial with 2 parallel groups. The study was approved by the local ethics committee. Registration took place on; www. CLINICALTRIALS gov with the identifier NCT04750512. SETTING Adults undergoing robotic inguinal hernia repair were recruited between January 2021 and April 2022 in a single referral center of southern Switzerland. METHODS To ensure blinding, the study employed a "double dummy" design, where all patients underwent both TAP and ESP blocks, but only one block was therapeutically active. The therapeutic block contained ropivacaine 0.2%, while the other infiltration contained placebo. The therapeutic intervention varied between groups, with one group receiving the TAP block as the active treatment and the other group receiving the ESP block as the active treatment. Computer generated 1:1 randomization determined allocation, which took place immediately prior to the intervention. As a result, blinding included patients, anesthesia, and surgery providers, outcome assessors and statistical analysts. The main outcome measure was the highest reported pain score on a Visual Analog Scale (VAS) during the 6 hours following the end of general anesthesia. Secondary outcomes included pain scores at set intervals, analgesic consumption, and complications. RESULTS A total of 50 patients (25 per arm) were enrolled and included in the analysis. The study found no significant difference in the mean maximal VAS scores between the 2 groups (TAP block 22.2, ESP block 20, difference 2.2, 95% CI is -12.1 to 16.5). Secondary endpoints, including VAS pain scores at different time points, use of rescue analgesics, time to first walk, duration of stay, and frequency of adverse events, did not show any significant differences between the 2 groups. However, post-hoc analysis suggested a more stable effect over time for the ESP block compared to the TAP block. LIMITATIONS The main limitation is a higher variance in VAS scores than expected in the power calculations. CONCLUSIONS ESP block was not superior to TAP block in the treatment of post-operative pain among patients undergoing robotic inguinal hernia repair.
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Affiliation(s)
- Enea M Ghielmini
- Department of Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland; Department of Surgery, Spital Limmattal, Switzerland
| | - Lorenzo Greco
- Department of Anesthesiology, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Sebastiano Spampatti
- Department of Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Andrea Saporito
- Department of Anesthesiology, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
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Roberto D, Quadri C, Capdevila X, Saporito A. Identification of interfascial plane using injection pressure monitoring at the needle tip during ultrasound-guided TAP block in cadavers. Reg Anesth Pain Med 2023; 48:615-618. [PMID: 37474284 DOI: 10.1136/rapm-2023-104550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Consistency in needle tip positioning within interfascial planes while performing infiltrative blocks under ultrasound guidance can be difficult. The exact determination of such planes may beyond the physical limits of common ultrasound machines. Aim of this pilot study was to understand if real-time continuous injection pressure monitoring at the needle tip, combined with ultrasound guidance, can help to immediately and consistently identify an interfascial plane needle tip placement. METHODS We performed four ultrasound-guided transversus abdominis plane (TAP) blocks on fresh cadaver using a modified conventional peripheral nerve block needle. The sensing needle contains Fabry-Perot miniaturized pressure sensor floating at the needle tip, connected to a measuring unit via an optical fiber. Injection-pressure measured at the needle tip was continuously recorded, while the needle was advanced toward the target and 0.9% saline was continuously injected via an electronic pump. RESULTS A recognizable, recurrent three-peaks injection pressure pattern was identified, while advancing the needle through the abdominal wall, the pressure peaks being identified with the needle to fasciae contact. In four different blocks, a total of 12 peaks and 12 troughs were identified. The mean injection pressure (95% CI) of the peaks varied substantially from the mean injection pressure of the troughs, from 119.55 kPa (95% CI 87.3 to 151 kPa) to 30.99 kPa (95% CI 12.5 to 47.5 kPa), respectively. The peaks (troughs) arose from reproducible pressure curves and were related to the needle tip encountering the muscle fasciae. CONCLUSION The identified injection pressure pattern, together with ultrasound image, may help in determine real-time the needle tip position, while performing a TAP block.
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Affiliation(s)
- Dossi Roberto
- Anesthesia, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Xavier Capdevila
- Anesthesiology and Critical Care Department, Hopital Lapeyronie, Montpellier, France
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, USI, Lugano, Switzerland
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El-Boghdadly K, Albrecht E, Wolmarans M, Mariano ER, Kopp S, Perlas A, Thottungal A, Gadsden J, Tulgar S, Adhikary S, Aguirre J, Agur AMR, Altıparmak B, Barrington MJ, Bedforth N, Blanco R, Bloc S, Boretsky K, Bowness J, Breebaart M, Burckett-St Laurent D, Carvalho B, Chelly JE, Chin KJ, Chuan A, Coppens S, Costache I, Dam M, Desmet M, Dhir S, Egeler C, Elsharkawy H, Bendtsen TF, Fox B, Franco CD, Gautier PE, Grant SA, Grape S, Guheen C, Harbell MW, Hebbard P, Hernandez N, Hogg RMG, Holtz M, Ihnatsenka B, Ilfeld BM, Ip VHY, Johnson RL, Kalagara H, Kessler P, Kwofie MK, Le-Wendling L, Lirk P, Lobo C, Ludwin D, Macfarlane AJR, Makris A, McCartney C, McDonnell J, McLeod GA, Memtsoudis SG, Merjavy P, Moran EML, Nader A, Neal JM, Niazi AU, Njathi-Ori C, O'Donnell BD, Oldman M, Orebaugh SL, Parras T, Pawa A, Peng P, Porter S, Pulos BP, Sala-Blanch X, Saporito A, Sauter AR, Schwenk ES, Sebastian MP, Sidhu N, Sinha SK, Soffin EM, Stimpson J, Tang R, Tsui BCH, Turbitt L, Uppal V, van Geffen GJ, Vermeylen K, Vlassakov K, Volk T, Xu JL, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks. Reg Anesth Pain Med 2023:rapm-2023-104884. [PMID: 38050174 DOI: 10.1136/rapm-2023-104884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/13/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. METHODS We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research. CONCLUSIONS We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.
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Affiliation(s)
| | - Eric Albrecht
- Department of Anaesthesia, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Anahi Perlas
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | - Jose Aguirre
- Ambulatory Center Europaallee, City Hospital Zurich, Zurich, Switzerland
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nigel Bedforth
- Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rafael Blanco
- Anaesthesia and Intensive Care, Corniche Hospital, Abu Dhabi, UAE
| | - Sébastien Bloc
- Anesthesiology Department, Clinique Drouot Sport, Paris, France
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Boston's Children's Hospital, Boston, Massachusetts, USA
| | - James Bowness
- Department of Anesthesia, Oxford University, Oxford, UK
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Margaretha Breebaart
- Department of Health Sciences, University of Antwerp, Antwerpen, Belgium
- Anesthesia, University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Jacques E Chelly
- Anesthesiology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Ki Jinn Chin
- Duke University Medical Center, Durham, North Carolina, USA
| | - Alwin Chuan
- Liverpool Hospital, Liverpool, New South Wales, Australia
- University of New South Wales, South West Sydney, New South Wales, Australia
| | - Steve Coppens
- Anesthesiology, KU Leuven University Hospitals, Leuven, Belgium
| | - Ioana Costache
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mette Dam
- Department of Anesthesia and Intensive Care, University Hospital Hvidore, Copenhagen, Denmark
| | | | - Shalini Dhir
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | | | | | | | - Ben Fox
- Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Carlo D Franco
- Anesthesiology, John H. Stroger Jr. Hospital of Cook Country, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Stuart Alan Grant
- Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sina Grape
- Anesthesia, Hôpital du Valais, Sion, Switzerland
| | - Carrie Guheen
- Anesthesia, Hospital for Special Surgery, New York, New York, USA
| | | | - Peter Hebbard
- Department of Anesthesia Northeast Health, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary M G Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Margaret Holtz
- Anesthesia, WellStar Health System, Marietta, Georgia, USA
| | - Barys Ihnatsenka
- Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Brian M Ilfeld
- Anesthesia, University of California, La Jolla, California, USA
- Anesthesia, University of California San Diego, La Jolla, California, USA
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - M Kwesi Kwofie
- Department of Anesthesia, Perioperative Medicine and Pain Managaement, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Le-Wendling
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Philipp Lirk
- Dept. of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Clara Lobo
- Cleveland Clinic, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | | | | | - Colin McCartney
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Graeme A McLeod
- Department of Anaesthesia, NHS Tayside, Dundee, UK
- Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - E M Louise Moran
- Anaesthesia and Critical Care, Letterkenny University Hospital, Letterkenny, Ireland
| | - Antoun Nader
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Anesthesiology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Ahtsham U Niazi
- Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Catherine Njathi-Ori
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Matt Oldman
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Steven L Orebaugh
- Anesthesiology, University of Pittsburgh Medical Center-Southside, Pittsburgh, Pennsylvania, USA
| | - Teresa Parras
- Anesthesiology, Critical Care, and Pain Medicine, Hospital Quironsalud, Malaga, Spain
| | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's college London, London, UK
| | - Philip Peng
- Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Bridget P Pulos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
- Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Axel R Sauter
- Department of Anaesthesiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Eric S Schwenk
- Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Navdeep Sidhu
- Anesthesia and Perioperative Medicine, North shore Hospital, Auckland, New Zealand
| | - Sanjay Kumar Sinha
- Anesthesiology, Woodland Anesthesiology Associates, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - James Stimpson
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Raymond Tang
- Anesthesia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Lloyd Turbitt
- Department of Anesthesia, Belfast Health and Social Care trust, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | | | - Kris Vermeylen
- Anesthesia and Intensive Care, Algemeen Ziekenhuis Turnhout Campus Sint Elisabeth, Turnhout, Belgium
| | - Kamen Vlassakov
- Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Jeff L Xu
- Anesthesiology, New York Medical College, Valhalla, New York, USA
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nabil M Elkassabany
- Anesthesiology & Critical Care, University of Virginia, Charlottesville, Virginia, USA
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La Regina D, Popeskou SG, Saporito A, Gaffuri P, Tasciotti E, Dossi R, Christoforidis D, Mongelli F. Laparoscopic versus ultrasound-guided transversus abdominis plane block in colorectal surgery: a non-inferiority, multicentric randomized double-blinded clinical trial. Colorectal Dis 2023; 25:1921-1928. [PMID: 37525414 DOI: 10.1111/codi.16689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/03/2023] [Accepted: 04/25/2023] [Indexed: 08/02/2023]
Abstract
AIM The aim of this study was to assess if laparoscopic-assisted transversus abdominis plane (TAP) block (L-TAPB) is as efficient as ultrasound-guided TAP block (U-TAPB) in postoperative pain control. METHOD In all, 112 patients scheduled for elective laparoscopic colon resection from February 2018 to December 2021 at two Swiss hospitals were included and randomized in a 1:1 ratio before surgery with either L-TAPB or U-TAPB. The primary end-point was the non-inferiority of the L-TAPB compared to U-TAPB with regard to the total opioid consumption within the first 24 h after surgery. Data regarding patients' characteristics, opioid consumption, pain on the visual analogue scale, operative and anaesthesia induction time, complications and length of stay were collected and analysed. RESULTS Fifty-five patients were allocated to the L-TAPB and fifty-seven to the U-TAPB. No significant difference was found in the overall dose of opioids within 24 h, and the non-inferiority of the L-TAPB was confirmed. There were almost twice as many patients in the L-TAPB group requesting opioid reserves compared to the U-TAPB group (54.5% vs. 29.8%, P = 0.008). The anaesthesia induction time was significantly longer in the U-TAPB group (17 ± 11 min vs. 23 ± 12 min, P = 0.014). For all other variables (pain on the visual analogue scale, opioid consumption, need of epidural analgesia, operating time, postoperative complications and hospital stay) no statistically significant difference between the L-TAPB and the U-TAPB groups was noted. CONCLUSION Our results showed the non-inferiority of the laparoscopic delivery compared to ultrasound-guided administration of the TAP block, with the advantage of not affecting anaesthesia times. STUDY REGISTRATION NUMBER 2017-02017 CE 3294, ClinicalTrials.gov identifier NCT04575233.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Sotirios Georgios Popeskou
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Edoardo Tasciotti
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Roberto Dossi
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Dimitri Christoforidis
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Lugano Regional Hospital, EOC, Lugano, Switzerland
- Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Saporito A, Tassone C, Di Iorio A, Barbieri Saraceno M, Bressan A, Pini R, Mongelli F, La Regina D. Six Sigma can significantly reduce costs of poor quality of the surgical instruments sterilization process and improve surgeon and operating room personnel satisfaction. Sci Rep 2023; 13:14116. [PMID: 37644121 PMCID: PMC10465484 DOI: 10.1038/s41598-023-41393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
Operating room (OR) management is a complex multidimensional activity combining clinical and managerial aspects. This longitudinal observational study aimed to assess the impact of Six-Sigma methodology to optimize surgical instrument sterilization processes. The project was conducted at the operating theatre of our tertiary regional hospital during the period from July 2021 to December 2022. The project was based on the surgical instrument supply chain analysis. We applied the Six Sigma lean methodology by conducting workshops and practical exercises and by improving the surgical instrument process chain, as well as checking stakeholders' satisfaction. The primary outcome was the analysis of Sigma improvement. Through this supply chain passed 314,552 instruments in 2022 and 22 OR processes were regularly assessed. The initial Sigma value was 4.79 ± 1.02σ, and the final one was 5.04 ± 0.85σ (SMD 0.60, 95%CI 0.16-1.04, p = 0.010). The observed improvement was estimated in approximately $19,729 of cost savings. Regarding personnel satisfaction, 150 questionnaires were answered, and the overall score improved from 6.6 ± 2.2 pts to 7.0 ± 1.9 pts (p = 0.013). In our experience the application of the Lean Six Sigma methodology to the process of handling the surgical instruments from/to the OR was cost-effective, significantly decreased the costs of poor quality and increased internal stakeholder satisfaction.
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Affiliation(s)
- Andrea Saporito
- Department of Anesthesia, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudio Tassone
- Operating Theatre, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Antonio Di Iorio
- Operating Theatre, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | | | - Alessandro Bressan
- Hospital Direction, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland.
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
| | - Davide La Regina
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
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Balafas S, Gagliano V, Di Serio C, Guidugli GA, Saporito A, Gabutti L, Ferrari P. Differential impact of transfusion guidelines on blood transfusion practices within a health network. Sci Rep 2023; 13:6264. [PMID: 37069210 PMCID: PMC10109235 DOI: 10.1038/s41598-023-33549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023] Open
Abstract
Whether clinical practice guidelines have a significant impact on practice is unclear. The effect of guideline recommendations on clinical practice often a lags behind the date of publication. We evaluated by means of a data-driven approach if and when the guidelines on red blood cell transfusions (RBCTs) issued by Swiss Smarter Medicine in 2016 had an impact on RBCTs practice within a hospital network, where awareness of guidelines was promoted mainly among internal medicine specialties. Data on RBCTs performed in a Swiss hospital network from January 2014 to April 2021 were analyzed by hospital site and specialty to assess whether guidelines led to a decrease in inappropriate RBCTs. RBCTs were defined as "inappropriate" if patients had a hemoglobin level ≥ 70 g/L without or ≥ 80 g/L with significant cardiovascular comorbidities. Changes in the rate of inappropriate transfusions were analyzed with an advanced statistical approach that included generalized additive models. Overall prior to March 2017 there were more inappropriate than appropriate RBCTs, but after October 2017 the opposite could be observed. A change-point in the time trend was estimated from transfusion data to occur in the time interval between March and October 2017. This change was mainly driven by practice changes in the medical wards, while no significant change was observed in the critical care, surgical and oncology wards. Change in practice varied by hospital site. In conclusion, our results show that a significant change in the RBCTs practice at the hospital level occurred approximately 18 months after national guidelines were issued.
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Affiliation(s)
- Spyros Balafas
- University Centre of Statistics in the Biomedical Sciences CUSSB, UniSR, Milan, Italy
- Vita-Salute San Raffaele University, UniSR, Milan, Italy
| | - Vanessa Gagliano
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences CUSSB, UniSR, Milan, Italy
- Vita-Salute San Raffaele University, UniSR, Milan, Italy
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland
| | | | - Andrea Saporito
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland
- Division of Anesthesiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Paolo Ferrari
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland.
- Clinical School, University of New South Wales, Sydney, Australia.
- Department of Nephrology, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland.
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Ceruti S, Glotta A, Biggiogero M, Marzano M, Bona G, Previsdomini M, Saporito A, Capdevila X. Long-Term Evolution of Activities of Daily Life (ADLs) in Critically Ill COVID-19 Patients, a Case Series. Healthcare (Basel) 2023; 11:healthcare11050650. [PMID: 36900655 PMCID: PMC10001119 DOI: 10.3390/healthcare11050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill COVID-19 patients admitted to a COVID-19 center in Lugano (Switzerland). METHODS A retrospective analysis on consecutive patients discharged alive from ICU with COVID-19 ARDS was performed based on a follow-up one year after hospital discharge; ADLs were assessed through the Barthel index (BI) and the Karnofsky Performance Status (KPS) scale. The primary objective was to assess differences in ADLs at hospital discharge (acute ADLs) and one-year follow-up (chronic ADLs). The secondary objective was to explore any correlations between ADLs and multiple measures at admission and during the ICU stay. RESULTS A total of 38 consecutive patients were admitted to the ICU; a t-test analysis between acute and chronic ADLs through BI showed a significant improvement at one year post discharge (t = -5.211, p < 0.0001); similarly, every single task of BI showed the same results (p < 0.0001 for each task of BI). The mean KPS was 86.47 (SD 20.9) at hospital discharge and 99.6 at 1 year post discharge (p = 0.02). Thirteen (34%) patients deceased during the first 28 days in the ICU; no patient died after hospital discharge. CONCLUSIONS Based on BI and KPS, patients reached complete functional recovery of ADLs one year after critical COVID-19.
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Affiliation(s)
- Samuele Ceruti
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +41-079/440-73-92
| | - Andrea Glotta
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Martino Marzano
- Department of Internal Medicine, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Giovanni Bona
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Marco Previsdomini
- Department of Intensive Care Medicine, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Andrea Saporito
- Service of Anesthesiology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Xavier Capdevila
- Department of Anesthesia and Intensive Care, Centre Hospitalier Universitaire de Montpellier, 34000 Montpellier, France
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Saporito A, La Regina D, Hofmann A, Ruinelli L, Merler A, Mongelli F, Trentino KM, Ferrari P. Perioperative inappropriate red blood cell transfusions significantly increase total costs in elective surgical patients, representing an important economic burden for hospitals. Front Med (Lausanne) 2022; 9:956128. [PMID: 36111110 PMCID: PMC9468475 DOI: 10.3389/fmed.2022.956128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/12/2022] [Indexed: 01/28/2023] Open
Abstract
Background Red blood cell (RBC) transfusions in surgical patients are associated with increased morbidity a hospital stay. However, little is known about how clinical and economic outcomes differ between appropriately and inappropriately transfused patients. We hypothesized that inappropriate RBC transfusions in elective surgical patients would significantly increase hospital cost. The aim of this study was to quantify the economic burden associated with inappropriate RBC transfusions. Methods We retrospectively included all adult patients admitted for elective non-cardiac surgery between January 2014 and March 2020. Patients were divided into three groups (not transfused, appropriately transfused and inappropriately transfused). The primary outcome was the excess in hospital cost in patients inappropriately transfused compared to non-transfused patients. Costs were calculated using a bottom–up approach and involving cost calculation on a granular level. According to international guidelines, transfusions were considered appropriate if administered with an ASA score of 1–2 and the last hemoglobin level measured before transfusion < 70 g/L, or with an ASA score ≥ 3 and the last hemoglobin level < 80 g/L. Cases where RBC transfusions were deemed necessary regardless of the Hb levels were reviewed by the patient blood management (PBM) board and classified accordingly. Secondary outcomes included total transfusion rate, transfusion index, and length of hospital stay. Statistical analysis was carried out by multivariable regression models. Results During the study period there were 54,922 consecutive surgical admissions, of these 1,997 received an RBC transfusion, with 1,125 considered inappropriate. The adjusted cost of each inappropriate RBC transfusions was estimated in United States dollars (USD) 9,779 (95% CI, 9,358 – 10,199; p < 0.001) and totaled USD 11,001,410 in our series. Inappropriately transfused patients stayed 1.6 times (95% CI, 1.5–1.6; p < 0.001) longer in hospital (10.6 days vs. 6.7 days) than non-transfused patients and a mean 2.35 RBC units per patient were administered. Conclusion Inappropriate RBC transfusions in elective surgical patients seem to be common and may represent a significant economic burden. In our experience, inappropriate transfusions significantly increased hospital costs by an average of USD 9,779 compared to non-transfused patients. Through specific PBM policy, hospitals may improve cost-effectiveness of their elective surgical activity by lowering inappropriate transfusions.
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Affiliation(s)
- Andrea Saporito
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Anesthesiology, Bellinzona e Valli Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Davide La Regina
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Department of Surgery, Bellinzona e Valli Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Axel Hofmann
- Institute of Anesthesiology, University Hospital of Zurich, Zurich, Switzerland
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Lorenzo Ruinelli
- Information and Communications Technology Unit, Bellinzona e Valli Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Alessandro Merler
- Information and Communications Technology Unit, Bellinzona e Valli Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Francesco Mongelli
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Department of Surgery, Bellinzona e Valli Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- *Correspondence: Francesco Mongelli,
| | - Kevin M. Trentino
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Paolo Ferrari
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Nephrology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Clinical School, University of New South Wales, Sydney, NSW, Australia
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Ceruti S, Dell’Era S, Ruggiero F, Bona G, Glotta A, Biggiogero M, Tasciotti E, Kronenberg C, Lollo G, Saporito A. Nasogastric tube in mechanical ventilated patients: ETCO2 and pH measuring to confirm correct placement. A pilot study. PLoS One 2022; 17:e0269024. [PMID: 35653380 PMCID: PMC9162373 DOI: 10.1371/journal.pone.0269024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/05/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Nasogastric tube (NGT) placement is a procedure commonly performed in mechanically ventilated (MV) patients. Chest X-Ray is the diagnostic gold-standard to confirm its correct placement, with the downsides of requiring MV patients’ mobilization and of intrinsic actinic risk. Other potential methods to confirm NGT placement have shown lower accuracy compared to chest X-ray; end-tidal CO2 (ETCO2) and pH analysis have already been singularly investigated as an alternative to the gold standard. Aim of this study was to determine threshold values in ETCO2 and pH measurement at which correct NGT positioning can be confirmed with the highest accuracy. Materials & methods This was a prospective, multicenter, observational trial; a continuous cohort of eligible patients was allocated with site into two arms. Patients underwent general anesthesia, orotracheal intubation and MV; in the first and second group we respectively assessed the difference between tracheal and esophageal ETCO2 and between esophageal and gastric pH values. Results From November 2020 to March 2021, 85 consecutive patients were enrolled: 40 in the ETCO2group and 45 in the pH group. The ETCO2 ROC analysis for predicting NGT tracheal misplacement demonstrated an optimal ETCO2 cutoff value of 25.5 mmHg, with both sensitivity and specificity reaching 1.0 (AUC 1.0, p < 0.001). The pH ROC analysis for predicting NGT correct gastric placement resulted in an optimal pH cutoff value of 4.25, with mild diagnostic accuracy (AUC 0.79, p < 0.001). Discussion In patients receiving MV, ETCO2 and pH measurements respectively identified incorrect and correct NGT placement, allowing the identification of threshold values potentially able to improve correct NGT positioning. Trial registration NCT03934515 (www.clinicaltrials.gov).
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Affiliation(s)
- Samuele Ceruti
- Department of Critical Care, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland
- * E-mail:
| | - Simone Dell’Era
- Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland
| | - Francesco Ruggiero
- Department of Internal Medicine, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland
| | - Giovanni Bona
- Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland
| | - Andrea Glotta
- Department of Critical Care, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Ticino, Switzerland
| | - Edoardo Tasciotti
- Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland
| | - Christoph Kronenberg
- Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland
| | - Gianluca Lollo
- Department of Gastroenterology and Hepatology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland
| | - Andrea Saporito
- Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Ticino, Switzerland
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Riegger M, Müller J, Giampietro A, Saporito A, Filardo G, Treglia G, Guidi M, Candrian C. Forefoot Adduction, Hindfoot Varus or Pes Cavus: Risk Factors for Fifth Metatarsal Fractures and Jones Fractures? A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2022; 61:641-647. [PMID: 35039196 DOI: 10.1053/j.jfas.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
The origin of fractures of the fifth metatarsus and Jones fracture is not clear. The goal of this study was to investigate the evidence of anatomical deformities such as metatarsus adductus, hindfoot varus, or pes cavus as risk factors for this pathology. A literature search of records related to the review question was performed screening PubMed/Medline, Embase and Cochrane library databases (last update: May 2020) according to PRISMA guidelines. A meta-analysis was performed using the mean difference of the assessed angles (in patients with the fractures vs controls) as outcome measure to summarize literature findings about metatarsus adductus angle (MAA) indicating forefoot adduction, calcaneal pitch angle (CP) indicating hindfoot cavus and varus deformity and Talo-1st metatarsus angle/Meary's angle (T1stMA) for varus alignment. Eight studies were included in the qualitative analysis (296 patients), 5 in the quantitative synthesis (132 patients). The pooled mean difference of MAA between fracture versus control group on a per patient-based analysis was 4.62 (95% CI 1.31-7.92). Statistical heterogeneity among studies was detected (I-Square: 76.1%), likely due to different patient groups and low number of studies. The pooled mean differences of CP and T1stMA among fracture group versus controls did not show statistical significance. Despite limited literature data, metatarsus adductus deformity seems to be correlated with higher risk of proximal metatarsal fractures and Jones fracture. A significant relationship between hindfoot varus or pes cavus and these fractures was not demonstrated. Further studies and trials are warranted to shed more lights on this topic.
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Affiliation(s)
- Martin Riegger
- Department of Orthopedic and Trauma Surgery, Ospedale Regionale di Lugano EOC, Ticino, Switzerland; Ospedale S. Giovanni di Bellinzona e valli EOC, Bellinzona, Switzerland; Department of Orthopedic and Trauma Surgery, Ospedale Regionale di Lugano EOC, Ticino, Switzerland; Department of Orthopedic and Trauma Surgery, Ospedale S. Giovanni di Bellinzona e valli EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.
| | - Jochen Müller
- Department of Orthopedic and Trauma Surgery, Ospedale Regionale di Lugano EOC, Ticino, Switzerland; Department of Orthopedic and Trauma Surgery, Ospedale Regionale di Lugano EOC, Ticino, Switzerland; Department of Orthopedic and Trauma Surgery, Ospedale S. Giovanni di Bellinzona e valli EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Amelia Giampietro
- Clinica Sant'Anna, Sorengo, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Andrea Saporito
- Ospedale S. Giovanni di Bellinzona e valli EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Giuseppe Filardo
- Istituto Ortopedico Rizzoli, Università degli Studi di Bologna, Bologna, Italy; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Giorgio Treglia
- Department of Research of the EOC, Ospedale S. Giovanni di Bellinzona e valli, Bellinzona, Switzerland; Academic Education, Research and Innovation Area, General Directorate, Ente ospedaliero Cantonale (EOC), Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marco Guidi
- Department of Plastic Surgery and Hand Surgery, Universitätsspital Zürich, Zurich, Switzerland
| | - Christian Candrian
- Department of Orthopedic and Trauma Surgery, Ospedale Regionale di Lugano EOC, Ticino, Switzerland; Ospedale S. Giovanni di Bellinzona e valli EOC, Bellinzona, Switzerland; Department of Orthopedic and Trauma Surgery, Ospedale Regionale di Lugano EOC, Ticino, Switzerland; Department of Orthopedic and Trauma Surgery, Ospedale S. Giovanni di Bellinzona e valli EOC, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Amati M, Valnegri A, Bressan A, La Regina D, Tassone C, Lo Piccolo A, Mongelli F, Saporito A. Reducing Changeover Time Between Surgeries Through Lean Thinking: An Action Research Project. Front Med (Lausanne) 2022; 9:822964. [PMID: 35573003 PMCID: PMC9091348 DOI: 10.3389/fmed.2022.822964] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Maximizing the utilization of the operating room suite by safely and efficiently changing over patients is an opportunity to deliver more value to patients and be more efficient in the operating suite. Lean Thinking is a concept that focuses on the waste inadvertently generated during organization and development of an activity, which should maximize customer value while minimizing waste. It has been widely applied to increase process efficiency and foster continuous improvement in healthcare and in the operating room environment. The objective of this paper is to provide insight on how healthcare professionals can be engaged in continuous improvement by embracing Lean Thinking and ultimately reducing changeover time between surgeries. Methods Using an action research approach, Lean methodology such as Gemba walks, Process Mapping, Root-Cause-Analysis, and the Single Minute Exchange of Dies (SMED) system was applied to understand the causes of variability and wastes concerning changeovers and improve processes in the context of gynecological- and general surgery. Data were collected and analyzed through observations and video recordings. Problem and issue have been raised to management team attention and included in the annual balanced scorecard of the hospital. This initiative has been also made relevant to the team working in the operating suite and related processes before and after the entry of the patient in the operating suite. Results Improved patient flow and inter-professional collaboration through standardized and safer work enabled effective parallel processing and allowed the hospital to reduce changeover time between operations by 25% on average, without changes in terms of infrastructure, technology or resources. Conclusion Lean thinking allowed the team to re-evaluate how the whole operating suite performs as a system, by starting from a sub-process as changeover. It is fundamental in order to improve further and obtain sustainable results over time, to act on a system level by defining a common goal between all stakeholders supported by a management and leading system such as visual/weekly management, optimizing planning, implementing standard-works to be followed by every associate and guaranteeing the role of the surgeon as process driver who pull performances.
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Affiliation(s)
- Mirjam Amati
- Information and Process Management/Supportive Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Alan Valnegri
- Information and Process Management/Supportive Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Alessandro Bressan
- Hospital Direction, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, University of Lugano, Lugano, Switzerland
| | - Claudio Tassone
- Operating Theatre, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Antonio Lo Piccolo
- Operating Theatre, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- *Correspondence: Francesco Mongelli, ; orcid.org/0000-0002-8824-651X
| | - Andrea Saporito
- Faculty of Biomedical Sciences, University of Lugano, Lugano, Switzerland
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
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Musiari M, Saporito A, Ceruti S, Biggiogero M, Iattoni M, Glotta A, Cantini L, Capdevila X, Cassina T. Can a Glove-Coach Technology Significantly Increase the Efficacy of Cardiopulmonary Resuscitation on Non-healthcare Professionals? A Controlled Trial. Front Cardiovasc Med 2021; 8:685988. [PMID: 34957226 PMCID: PMC8695546 DOI: 10.3389/fcvm.2021.685988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cardiovascular accidents are the world's leading cause of death. A good quality cardiopulmonary resuscitation (CPR) can reduce cardiac arrest-associated mortality. This study aims to test the coaching system of a wearable glove, providing instructions during out-of-hospital CPR. Materials and Methods: We performed a single-blind, controlled trial to test non-healthcare professionals during a simulated CPR performed on an electronic mannequin. The no-glove group was the control. The primary outcome was to compare the accuracy of depth and frequency of two simulated CPR sessions. Secondary outcomes were to compare the decay of CPR performance and the percentage of the duration of accurate CPR. Results: About 130 volunteers were allocated to 1:1 ratio in both groups; mean age was 36 ± 15 years (min-max 21-64) and 62 (48%) were men; 600 chest compressions were performed, and 571 chest compressions were analyzed. The mean frequency in the glove group was 117.67 vs. 103.02 rpm in the control group (p < 0.001). The appropriate rate cycle was 92.4% in the glove group vs. 71% in the control group, with a difference of 21.4% (p < 0.001). Mean compression depth in the glove group was 52.11 vs. 55.17 mm in the control group (p < 0.001). A mean reduction of compression depth over time of 5.3 mm/min was observed in the control group vs. 0.83 mm/min of reduction in the glove group. Conclusion: Visual and acoustic feedbacks provided through the utilization of the glove's coaching system were useful for non-healthcare professionals' CPR performance.
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Affiliation(s)
- Michele Musiari
- Department of Anaesthesiology, Fribourg Cantonal Hospital (HFR), Villars-sur-Glâne, Switzerland.,University Clinic for Anesthesiology and Pain Therapy Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Saporito
- Department of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Samuele Ceruti
- Department of Intensive Care Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Martina Iattoni
- Department of Internal Medicine, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Andrea Glotta
- Department of Intensive Care Unit, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Laura Cantini
- Department of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Xavier Capdevila
- Montpellier University Hospital, Department of Anaesthesia and Intensive Care, Montpellier, France
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Ceruti S, Glotta A, Biggiogero M, Bona G, Saporito A, Faldarini N, Olivieri D, Molteni C, Petazzi S, Capdevila X. Multidisciplinary team approach in critically ill COVID-19 patients reduced pronation-related complications rate: A retrospective cohort study. Ann Med Surg (Lond) 2021; 70:102836. [PMID: 34518782 PMCID: PMC8427910 DOI: 10.1016/j.amsu.2021.102836] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
Background In the pandemic scenario, critically ill COVID-19 patients' management presented an increased workload for Intensive Care Unit (ICU) nursing staff, particularly during pronation maneuvers, with high risk of complications. In this contest, some authors described an increase in complications incidence after pronation. An ICU Pronation Team (IPT) was implemented to support this maneuver. Material and methods Retrospective analysis was conducted on consecutive critically ill COVID-19 patients in COVID-19 Center in southern Switzerland, between March and April 2020. Aim of the study was to determine rates and characteristics of pronation-related complications managed by IPT according to standard protocols. Results Forty-two patients undergoing mechanical ventilation (MV) were enrolled; 296 prone/supine positioning were performed, with 3.52 cycles/patient. All patients were equipped with arterial line, central venous catheter, urinary catheter, 28 (66%) endotracheal tube, 8 (19%), tracheostomy, 6 (14%) dialysis catheter, 3 (7%) abdominal drainage and 8 (19%) femoral thermodilution catheter; mean BMI was 28.3 kg/m2. One (0.3%) major complication was observed, while fourteen (33.3%) patients developed minor complications (pressure injuries). ICU length-of-stay and MV days correlated with both incidence (p = 0.029 and p = 0.015 respectively) and number (p = 0.001 and p = 0.001 respectively) of pressure sores (n = 27). Propensity matching score analysis did not show any protective factor of pronation regarding pressure injuries (p = 0.448). No other significant correlation was found. Conclusion Multidisciplinary healthcare professional management can reduce most severe complication related to pronation in critical care setting. Rather than from pronation, the persistent high rate of minor complications appeared to be related to disease severity.
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Affiliation(s)
- Samuele Ceruti
- Clinica Luganese Moncucco, Critical Care Department, Lugano, Switzerland
| | - Andrea Glotta
- Clinica Luganese Moncucco, Critical Care Department, Lugano, Switzerland
| | - Maira Biggiogero
- Clinica Luganese Moncucco, Clinical Research Unit, Lugano, Switzerland
| | - Giovanni Bona
- Clinica Luganese Moncucco, Clinical Research Unit, Lugano, Switzerland
| | - Andrea Saporito
- Ente Ospedaliero Cantonale, Bellinzona Regional Hospital, Service of Anaesthesia, Switzerland
| | - Nicola Faldarini
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Diana Olivieri
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Claudia Molteni
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Stefano Petazzi
- Clinica Luganese Moncucco, Physiotherapy Service, Lugano, Switzerland
| | - Xavier Capdevila
- Centre Hospitalier Universitaire de Montpellier, Department of Anesthesia and Intensive Care, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
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El-Boghdadly K, Wolmarans M, Stengel AD, Albrecht E, Chin KJ, Elsharkawy H, Kopp S, Mariano ER, Xu JL, Adhikary S, Altıparmak B, Barrington MJ, Bloc S, Blanco R, Boretsky K, Børglum J, Breebaart M, Burckett-St Laurent D, Capdevila X, Carvalho B, Chuan A, Coppens S, Costache I, Dam M, Egeler C, Fajardo M, Gadsden J, Gautier PE, Grant SA, Hadzic A, Hebbard P, Hernandez N, Hogg R, Holtz M, Johnson RL, Karmakar MK, Kessler P, Kwofie K, Lobo C, Ludwin D, MacFarlane A, McDonnell J, McLeod G, Merjavy P, Moran E, O'Donnell BD, Parras T, Pawa A, Perlas A, Rojas Gomez MF, Sala-Blanch X, Saporito A, Sinha SK, Soffin EM, Thottungal A, Tsui BCH, Tulgar S, Turbitt L, Uppal V, van Geffen GJ, Volk T, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med 2021; 46:571-580. [PMID: 34145070 DOI: 10.1136/rapm-2020-102451] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. METHODS We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement. RESULTS Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified. CONCLUSIONS Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.
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Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
| | - Angela D Stengel
- American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric Albrecht
- Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Ki Jinn Chin
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Hesham Elsharkawy
- Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeff L Xu
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | | | | | - Sébastien Bloc
- Anesthesiology Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France.,Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France
| | - Rafael Blanco
- Anaesthesia and Intensive Care, King's College Hospital Dubai, Abu Dhabi, UAE
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts, USA
| | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | | | | | - Xavier Capdevila
- Anesthesiology and Critical Care department, Hôpital Lapeyronie, Montpellier, Languedoc-Roussillon, France
| | | | - Alwin Chuan
- University of New South Wales Faculty of Medicine, Putney, New South Wales, Australia
| | | | - Ioana Costache
- Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mette Dam
- Anaesthesiology, Zealand University Hospital Koge, Koge, Sjælland, Denmark
| | | | - Mario Fajardo
- Anesthesiology, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Stuart Alan Grant
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium.,NYSORA, New York, New York, USA
| | - Peter Hebbard
- Department of Anesthesia Northeast Health Wangaratta, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre - Wangaratta, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Kwesi Kwofie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Clara Lobo
- Anestesiologia, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | | | - Alan MacFarlane
- Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | | | - Eml Moran
- Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Brian D O'Donnell
- Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | | | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK.,Regional Anaesthesia - UK, London, UK
| | - Anahi Perlas
- Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Sanjay Kumar Sinha
- Anesthesiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Serkan Tulgar
- Anesthesiology and reanimatiom, Maltepe Universitesi Tip Fakultesi, Maltepe, Turkey
| | - Lloyd Turbitt
- Royal Victoria Hospital Laboratory and Mortuary Services, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | - Geert J van Geffen
- Anesthesiology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany.,Saarland University, Saarbrucken, Saarland, Germany
| | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Mongelli F, Lucchelli M, La Regina D, Christoforidis D, Saporito A, Vannelli A, Di Giuseppe M. Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial. Clinicoecon Outcomes Res 2021; 13:299-306. [PMID: 33953578 PMCID: PMC8088981 DOI: 10.2147/ceor.s306138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Background Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy. Methods From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed. Results Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of −243 ± 881 EUR/pain unit on the VAS. Conclusion Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.
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Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Massimo Lucchelli
- Financial Department, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Andrea Saporito
- Department of Anesthesia, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | | | - Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
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17
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Saporito A, La Regina D, Perren A, Gabutti L, Anselmi L, Cafarotti S, Mongelli F. Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis. Braz J Anesthesiol 2021; 73:243-249. [PMID: 33930345 DOI: 10.1016/j.bjane.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/01/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. METHODS For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. RESULTS Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random "first come-first serve" basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). CONCLUSION Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.
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Affiliation(s)
- Andrea Saporito
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Davide La Regina
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Andreas Perren
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Luca Gabutti
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Luciano Anselmi
- Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
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18
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Aguirre J, Bonvini JM, Rupnik B, Camponovo C, Saporito A, Borgeat A. Inflammation reduces osteoblast cytotoxicity induced by diclofenac: An in vitro study. Eur J Anaesthesiol 2021; 38:S24-S32. [PMID: 33122572 DOI: 10.1097/eja.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diclofenac and other NSAIDs are routinely used in the postoperative period. Their effect on fracture healing remains unclear and controversial. OBJECTIVE The primary outcome was to assess the potential cytotoxicity of clinically relevant concentrations of diclofenac on human osteoblasts. DESIGN Laboratory in vitro study. SETTING Institute of Physiology, Zurich, Center for Integrative Human Physiology, University of Zurich. MATERIALS Monolayers of human osteoblasts. INTERVENTIONS Exposure of human osteoblast monolayers to several concentrations of diclofenac, for different periods of time, with and without an artificially induced inflammatory process. MAIN OUTCOME MEASURES Cell count, cell viability, cell proliferation and apoptosis. RESULTS A concentration-mediated, time and exposure dependent cytotoxic effect of diclofenac-mediated apoptosis was observed. Stimulated inflammatory conditions seemed to reduce toxic effects. CONCLUSION Cytotoxic effects of diclofenac are exposure, time and concentration dependent. Simulating aspects of inflammatory conditions seems to increase resistance to diclofenac cytotoxicity, especially in the presence of higher concentration and longer exposure time.
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Affiliation(s)
- José Aguirre
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital Zurich, Zurich (JA, JMB, BR, AB), Department of Anaesthesiology, Clinica Ars Medica, Gravesano (CC), Department of Anaesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland (AS) and Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA (AB)
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19
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Saporito A, Quadri C, Steinfeldt T, Wiesmann T, Cantini LM, Capdevila X. Early detection of intraneural and intravascular injections with real-time injection pressure monitoring in cadavers. Acta Anaesthesiol Scand 2020; 64:1513-1518. [PMID: 33439487 DOI: 10.1111/aas.13681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Injection pressure monitoring can help detecting the needle tip position and avoid intraneural injection. However, it shall be measured at the needle tip in order to be accurate and reproducible with any injection system and non operator-dependent. With an innovative system monitoring the injection pressure right at the needle tip we show that it is possible to early detect an intraneural and also an intravascular injection. METHODS We performed supraclavicular block-like procedures under real-time ultrasound guidance on two fresh cadaver torsos using a sensing needle with an optical fiber pressure sensor within the shaft continuously measuring injection pressure at the needle tip. A total of 45 ultrasound-guided injections were performed (15 perineural, 15 intraneural and 15 intravenous injections). RESULTS Mean (SD) injection pressure after only 1 mL injected volume was already significantly higher for the intraneural compared to the perineural injections: 70.46 kPa (11.72) vs 8.34 (4.68) kPa; P < .001. Mean (SD) injection pressure at 1 mL injected volume was significantly lower for the intravascular compared to the perineural injections: 1.51 (0.48) vs 8.34 (4.68) kPa; P < .001. CONCLUSIONS Our results show that injection pressure monitoring at the needle tip has the potential to help identifying an accidental intraneural or intravascular injection at a very early stage.
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Affiliation(s)
- Andrea Saporito
- Department of Anesthesia Bellinzona Regional Hospital Bellinzona Switzerland
| | - Christian Quadri
- Department of Anesthesia Lugano Regional Hospital Lugano Switzerland
| | - Thorsten Steinfeldt
- Department of Anesthesia and Intensive CareDiakonie‐Klinikum Schwäbisch Hall gGmbH Schwäbisch Hall Germany
| | - Thomas Wiesmann
- Department of Anesthesia and Intensive Care Philipps‐University Hospital Marburg Germany
| | - Laura Micòl Cantini
- Department of Anesthesia Bellinzona Regional Hospital Bellinzona Switzerland
| | - Xavier Capdevila
- Department of Anesthesia and Intensive Care Montpellier University Hospital University Montpellier Montpellier France
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20
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Capdevila M, Choquet O, Saporito A, Djanikian F, Swisser F, Marques M, Bringuier S, Capdevila X. Injection pressure monitoring during peripheral nerve blocks: from bench to operating theatre. Anaesth Crit Care Pain Med 2020; 39:603-610. [DOI: 10.1016/j.accpm.2020.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/05/2020] [Accepted: 03/18/2020] [Indexed: 10/23/2022]
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21
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Minotti B, Treglia G, Pascale M, Ceruti S, Cantini L, Anselmi L, Saporito A. Prevalence of microhematuria in renal colic and urolithiasis: a systematic review and meta-analysis. BMC Urol 2020; 20:119. [PMID: 32770985 PMCID: PMC7414650 DOI: 10.1186/s12894-020-00690-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/29/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to investigate the prevalence of microhematuria in patients presenting with suspected acute renal colic and/or confirmed urolithiasis at the emergency department. METHODS A comprehensive literature search was conducted to find relevant data on prevalence of microhematuria in patients with suspected acute renal colic and/or confirmed urolithiasis. Data from each study regarding study design, patient characteristics and prevalence of microhematuria were retrieved. A random effect-model was used for the pooled analyses. RESULTS Forty-nine articles including 15'860 patients were selected through the literature search. The pooled microhematuria prevalence was 77% (95%CI: 73-80%) and 84% (95%CI: 80-87%) for suspected acute renal colic and confirmed urolithiasis, respectively. This proportion was much higher when the dipstick was used as diagnostic test (80 and 90% for acute renal colic and urolithiasis, respectively) compared to the microscopic urinalysis (74 and 78% for acute renal colic and urolithiasis, respectively). CONCLUSIONS This meta-analysis revealed a high prevalence of microhematuria in patients with acute renal colic (77%), including those with confirmed urolithiasis (84%). Intending this prevalence as sensitivity, we reached moderate values, which make microhematuria alone a poor diagnostic test for acute renal colic or urolithiasis. Microhematuria could possibly still important to assess the risk in patients with renal colic.
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Affiliation(s)
- Bruno Minotti
- Emergency Department, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
| | - Giorgio Treglia
- Heath Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Mariarosa Pascale
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Samuele Ceruti
- Department of Intensive Care Medicine, Clinica Luganese, Lugano, Switzerland
| | - Laura Cantini
- Department of Anesthesia, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Luciano Anselmi
- Department of Anesthesia, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Ospedale San Giovanni, Bellinzona, Switzerland
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22
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Capdevila M, Saporito A, Quadri C, Dick M, Cantini LM, Bringuier S, Capdevila X. Real-time continuous monitoring of injection pressure during peripheral nerve blocks in fresh cadavers. Anaesth Crit Care Pain Med 2020; 39:597-601. [PMID: 32771496 DOI: 10.1016/j.accpm.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/21/2020] [Accepted: 03/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of unintentional intraneural injection while performing peripheral nerve block has been estimated to be 15% under real-time ultrasound guidance. Injection pressure increase may detect an intraneural injection. Real-time injection pressure changes throughout an entire nerve block procedure in relationship with needle tip location have never been reported. METHODS A new method was developed to precisely monitor the injection pressure curve during nerve blocks, based on a miniaturised Fabbri-Perrot pressure sensor. We tested in three fresh cadavers the ability of continuous pressure monitoring to discriminate between different tissues, as the injection pressure curve ascending slope, shape and plateau pressure value depend on tissue compliance. Injections of saline were performed by an electronic syringe pump with three different constant flow rates. Pressure was measured simultaneously at the tip and in the tubing of the needle. RESULTS At 10 mL/min injection flow, median peak injection pressure in the intraneural group at the needle tip was 315 mmHg, while at the perineural location it was 100 mmHg (p < 0.05). Median injection pressure was 95 mmHg in the intramuscular locations group, and 819 mmHg when a muscular fascia was indented (p < 0.05). A significant difference was noted for pressure measurements between the proximal port of the needle and the tip, 625 and 417 respectively. CONCLUSIONS Based on significant differences in injection pressure values and curve shapes, the system was able to discriminate between four needle tip locations. This may help with needle tracking while performing a peripheral nerve block.
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Affiliation(s)
- Mathieu Capdevila
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France
| | - Andrea Saporito
- Southern Switzerland Cantonal Hospital Trust (EOC), 6500 Bellinzona, Switzerland
| | - Christian Quadri
- Southern Switzerland Cantonal Hospital Trust (EOC), 6500 Bellinzona, Switzerland
| | - Maxime Dick
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France
| | - Laura M Cantini
- Southern Switzerland Cantonal Hospital Trust (EOC), 6500 Bellinzona, Switzerland.
| | - Sophie Bringuier
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France; Department of Medical Biostatistics, Arnaud de Villeneuve University Hospital, 34295 Montpellier Cedex 5, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France; Inserm Unit 1051 Montpellier NeuroSciences Institute, Montpellier University, 34295 Montpellier Cedex 5, France
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23
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Patella M, Mongelli F, Minerva EM, Previsdomini M, Perren A, Saporito A, La Regina D, Gavino L, Inderbitzi R, Cafarotti S. Effect of postoperative haemoglobin variation on major cardiopulmonary complications in high cardiac risk patients undergoing anatomical lung resections. Interact Cardiovasc Thorac Surg 2019; 29:883-889. [PMID: 31408170 DOI: 10.1093/icvts/ivz199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Recent evidence shows that permissive anaemia strategies are safe in different surgical settings. However, effects of variations in haemoglobin (Hb) levels could have a negative impact in high-risk patients. We investigated the combined effect of postoperative Hb concentration and cardiac risk status on major cardiopulmonary complications after anatomical lung resections. METHODS We retrospectively analysed the records, collected in a prospective clinical database, of 154 consecutive patients undergoing anatomical lung resections at our institution (February 2017-February 2019). Hb levels were displayed as preoperative concentration, nadir Hb level before onset of complications and delta Hb (ΔHb). Cardiac risk was stratified according to the Thoracic Revised Cardiac Risk Index (ThRCRI). Univariable and multivariable logistic regression analyses were used to test the associations between patients, surgical variables and cardiopulmonary complications according to the European Society of Thoracic Surgeons definitions. RESULTS Cardiopulmonary complications occurred in 63 patients (17%). In the fully adjusted multivariable model, higher values of ΔHb were associated with increased risk of complications [odds ratio (OR) 1.07; P < 0.001], along with higher ThRCRI classes (classes A-B versus C-D: OR 0.09; P < 0.001). Interaction terms with transfusion were not statistically significant, indicating that the harmful effect of ΔHb was independent. According to receiver operating characteristic curve analysis, a ΔHb of 29 g/l was found to be the best cut-off value for predicting complications. CONCLUSIONS In our series, ΔHb, rather than nadir Hb, was associated with an increased risk of complications, particularly in patients with higher cardiac risk. Restrictive transfusion strategies should be carefully applied in patients undergoing lung resections and balanced according to individual clinical status.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | | | - Marco Previsdomini
- Department of Intensive Medicine, San Giovanni Hospital, Bellinzona, Switzerland
| | - Andreas Perren
- Department of Intensive Medicine, San Giovanni Hospital, Bellinzona, Switzerland
| | - Andrea Saporito
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Davide La Regina
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Lorenzo Gavino
- Department of Intensive Medicine, San Giovanni Hospital, Bellinzona, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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La Regina D, Mongelli F, Fasoli A, Lollo G, Ceppi M, Saporito A, Garofalo F, Di Giuseppe M, Ferrario di Tor Vajana A. Clinical Adverse Events after Endoscopic Resection for Colorectal Lesions: A Meta-Analysis on the Antibiotic Prophylaxis. Dig Dis 2019; 38:15-22. [PMID: 31408875 DOI: 10.1159/000502055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Post-polypectomy coagulation syndrome (PECS) is a well-known adverse event after endoscopic polypectomy for colorectal lesions. To date, there are no standardized guidelines for the antimicrobial prophylaxis. The aim of this meta-analysis is to evaluate the usefulness of antibiotics in patients undergoing endoscopic mucosal or submucosal resections. METHODS A comprehensive literature search of PubMed, MEDLINE, EMBASE, and Web of Science databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies investigating the role of prophylactic antibiotic administration in reducing the PECS after endoscopic polypectomy were considered. The terms used to search were ("antimicrobial"OR"antibiotics"OR"prophylaxis"OR"prophylactic") AND ("resection"OR"polypectomy"OR"dissection") AND ("endoscopic"OR"mucosal"OR"submucosal") AND ("colon"OR"colorectal"OR"colonic"OR"rectum"). Data of included studies were collected and analysed. RESULTS The literature search revealed 262 articles, 3 of whom were randomized trials and one was a retrospective study. Patients included were 850 (548 treated with antibiotics and 302 received no treatment). The overall incidence rate was 2.4 and 19.9% in treatment and control groups, respectively. The pooled analysis showed a reduction of 83% of postoperative events in the antibiotics group (relative risk 0.181; 95% CI 0.100-0.326, p < 0.001). CONCLUSIONS In our meta-analysis, the antibiotic prophylaxis showed a positive effect in reducing the incidence of postoperative adverse events other than perforation and bleeding in patients treated with endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions. Despite the low-level of evidence of this meta-analysis, the antibiotic prophylaxis should be taken into account. Further multicenter, large-sample, randomized controlled studies are needed to confirm our results and to evaluate whether specific subgroups of patients could actually benefit from an antibiotic prophylaxis.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland,
| | - Alberto Fasoli
- Department of Gastroenterology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Gianluca Lollo
- Department of Gastroenterology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marcello Ceppi
- Unit of Clinical Epidemiology, Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Saporito
- Perioperative Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
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Saporito A, Quadri C, Kloth N, Capdevila X. Injection line pressure – inaccurate but still useful? A reply. Anaesthesia 2019; 74:681. [DOI: 10.1111/anae.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Saporito
- Bellinzona Regional Hospital Bellinzona Switzerland
| | - C. Quadri
- Lugano Regional Hospital Lugano Switzerland
| | - N. Kloth
- See‐Spital Horgenand Kilchberg Horgen Switzerland
| | - X. Capdevila
- Montpellier University Hospital University Montpellier France
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Saporito A, Aguirre J, Borgeat A, Perren A, Anselmi L, Poggi R, Minotti B, Cafarotti S, La Regina D, Ceruti S. Persistent postdischarge pain and chronic postoperative pain after breast cancer surgery under general anesthesia and single-shot paravertebral block: incidence, characteristics and impact on quality of life and healthcare costs. J Pain Res 2019; 12:1193-1199. [PMID: 31114301 PMCID: PMC6489588 DOI: 10.2147/jpr.s195702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction: Breast surgery is associated with persistent postsurgical pain; usually related to poorly treated acute pain. Paravertebral block has been successfully employed in analgesic protocols for breast surgery; its impact on postdischarge pain (PDP) has not been investigated. The aim of this study was to assess characteristics of PDP after breast surgery, the development of chronic postoperative pain (CPP) and its impact on health care costs. Methods: We conducted a retrospective, observational study on a continuous cohort of adult female patients undergoing local breast cancer surgery under combined anesthesia. All patients were interviewed 6 months after hospital discharge. The survey was specifically conceived to assess incidence, features and duration of PDP. The overall cost of additional healthcare resources consumed with a specific relationship to persistent PDP was estimated. Results: A database of 244 patients was preliminarily analyzed. Of these, 188 were included in the following statistical analysis; 123 patients (65.2%) reported significant PDP, with a median intensity on NRS of 6 (IQR=2), more frequently described as burning and associated with paresthesia and/or hyperalgesia (87 patients, 46%). One hundred and six patients (56.5%) reported this pain as interfering with their normal daily activities, work and sleep. In 26.8% of cases (50 patients) symptoms lasted more than 1 month and in 28 patients (15.0%) pain became chronic. The majority of patients self-treated their pain with non-steroideal anti-inflammatory drugs, but in 50 patients (26.8%) this therapy was reported as ineffective. This additional consumption of healthcare resources led to a significant economical impact. Conclusion: PDP and CPP seem to be common complications after breast cancer surgery, even if a combined anesthesia technique with a thoracic paravertebral block is performed, leading to severe consequences on patients’ quality of life and increasing consumption of healthcare resources after discharge. Trial number: NCT03618459 (www.clinicaltrials.gov).
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Affiliation(s)
- Andrea Saporito
- Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - José Aguirre
- Department of Anesthesiology, Balgrist University Hospital, Zürich, Switzerland
| | - Alain Borgeat
- Department of Anesthesiology, Balgrist University Hospital, Zürich, Switzerland
| | - Andreas Perren
- Department of Intensive Care, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Luciano Anselmi
- Service of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Roberto Poggi
- Service of Anesthesiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Bruno Minotti
- Department of Emergency Medicine, St Gallen General Hospital, St Gallen, Switzerland
| | - Stefano Cafarotti
- Service of Thoracic Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Davide La Regina
- Service of Visceral Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Samuele Ceruti
- Department of Intensive Care, Geneva University Hospital (HUG), Geneva, Switzerland
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Saporito A, Quadri C, Capdevila X. Real-time continuous injection pressure monitoring during regional anaesthesia administration. Anaesthesia 2019; 74:404. [PMID: 30734947 DOI: 10.1111/anae.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Saporito
- Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - C Quadri
- Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - X Capdevila
- Bellinzona Regional Hospital, Bellinzona, Switzerland
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Saporito A, Ceppi M, Perren A, La Regina D, Cafarotti S, Borgeat A, Aguirre J, Van De Velde M, Teunkens A. Does spinal chloroprocaine pharmacokinetic profile actually translate into a clinical advantage in terms of clinical outcomes when compared to low-dose spinal bupivacaine? A systematic review and meta-analysis. J Clin Anesth 2019; 52:99-104. [DOI: 10.1016/j.jclinane.2018.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/15/2018] [Accepted: 09/08/2018] [Indexed: 10/28/2022]
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La Regina D, Gaffuri P, Ceppi M, Saporito A, Ferrari M, Di Giuseppe M, Mongelli F. Safety, feasibility and clinical outcome of minimally invasive inguinal hernia repair in patients with previous radical prostatectomy: A systematic review of the literature. J Minim Access Surg 2019; 15:281-286. [PMID: 30416142 PMCID: PMC6839359 DOI: 10.4103/jmas.jmas_218_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related preperitoneal fibrotic reaction can make the laparoendoscopic repair of the IH technically difficult, even if safety and feasibility have not been extensively evaluated yet. We conducted a systematic review of the available literature. Methods: A comprehensive computer literature search of PubMed and MEDLINE databases was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Terms used to search were (‘laparoscopic’ OR ‘laparoscopy’) AND (‘inguinal’ OR ‘groin’ OR ‘hernia’) AND ‘prostatectomy’. Results: The literature search from PubMed and MEDLINE databases revealed 156 articles. Five articles were considered eligible for the analysis, including 229 patients who underwent 277 hernia repairs. The pooled analysis indicates no statistically significant difference of post-operative complications (Risk Ratios [RR] 2.06; 95% confidence interval [CI] 0.85–4.97), conversion to open surgery (RR 3.91; 95% CI 0.85–18.04) and recurrence of hernia (RR 1.39; 95% CI 0.39–4.93) between the post-prostatectomy group and the control group. There was a statistically significant difference of minor intraoperative complications (RR 4.42; CI 1.05–18.64), due to an injury of the inferior epigastric vessels. Conclusions: Our systematic review suggests that, in experienced hands, safety, feasibility and clinical outcomes of minimally invasive repair of IH in patients previously treated with prostatectomy, are comparable to those patients without previous RP.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Marcello Ceppi
- Department of Clinical Epidemiology, Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Saporito
- Department of Anaesthesiology, San Giovanni Hospital, Bellinzona, Switzerland
| | - Matteo Ferrari
- Department of Urology, San Giovanni Hospital, Bellinzona, Switzerland
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La Regina D, Mongelli F, Cafarotti S, Saporito A, Ceppi M, Di Giuseppe M, Ferrario di Tor Vajana A. Use of retrieval bag in the prevention of wound infection in elective laparoscopic cholecystectomy: is it evidence-based? A meta-analysis. BMC Surg 2018; 18:102. [PMID: 30453917 PMCID: PMC6245513 DOI: 10.1186/s12893-018-0442-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/08/2018] [Indexed: 01/29/2023] Open
Abstract
Background Surgical site infections complicate elective laparoscopic cholecystectomies in 2,4-3,2% of cases. During the operation the gallbladder is commonly extracted with a retrieval bag. We conducted a meta-analysis to clarify whether its use plays a role in preventing infections. Methods Inclusion criteria: elective cholecystectomy, details about the gallbladder extraction and data about local or systemic infection rate. Exclusion criteria: cholecystitis, jaundice, concurrent antibiotic therapy, immunosuppression, cancer. A comprehensive literature search of PubMed, Cochrane Library and MEDLINE databases was carried out independently by two researchers, according to the PRISMA guidelines and applying the GRADE approach. Terms used were (“gallbladder”AND(“speciment”OR“extraction”OR“extract”))OR(“gallbladder”OR“cholecystectomy”)AND(“bag”OR“retrieval|”OR|“endobag”OR“endocatch”). Results The comprehensive literature revealed 279 articles. The eligible studies were 2 randomized trials and a multicentre prospective study. Wound infections were documented in 14 on 334 (4,2%) patients operated using a retrieval bag versus 16 on 271 (5,9%) patients operated without the use of a retrieval bag. The statistical analysis revealed a risk ratio (RR) of 0.82 (0.41–1.63 95% CI). Concerning sensitivity analysis the estimated pooled RR ranged from 0.72 to 0.96, both not statistically significant. Harbord test did not reveal the occurrence of small-study effect (p = 0.892) and the funnel-plot showed no noteworthy pattern. Conclusions The results of this review highlight the paucity of well-designed large studies and despite limitations related to the low level of evidence, our meta-analysis showed no significant benefit of retrieval bags in reducing the infection rate after elective laparoscopic cholecystectomy. In absence of acute cholecystitis, accidental intraoperative gallbladder perforation or suspected carcinoma their use, to date, may not be mandatory, so that, further studies focusing on complex cases are needed. Electronic supplementary material The online version of this article (10.1186/s12893-018-0442-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
| | - Stefano Cafarotti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anaesthesiology, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Marcello Ceppi
- Unit of Clinical Epidemiology, IRCCS - Ospedale San Martino, Genoa, Italy
| | - Matteo Di Giuseppe
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
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Saporito A, Quadri C, Capdevila X. The ability of a real-time injection pressure monitoring system to discriminate between perineural and intraneural injection of the sciatic nerve in fresh cadavers. Anaesthesia 2018; 73:1118-1122. [DOI: 10.1111/anae.14330] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A. Saporito
- Bellinzona Regional Hospital; Bellinzona Switzerland
| | - C. Quadri
- Service of Anaesthesia; Lugano Regional Hospital; Lugano Switzerland
| | - X. Capdevila
- Montpellier University Hospital; University Montpellier; France
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Patella M, Saporito A, Mongelli F, Inderbitzi R, Cafarotti S. Reply. Ann Thorac Surg 2018; 106:937-938. [PMID: 30139502 DOI: 10.1016/j.athoracsur.2018.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Via Ospedale, 6500 Bellinzona, Switzerland.
| | - Andrea Saporito
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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Saporito A, Quadri C, Kloth N, Capdevila X. The effect of rate of injection on injection pressure profiles measured using in-line and needle-tip sensors: an in-vitro study. Anaesthesia 2018; 74:64-68. [DOI: 10.1111/anae.14415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- A. Saporito
- Bellinzona Regional Hospital; Bellinzona Switzerland
| | - C. Quadri
- Service of Anaesthesia; Lugano Regional Hospital; Lugano Switzerland
| | - N. Kloth
- See-Spital Horgen and Kilchberg; Switzerland
| | - X. Capdevila
- Montpellier University Hospital; University Montpellier; France
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Patella M, Saporito A, Mongelli F, Pini R, Inderbitzi R, Cafarotti S. Management of residual pleural space after lung resection: fully controllable paralysis of the diaphragm through continuous phrenic nerve block. J Thorac Dis 2018; 10:4883-4890. [PMID: 30233862 DOI: 10.21037/jtd.2018.07.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Residual pleural space after lung resection associated with air leak is a challenging issue, potentially causing serious complications. We report a new, postoperative technique to reduce the pleural space, inducing a controlled and reversible paralysis of the diaphragm. Methods Ten patients were enrolled (7 lobectomies, 2 bilobectomy, 1 wedge resection). Inclusion criteria were: digitally detected air flow >200 mL/min at post-op day 3, presence of empty pleural space at chest x-ray, absence of restrictive lung disease, absence of known arrhythmias. A 22G nerve-block catheter was place under ultrasound guidance in proximity to the phrenic nerve, between the sternocleidomastoid muscle and the anterior scalene muscle at the level of 6th cervical vertebra. Continuous infusion of ropivacaine 0.2% 3 mL/h was started. Fluoroscopy was used to confirm significant reduction in hemidiaphragm movements. Monitoring of vital signs and intense respiratory physiotherapy were enhanced. The infusion was stopped at air leak cessation and the catheter was removed along with the chest drain. Results No peri- and post-procedural complications occurred. In all patients, we observed an immediate reduction of the empty pleural space and resolution of the air leak within few days (3±1.16 days). After suspension of local anaesthetic, complete restoration of the hemidiaphragm function has been documented. Conclusions This is an effective and minimally invasive method to reduce the residual pleural space after lung resections. Narrowing of the pleural space facilitates the contact between the lung and the chest wall promoting the resolution of the air leak. Diaphragm paralysis is controlled and temporary with no residual disabilities.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Andrea Saporito
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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Mongelli F, Regina DL, Marengo M, Pini R, Saporito A, FitzGerald M, Giuseppe MD. Development of a model for laparoscopic cholecystectomy video assisted training. A randomized study. Acta Cir Bras 2018; 33:551-555. [PMID: 30020317 DOI: 10.1590/s0102-865020180060000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/14/2018] [Indexed: 08/30/2023] Open
Abstract
PURPOSE To identify the surgical trainee benefits through the use of video assisted training (VAT). METHODS Twelve cases of uncomplicated laparoscopic cholecystectomy (LC) were selected. Edited video segments focused on essential intra-operative anatomical structure identification and critical surgical steps. Evaluation of these videos was constructed on a scoring system based on pre and post-teach tests. RESULTS The mean value of the pre-teach score was 33.2 ± 18.0 points and in the post-teach test the mean value was 66.7 ± 9.7 points. A statistically significant difference was seen when comparing pre and post-teach results (p<.00001). CONCLUSION The widespread and the systematic use of video assisted learning may be a useful and economic tool in adjunct to the surgical training techniques practiced until now throughout the surgical community.
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Affiliation(s)
- Francesco Mongelli
- MD, Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Switzerland. Manuscript writing
| | - Davide La Regina
- MD, Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Switzerland. Critical revision
| | - Michele Marengo
- MD, Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Switzerland. Acquisition of data
| | - Ramon Pini
- MD, Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Switzerland. Conception and design of the study
| | - Andrea Saporito
- MD, Division of Anesthesiology, Ospedale Regionale di Bellinzona e Valli, Switzerland. Statistical analysis
| | - Maurice FitzGerald
- MD, Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Switzerland. Manuscript preparation
| | - Matteo Di Giuseppe
- MD, Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Switzerland. Manuscript preparation. Final approval
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Borgeat A, Ofner C, Saporito A, Farshad M, Aguirre J. The effect of nonsteroidal anti-inflammatory drugs on bone healing in humans: A qualitative, systematic review. J Clin Anesth 2018; 49:92-100. [PMID: 29913395 DOI: 10.1016/j.jclinane.2018.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/29/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in postoperative pain management. While an increasing number of in vitro and animal studies point toward an inhibitory effect of NSAIDs on bone healing process, the few existing retro- and prospective clinical studies present conflicting data. DESIGN The aim of this qualitative, systematic review was to investigate the impact of perioperative use of NSAIDs in humans on postoperative fracture/spinal fusion healing compared to other used analgesics measured as fracture nonunion with radiological control. PATIENTS/INTERVENTIONS We performed a systematic literature search of the last 38 years using PubMed Embase and the Cochrane Controlled Trials Register including retro- and prospective clinical, human trials assessing the effect of NSAIDs on postoperative fracture/spinal fusion healing when used for perioperative pain management with a radiological follow up to assess eventual nonunion. Due to different study designs, drugs, dosages/exposition times and different methods to assess fracture nonunion, these studies were not pooled for a meta-analysis. A descriptive summary of all studies, level of evidence, study quality and study bias assessment using different scores were used. MAIN RESULTS Three prospective randomized controlled studies and thirteen retrospective cohort human studies were identified for a total of 12'895 patients. The overall study quality was low according to Jadad and Oxford Levels of Evidence scores. CONCLUSIONS Published results of human trials did not show strong evidence that NDAIDs for pain therapy after fracture osteosynthesis or spinal fusion lead to an increased nonunion rate. Reviewed studies present such conflicting data, that no clinical recommendation can be made regarding the appropriate use of NSAIDs in this context. Considering laboratory data of animal, human tissue research and recommendation of clinical reviews, a short perioperative exposition to NSAIDs is most likely not deleterious. However, randomized, controlled studies are warranted to support or refute this hypothesis.
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Affiliation(s)
- Alain Borgeat
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland.
| | - Christian Ofner
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Andrea Saporito
- Service of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Mazda Farshad
- Spine Surgery, Balgrist University Hospital Zurich, Switzerland
| | - José Aguirre
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
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Patella M, Saporito A, Puligheddu C, Mongelli F, La Regina D, Pini R, Inderbitzi R, Cafarotti S. Lung Ultrasound to Detect Residual Pneumothorax After Chest Drain Removal in Lung Resections. Ann Thorac Surg 2018; 105:1537-1542. [PMID: 29331648 DOI: 10.1016/j.athoracsur.2017.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Indication for postdrain removal imaging after lung resection is debated. Chest roentgenogram (CR) is widely used to confirm lung expansion but not evidence based. We propose to introduce lung ultrasound (LUS) as alternative to exclude significant pneumothorax (PTx) in this setting. METHODS The study enrolled 50 patients undergoing lung resections. Inclusion criteria were complete expansion of the lung at postoperative CR, pleural effusion of less than 300 mL/24 h, air leak of 10 to 20 mL/min for 6 hours. Two hours after chest drain removal, LUS was performed at the second and third intercostal spaces to assess pleural sliding. Patients with no detected PTx or with apical PTx were considered for discharge. The same patients were blindly evaluated with CR by a second operator, and a comparison between the two methods was performed. Clinical decisions were taken based on CR results. RESULTS LUS confirmed large PTxs in 7 patients, apical PTxs in 10 patients, and no PTx in 33 patients. CR confirmed 5 of 7 significant PTxs (1 chest drain reinserted, 4 patients observed), and 2 of 7 PTx were considered irrelevant. Apical PTxs were confirmed in 8 of 10 patients, and in 2 patients there was no PTx at CR. The 33 patients with no PTx at LUS had full lung expansion at CR. LUS has a negative predictive value of 100% in excluding large PTxs and a positive predictive value of 71%. CONCLUSIONS In this subgroup of patients with air leak of 10 to 20 mL/min, performing an imaging study to verify the absence of PTx is desirable; however, when LUS confirms lung expansion or the presence of apical PTx, CR does not seem to be needed.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland.
| | - Andrea Saporito
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Carla Puligheddu
- Department of Radiology, San Giovanni Hospital, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Davide La Regina
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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Finsterwald M, Muster M, Farshad M, Saporito A, Brada M, Aguirre JA. Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth 2018; 46:3-7. [PMID: 29316474 DOI: 10.1016/j.jclinane.2018.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/19/2017] [Accepted: 01/04/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE More stable perioperative hemodynamic conditions, lower costs and a lower perioperative complication rate were reported in young healthy patients undergoing lumbar spine surgery in spinal anesthesia (SA) compared to general anesthesia (GA). However, the benefits of SA in high risk patients (ASA≥II suffering from cardiovascular and/or pulmonary pathologies) undergoing this surgery are unclear. Our objective was to analyze whether SA leads to an improved perioperative hemodynamic stability and to a more cost-effective management compared to GA in high risk patients undergoing this surgery. METHODS In a retrospective analysis 146 ASA II-III patients who underwent lumbar spine surgery in SA were compared with 292 ASA I-III patients who were operated in GA between 2000 and 2014. Hemodynamic effects, hospitalization times, complications, and costs according to the Swiss billing system were assessed. The data extraction was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative for cohort studies. RESULTS The patients in the SA group were older (75years (±9.6) vs 69 (±11.5), p<0.001), had a lower BMI (25.8kg/m2 (±4.8) vs 27.2 (±4.7), p=0.003) and showed a higher ASA score (3 vs 2, p<0.001). However, SA was associated with significantly better perioperative hemodynamic stability with less need for intraoperative vasopressors (15% vs 57%, p<0.001), volume supplementation (1113ml ±458 vs 1589±644, p<0.001) and transfusions (0% vs 4%, p<0.001). Additionally, the number of hypotension episodes was lower in the SA group (15% vs 47%, p<0.001). Furthermore, the SA group showed a significantly shorter duration of surgery (70min (±1.2) vs 91 (±41), p<0.001), lower postoperative nausea and vomiting (PONV) (4% vs 28%, p<0.001) and pain in the post anesthesia care unit (PACU) (visual analogue scale (VAS) 2.3 (±1.1) vs 0.8 (±0.8), p<0.001), whereas pain after 24h did not differ (VAS 0.9 (±1) vs 0.8 (±1.1), p=ns). The postoperative complication (7% vs 5%, p=0.286) and revision rates (4% vs 5%, p=0.626) were similar in both groups. Total costs (United States Dollars (USD) 6377 (±2332) vs 7018 (±4056), p=0.003) and PACU time were significantly lower in the SA group (35min (±12) vs 109 (±173), p<0.001). CONCLUSIONS Lumbar spine surgery in cardiovascular high risk patients with SA is safe, allows good perioperative hemodynamic stability and might lead to lower health care costs. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Michael Finsterwald
- Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Marco Muster
- Division of Anesthesiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Andrea Saporito
- Anesthesiology Department, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
| | - Muriel Brada
- Division of Anesthesiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - José A Aguirre
- Division of Anesthesiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
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Ceruti S, Anselmi L, Minotti B, Franceschini D, Aguirre J, Borgeat A, Saporito A. Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth 2018; 120:101-108. [DOI: 10.1016/j.bja.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022] Open
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Patella M, Pini R, Saporito A, Inderbitzi R, Cafarotti S. P-173PERSISTENT AIR LEAK IN THORACIC SURGERY: A NEW POSTOPERATIVE TECHNIQUE TO REDUCE THE PLEURAL SPACE AFTER LUNG RESECTION. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Quadri C, Saporito A, Capdevila X. Real-time continuous monitoring of injection pressure at the needle tip for peripheral nerve blocks: description of a new method. Anaesthesia 2017; 73:187-194. [DOI: 10.1111/anae.14041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/01/2022]
Affiliation(s)
- C. Quadri
- Anaesthesiology Department; Lugano Regional Hospital; Lugano Switzerland
| | - A. Saporito
- Anaesthesiology Department; Bellinzona Regional Hospital; Bellinzona Switzerland
| | - X. Capdevila
- Department of Anaesthesiology and Critical Care Medicine; Inserm Unit 1051; Montpellier University Hospital; University Montpellier 1; Montpellier France
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Saporito A, Anselmi L, Sturini E, Borgeat A, Aguirre JA. Is outpatient continuous regional analgesia more effective and equally safe than single-shot peripheral nerve blocks after ambulatory orthopedic surgery? Minerva Anestesiol 2017; 83:972-981. [DOI: 10.23736/s0375-9393.17.11643-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aguirre JA, Märzendorfer O, Brada M, Saporito A, Borgeat A, Bühler P. Cerebral oxygenation in the beach chair position for shoulder surgery in regional anesthesia: impact on cerebral blood flow and neurobehavioral outcome. J Clin Anesth 2016; 35:456-464. [DOI: 10.1016/j.jclinane.2016.08.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/09/2016] [Accepted: 08/14/2016] [Indexed: 10/20/2022]
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Saporito A, Calciolari S, Ortiz LG, Anselmi L, Borgeat A, Aguirre J. A cost analysis of orthopedic foot surgery: can outpatient continuous regional analgesia provide the same standard of care for postoperative pain control at home without shifting costs? Eur J Health Econ 2016; 17:951-961. [PMID: 26467165 DOI: 10.1007/s10198-015-0738-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Same-day surgery is common for foot surgery. Continuous regional anesthesia for outpatients has been shown effective but the economic impact on the perioperative process-related healthcare costs remains unclear. METHODS One hundred twenty consecutive patients were included in this assessor-blinded, prospective cohort study and allocated according to inclusion criteria in the day-care or in the in-patient group. Standardized continuous popliteal sciatic nerve block was performed in both groups for 48 h using an elastomeric pump delivering ropivacaine 0.2 % at a rate of 5 ml/h with an additional 5 ml bolus every 60 min. Outpatients were discharged the day of surgery and followed with standardized telephone interviews. The total direct health costs of both groups were compared. Moreover, the difference in treatment costs and the difference in terms of quality of care and effectiveness between the groups were compared. RESULTS Total management costs were significantly reduced in the day-care group. There was no difference between the groups regarding pain at rest and with motion, persistent pain after catheter removal and the incidence of PONV. Persistent motor block and catheter inflammation/infection were comparable in both groups. There was neither a difference in the number of unscheduled ambulatory visits nor in the number of readmissions. CONCLUSIONS Day-care continuous regional analgesia leads to an overall positive impact on costs by decreasing the incidence of unplanned ambulatory visits and unscheduled readmissions, without compromising on the quality of analgesia, patients' satisfaction, and safety.
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Affiliation(s)
- Andrea Saporito
- Anaesthesiology Department, Bellinzona Regional Hospital, Bellinzona, Switzerland.
| | - Stefano Calciolari
- Mecop Institut, University of Italian Switzerland (USI), Lugano, Switzerland
| | | | - Luciano Anselmi
- Anaesthesiology Department, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Alain Borgeat
- Anaesthesiology Division, Balgrist University Hospital, Zurich, Switzerland
| | - José Aguirre
- Anaesthesiology Division, Balgrist University Hospital, Zurich, Switzerland
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Saporito A, Anselmi L, Borgeat A, Aguirre JA. Can the choice of the local anesthetic have an impact on ambulatory surgery perioperative costs? Chloroprocaine for popliteal block in outpatient foot surgery. J Clin Anesth 2016; 32:119-26. [DOI: 10.1016/j.jclinane.2016.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/09/2015] [Accepted: 02/02/2016] [Indexed: 11/15/2022]
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Valle G, Cucciolito ME, Ganis P, Saporito A. The crystal structure of Cu(II)-bis[1-(2-pyridinyl)-2-propanonato-N,O]. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1989.189.14.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ceruti S, De Vivo S, Peruzzo M, De Bianchi D, Anselmi L, Saporito A. PROtocolized Care to Reduce HYpotension after Spinal Anesthesia (ProCRHYSA randomized trial): statistical plan. Crit Ultrasound J 2015. [PMCID: PMC4401418 DOI: 10.1186/2036-7902-7-s1-a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Saporito A, Sturini E, Borgeat A, Aguirre J. A reply. Anaesthesia 2015; 70:232. [PMID: 25583194 DOI: 10.1111/anae.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Saporito
- Bellinzona Regional Hospital, Bellinzona, Switzerland
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Saporito A, Sturini E, Borgeat A, Aguirre J. The effect of continuous popliteal sciatic nerve block on unplanned postoperative visits and readmissions after foot surgery - a randomised, controlled study comparing day-care and inpatient management. Anaesthesia 2014; 69:1197-205. [DOI: 10.1111/anae.12710] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A. Saporito
- Anaesthesiology Service; Regional and Ambulatory Anesthesia Unit; Bellinzona Regional Hospital; Bellinzona Switzerland
| | - E. Sturini
- Anaesthesiology Service; St. Chiara Clinic; Locarno Switzerland
| | - A. Borgeat
- Division of Anaesthesiology; Balgrist University Hospital; Zurich Switzerland
| | - J. Aguirre
- Division of Anaesthesiology; Balgrist University Hospital; Zurich Switzerland
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Smilari P, Praticò AD, Salafia S, Praticò ER, Cilauro S, Saporito A, Pavone P, Ruggieri M. Brain ultrasound features in multiple births due to spontaneous conception compared with assisted reproductive techniques: a cross-sectional, population-based study. Minerva Pediatr 2014; 66:17-22. [PMID: 24608578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Multiple pregnancies from spontaneous conception and obtained by assisted reproductive techniques (ART) are associated with a disproportionate share of complications compared with natural singleton pregnancies. The outcome of multiple pregnancies obtained by ART is still the subject of controversial opinions in the medical literature as they are associated with increased rates of perinatal complications, and perinatal mortality, as well as maternal complications. Aim of this study was to determine whether there are differences between these two groups of infants. METHODS We examined the imaging findings by means of brain ultrasound (performed at birth and sequentially up to their 6th month of age) in a cohort of 296 twins and triplets born following different techniques of assisted fertilization (63 pregnancies; 119 neonates) vs. spontaneous conception (94 pregnancies; 177 neonates). RESULTS We did record, by means of X square corrected test, statistically significant differences (P=0.002) between the two populations at birth in the number of normal ultrasound scans (ART<spontaneous neonates); transient hyperechogenecity (spontaneous<ART neonates) and persistent hyperechogenecity (ART<spontaneous neonates). CONCLUSION No differences in brain ultrasound findings between the two groups of ART and between spontaneous vs. assisted conceptions (P=0.959) at long-term follow-up have been noticed.
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Affiliation(s)
- P Smilari
- Unit of Pediatrics, Department of Pediatrics University of Catania, Catania, Italy -
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