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Álvarez-Aguilera M, González De Pedro C, Aparicio-Sánchez D, Espada Fuentes FJ, Padillo-Ruiz J, Díaz Gómez D. Standardized laparoscopic staging protocol for incidental and elective carcinomatosis surgery. Am J Surg 2024; 232:146-148. [PMID: 38218682 DOI: 10.1016/j.amjsurg.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Affiliation(s)
- M Álvarez-Aguilera
- Department of Surgery, Virgen del Rocio University Hospital, Seville, Spain
| | - C González De Pedro
- Surgical Oncology and Peritoneal Malignancies Unit, Department of Surgery, Virgen del Rocio University Hospital, Seville, Spain
| | - D Aparicio-Sánchez
- Surgical Oncology and Peritoneal Malignancies Unit, Department of Surgery, Virgen del Rocio University Hospital, Seville, Spain.
| | - F J Espada Fuentes
- Department of Surgery, Virgen del Rocio University Hospital, Seville, Spain
| | - J Padillo-Ruiz
- Chief of department. Department of Surgery, Virgen del Rocio University Hospital, Seville, Spain
| | - D Díaz Gómez
- Surgical Oncology and Peritoneal Malignancies Unit Chief, Department of Surgery, Virgen del Rocio University Hospital, Seville, Spain
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Cerullo M, Patel K. Invited Commentary: When It Is Not Worth the Wait: Early Elective Repair for Paraesophageal Hernia. J Am Coll Surg 2024; 238:1082-1084. [PMID: 38357979 DOI: 10.1097/xcs.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
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McGarrigle C, McGrath L, Khan E. Anaesthesia management of a patient with Bethlem Myopathy for elective tonsillectomy: a case report. BMC Anesthesiol 2024; 24:173. [PMID: 38730355 PMCID: PMC11083902 DOI: 10.1186/s12871-024-02539-0] [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: 01/29/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Bethlem Myopathy is a collagen VI-related myopathy presenting as a rare hereditary muscular disorder with progressive muscular weakness and joint contractures. Despite its milder clinical course relative to other myopathies, anaesthetic management can be challenging. High arched palates and fixed flexion deformities may contribute to a difficult airway. A progressive decline in pulmonary function can present later into adulthood. This respiratory decline can carry secondary cardiovascular consequences due to the progressive nature of restrictive lung disease, including right sided heart disease and pulmonary hypertension. We describe a case of a male patient with Bethlem Myopathy undergoing anaesthesia, to contribute to the limited body of literature on this condition and enhance awareness and guidance amongst anaesthesiologists on approaching patients with this condition. This is the first case report within the literature of its kind. CASE PRESENTATION This case details a 33-year-old male with Bethlem Myopathy undergoing tonsillectomy. Diagnosed in childhood following developmental delays, the patient had no prior anaesthetic exposure and no family history of anaesthetic complications. Anaesthetic induction was achieved without complications, avoiding depolarizing muscle relaxants and careful airway management. Extreme care was taken in patient positioning to prevent complications. The surgery proceeded without incident and muscle paralysis was reversed with Suggammadex, resulting in no adverse post-operative respiratory complications. The patient was discharged on the first post-operative day without any respiratory or cardiovascular compromise. CONCLUSIONS Bethlem Myopathy, while often exhibiting a mild clinical course, can present anaesthetic challenges. Awareness of potential complications including a difficult airway, cardiovascular and respiratory implications as well as the need for specialised monitoring and positioning is crucial to ensure a safe peri-operative course.
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Kim AS, Hong JS, Levine JN, Foglia C, Saldinger P, Chao SY. Enhanced Recovery After Surgery protocols mitigate the weekend effect on length of stay following elective colectomy. J Gastrointest Surg 2024; 28:662-666. [PMID: 38704203 DOI: 10.1016/j.gassur.2024.02.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND This study aimed to determine the effect of Enhanced Recovery After Surgery (ERAS) protocols on the weekend effect after elective colectomies. METHODS This was a retrospective study on all elective colorectal surgeries at a single institution in New York City between January 1, 2015, and December 31, 2020. The length of stay (LOS) by day of the week of surgery and the effect of ERAS using univariable and multivariable analyses were compared. RESULTS A total of 605 patients were included in the study. Of note, 41 cases were performed on Mondays, 197 cases were performed on Tuesdays, 45 cases were performed on Wednesdays, 187 cases were performed on Thursdays, and 135 cases were performed on Fridays. Univariate analysis showed that, for patients who did not undergo ERAS, Monday and Tuesday were significantly associated with decreased LOS (P < .001). For patients who underwent ERAS, there was no statistically significant difference in LOS (P = .06) when operated on early in the week vs later. After controlling for age, race/ethnicity, comorbidities, complications, functional health status, operation type, duration of surgery, presence of ostomy, and albumin level, adhering to the ERAS protocol was significantly associated with a shorter LOS (P < .001). CONCLUSION Our study demonstrated that ERAS can mitigate the weekend effect on LOS. ERAS protocols may provide more structure to the expected hospital course and allow patients to reach recovery milestones earlier, facilitating discharge even by covering teams.
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Affiliation(s)
- Angelina S Kim
- Department of Surgery, NewYork-Presbyterian Queens, Flushing, New York, United States.
| | - Julie S Hong
- Department of Surgery, NewYork-Presbyterian Queens, Flushing, New York, United States
| | - Jared N Levine
- Department of Surgery, NewYork-Presbyterian Queens, Flushing, New York, United States
| | - Christopher Foglia
- Department of Surgery, NewYork-Presbyterian Queens, Flushing, New York, United States; Department of Surgery, Weill Cornell Medicine, New York, New York, United States
| | - Pierre Saldinger
- Department of Surgery, NewYork-Presbyterian Queens, Flushing, New York, United States; Department of Surgery, Weill Cornell Medicine, New York, New York, United States
| | - Steven Y Chao
- Department of Surgery, NewYork-Presbyterian Queens, Flushing, New York, United States; Department of Surgery, Weill Cornell Medicine, New York, New York, United States
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Buddeberg BS, Seeberger E, Bläsi C, Dutilh G, Steiner LA, Bandschapp O, Palanisamy A, Girard T. Is crystalloid co-loading necessary to prevent spinal hypotension during elective cesarean delivery? A randomized double-blind trial. Int J Obstet Anesth 2024; 58:103968. [PMID: 38485584 DOI: 10.1016/j.ijoa.2023.103968] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND Hypotension is common during spinal anesthesia for cesarean delivery. Preventive strategies include fluid loading and phenylephrine. We hypothesized that if prophylactic phenylephrine infusion is used, omission of fluid loading would be non-inferior to fluid co-loading in maintaining cardiac output. We assumed that if there was a difference, the increase in cardiac output would be greater in the no-loading than in the co-loading group. METHODS Term pregnant women scheduled for elective cesarean delivery were randomized to receive 1 L crystalloid co-loading or maintenance fluids only. Phenylephrine was titrated to maintain blood pressure. Changes in cardiac output following spinal anesthesia were the primary outcome. The study was powered as a non-inferiority trial, allowing the no-loading arm to have a 50% greater change in cardiac output. Heart rate, dose of phenylephrine, occurrence of nausea and vomiting, Apgar scores and neonatal acid base status were secondary outcomes. RESULTS Data from 63 women were analyzed. In contrast to our hypothesis, there was 33% less increase in cardiac output with no loading (ratio 0.67, 95% CI 0.15 to 1.36), and 60% greater reduction of cardiac output with no loading (ratio 1.6, 95% CI 1.0 to 2.7). Total dose of phenylephrine was higher in the no-loading group. There may be a less favorable neonatal acid base status without volume loading. CONCLUSION Omission of crystalloid co-loading leads to a decrease in cardiac output which has a potentially unfavorable impact on neonatal acid base status. We conclude that crystalloid co-loading may be useful in the presence of phenylephrine infusion.
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Affiliation(s)
- B S Buddeberg
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland.
| | - E Seeberger
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland
| | - C Bläsi
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland
| | - G Dutilh
- Department of Clinical Research, University of Basel, Switzerland
| | - L A Steiner
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland
| | - O Bandschapp
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland
| | - A Palanisamy
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - T Girard
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland
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Bhanwra A, Palta S, Saroa R, Saxena P, Bhanwra S, Jain A. Role of preoperative zinc, magnesium and budesonide gargles in Postoperative Sore Throat (POST) - a randomised control trial. BMC Anesthesiol 2024; 24:164. [PMID: 38693477 PMCID: PMC11061912 DOI: 10.1186/s12871-024-02534-5] [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: 05/27/2023] [Accepted: 04/09/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Post-operative sore throat (POST) has an incidence ranging from 21 to 80%. To prevent the development of POST, several pharmacological measures have been tried. Aim of this study was to compare the efficacy of preoperative zinc, magnesium and budesonide gargles in reducing the incidence and severity of POST in patients who underwent endotracheal intubation for elective surgeries. METHODS We conducted a prospective, randomized, double-blind, controlled equivalence trial in 180 patients admitted for elective surgical procedures under general anaesthesia. Patients were randomised into three groups; group Z received 40 mg Zinc, group M received 250 mg Magnesium Sulphate and group B received 200 µg Budesonide in the form of 30 ml tasteless and colourless gargle solutions. Sore throat assessment and haemodynamic recording was done postoperatively at immediate recovery (0 h) and 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). RESULTS POST score was comparable at all recorded time points i.e. 0,2,4,6,8,12 and 24 h. Maximum incidence was seen at 8 h in group B (33.3%) and the minimum incidence was at 24 h in group Z (10%) (p > 0.05). It was found that the incidence of POST was more in the surgeries lasting longer than 2 h in all groups. This difference was found to be statistically significant in Groups M and B. The incidence of POST was found to be comparable between laparoscopic and open procedures. CONCLUSION Magnesium, zinc and budesonide have an equivocal effect in the prevention of POST at different time points. The incidence of sore throat increases significantly in surgeries lasting more than two hours if magnesium or budesonide have been used as premedicant. Duration of surgery is an independent predictor for POST. TRIAL REGISTRATION CTRI/2021/05/033741 Date-24/05/2021(Clinical Trial Registry of India).
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Affiliation(s)
- Aakanksha Bhanwra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Sanjeev Palta
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Richa Saroa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Puja Saxena
- Department of Anaesthesia and Intensive Care, Dr. B.R. Ambedkar State Institute of Medical Sciences, Sector 57, Sahibzada Ajit Singh Nagar, Punjab, 160055, India
| | - Sangeeta Bhanwra
- Department of Pharmacology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Aditi Jain
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
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Hawkins AT, Penson DF, Geiger TM, Bonnet KR, Mutch MG, Maguire LH, Schlundt DG, Rothman RL. The Patient Perspective on Colectomy for Recurrent Diverticulitis: A Qualitative Study. Ann Surg 2024; 279:818-824. [PMID: 38318711 PMCID: PMC10997445 DOI: 10.1097/sla.0000000000006225] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Understand the patient's decision-making process regarding colectomy for recurrent diverticulitis. BACKGROUND The decision to pursue elective colectomy for recurrent diverticulitis is highly preference-sensitive. Little is known about the patient's perspective in this decision-making process. METHODS We performed a qualitative study utilizing focus groups of patients with recurrent diverticulitis at 3 centers across the United States. Using an iterative inductive/deductive approach, we developed a conceptual framework to capture the major themes identified in the coded data. RESULTS From March 2019 to July 2020, 39 patients were enrolled across 3 sites and participated in 6 focus groups. After coding the transcripts using a hierarchical coding system, a conceptual framework was developed. Major themes identified included participants' beliefs about surgery, such as normative beliefs (eg, subjective, value placed on surgery), control beliefs (eg, self-efficacy, stage of change), and anticipated outcomes (eg, expectations, anticipated regret); the role of behavioral management strategies (eg, fiber, eliminate bad habits); emotional experiences (eg, depression, embarrassment); current symptoms (eg, severity, timing); and quality of life (eg, cognitive load, psychosocial factors). Three sets of moderating factors influencing patient choice were identified: clinical history (eg, source of diagnosis, multiple surgeries), clinical protocols (eg, pre-op and post-op education), and provider-specific factors (eg, specialty, choice of surgeon). CONCLUSIONS Patients view the decision to undergo colectomy through 3 major themes: their beliefs about surgery, their psychosocial context, and moderating factors that influence participant choice to undergo surgery. This knowledge is essential both for clinicians counseling patients who are considering colectomy and for researchers studying the process to optimize care for recurrent diverticulitis.
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Affiliation(s)
- Alexander T Hawkins
- Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Timothy M Geiger
- Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Matthew G Mutch
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Lilias H Maguire
- Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
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Jones AJ, Naik AN, Moore MG, Chen DW, Yesensky JA, Mantravadi AV, Campbell DA, Sim MW. Elective nodal dissection for cN0 intermediate-grade parotid mucoepidermoid carcinoma: A NCDB study. Am J Otolaryngol 2024; 45:104214. [PMID: 38218029 DOI: 10.1016/j.amjoto.2023.104214] [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: 09/03/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE To determine the occult nodal disease rate and whether elective regional lymph node dissection (RLND) confers any 10-year overall survival (OS) in cN0 intermediate-grade mucoepidermoid carcinoma (MEC) of the parotid gland. MATERIALS & METHODS The National Cancer Database was reviewed from 2004 to 2016 on adults with cT1-4aN0M0 intermediate-grade parotid MEC undergoing resection with/without RLND. Comparisons between patients with and without RLND were made. Occult nodal rate and 10-year overall survival (OS) were determined. RESULTS Out of 898 included patients with cN0 intermediate grade parotid MEC undergoing elective RLND, the occult nodal rate was 7.6%. This was significantly different from low-grade (3.9%) and high-grade (25.7%) cN0 disease. When stratified by pT-classification, marginal differences were identified between low-grade and intermediate-grade tumors, whereas high-grade tumors demonstrated increased occult nodal disease with low T-stage (pT1-pT2, 20.4% vs. 5.1%) and high T-stage (pT3-pT4a, 32.1% vs. 17.6%). Patients undergoing elective RLND were more often treated at an academic facility (53.8% vs. 41.2%), had higher pT3-pT4 tumors (19.2% vs. 10.4%), and more frequently underwent total/radical parotidectomy (46.0% vs. 29.9%) with adjuvant radiation therapy (53.8% vs. 41.0%) Cox-proportional hazard modeling did not identify RLND, regardless if stratified by nodal yield or pT-classification, nor nodal positivity as significant predictors of 10-year OS. CONCLUSIONS The occult nodal disease in intermediate-grade parotid MEC is low and similar to low-grade. Elective RLND may have a limited impact on OS, though its effect on locoregional control remains unknown. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexander J Jones
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States.
| | - Akash N Naik
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Michael G Moore
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Diane W Chen
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Jessica A Yesensky
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Avinash V Mantravadi
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - David A Campbell
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
| | - Michael W Sim
- Indiana University School of Medicine, Department of Otolaryngology - Head & Neck Surgery, Indianapolis, IN, United States
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Kinugasa Y, Ida M, Kawaguchi M. Fried Frailty Phenotype Questionnaire scores and postoperative patient-reported outcomes of patients undergoing major abdominal cancer surgery: A secondary analysis. Geriatr Gerontol Int 2024; 24:464-469. [PMID: 38597119 DOI: 10.1111/ggi.14872] [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: 11/04/2023] [Revised: 02/22/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
AIM This study aimed to evaluate the effects of Fried Frailty Phenotype Questionnaire (FFPQ) scores on patient-reported postoperative outcomes. METHODS This secondary analysis of a prospective observational study included 230 inpatients aged ≥65 years undergoing elective abdominal cancer surgery. The primary outcome was the Quality of Recovery-15 score on postoperative days 2, 4 and 7. The secondary outcomes included disability-free survival, defined as a 12-item World Health Organization Disability Assessment Schedule 2.0 score of <16% at 3 months. The associations of the FFPQ scores, ranging from 0 (robust) to 5 (frailty), with the primary and secondary outcomes were assessed using multiple analysis. RESULTS After confirming the linearity of the FFPQ score for the outcomes, multiple regression analysis adjusted for prominent factors showed that the FFPQ score was a significant factor influencing the decrease in the Quality of Recovery-15 score on postoperative day 2 (β = -2.67, 95% confidence interval -5.20, -0.15), 4 (β = -3.54, 95% confidence interval -5.77, -1.30) and 7 (β = -3.70, 95% confidence interval -5.75, -1.65). The adjusted odds ratio of the FFPQ score for disability-free survival postoperatively was 0.66 (95% confidence interval 0.49-0.90). CONCLUSIONS Patients with higher FFPQ scores before elective major abdominal cancer surgery were likely to have lower postoperative Quality of Recovery-15 scores and poor disability-free survival. Geriatr Gerontol Int 2024; 24: 464-469.
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Affiliation(s)
- Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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Ceresoli M, Pedrazzani C, Pellegrino L, Ficari F, Braga M. Early non compliance to enhanced recovery pathway might be an alert for underlying complications following colon surgery. Eur J Surg Oncol 2024; 50:106650. [PMID: 35817632 DOI: 10.1016/j.ejso.2022.06.033] [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: 04/08/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Early non compliance to postoperative ERAS pathway has been reported in 20-30% of patients who underwent elective colon surgery. The aim of the present study is to investigate the possible relationship between early non compliance and postoperative complications. METHODS We reviewed a prospective database including 1391 consecutively collected patients undergoing elective colon surgery in 22 Italian hospitals between January 2017 and June 2020. Early compliance to ERAS protocol was assessed on postoperative day (POD) 2. Failure of oral feeding, urinary catheter removal, intravenous fluids stop, and adequate mobilization were indicators of non compliance. Postoperative follow-up was carried out for 30 days after hospital discharge. The association among early postoperative ERAS compliance and the occurrence of complications was assessed with uni- and multivariate analysis. RESULTS A total of 1089 (78.3%) patients had malignancy and minimally invasive surgery was successfully performed in 1174 (84.3%) patients. Postoperative morbidity occurred in 403 (29.0%) patients. At multivariate analysis, male gender, open surgery, and each of the four non compliance indicators on POD 2 were significantly associated to postoperative complications. Morbidity progressively increased from 16.8% in patients with full compliance to ERAS protocol to 47.2% in patients with two non compliance indicators and 69.2% in patients with all four indicators (p < 0.001). CONCLUSIONS Early non compliance to ERAS protocol was significantly associated with postoperative morbidity.
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Affiliation(s)
- Marco Ceresoli
- General and Emergency Surgery Dept, University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy
| | | | | | - Ferdinando Ficari
- General Surgery, Careggi Hospital - University of Firenze, Firenze, Italy
| | - Marco Braga
- General and Emergency Surgery Dept, University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy.
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Piccolo R, Angellotti D, Simonetti F, Leone A, Avvedimento M, Bardi L, Fortunato G, Spaccarotella CAM, Franzone A, Esposito G. Evidence Supporting Criteria for Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Intervention. J Am Coll Cardiol 2024; 83:1713-1715. [PMID: 38658110 DOI: 10.1016/j.jacc.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Raffaele Piccolo
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy.
| | - Domenico Angellotti
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Fiorenzo Simonetti
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Attilio Leone
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Marisa Avvedimento
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Luca Bardi
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Giuliana Fortunato
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | | | - Anna Franzone
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Giovanni Esposito
- University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
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Ripollés-Melchor J, Carrasco-Sánchez L, Tomé-Roca JL, Aldecoa C, Zorrilla-Vaca A, Lorente-Olazábal JV, Colomina MJ, Pérez A, Jiménez-López JI, Navarro-Pérez R, Abad-Gurumeta A, Monge-García MI. Hypotension prediction index guided goal-directed therapy to reduce postoperative acute kidney injury during major abdominal surgery: study protocol for a multicenter randomized controlled clinical trial. Trials 2024; 25:288. [PMID: 38685032 PMCID: PMC11057064 DOI: 10.1186/s13063-024-08113-w] [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: 11/07/2023] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a significant postoperative complication associated with increased mortality and hospital costs. Hemodynamic strategies, such as goal-directed therapy, might reduce AKI risk. Predicting and proactively managing intraoperative hypotension may be helpful. This trial aims to investigate if a preemptive hemodynamic strategy guided by the hypotension prediction index (HPI) can decrease the incidence of moderate-to-severe AKI within 30 days following major elective abdominal surgery. METHODS This is an open-label, controlled, multicenter, randomized clinical trial that involves daily patient follow-up until hospital discharge. Inclusion criteria are patients aged over 65 and/or categorized as ASA III or IV physical status, undergoing major elective abdominal surgery (general, urological, or gynecological procedures) via laparoscopic or open approach under general or combined anesthesia. INTERVENTION In the intervention group, hemodynamic management will be based on the HPI and the advanced functional hemodynamic variables provided by the Hemosphere platform and the AcumenIQ® sensor (Edwards Lifesciences). The primary outcome is the incidence of moderate-to-severe AKI within 7 days post-surgery. Secondary outcomes include postoperative complications and 30-day mortality. DISCUSSION This study explores the potential of HPI-guided hemodynamic management in reducing AKI after major elective abdominal surgery, with implications for postoperative outcomes and patient care. TRIAL REGISTRATION ClinicalTrials.gov NCT05569265. Registered on October 6, 2022.
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Affiliation(s)
- Javier Ripollés-Melchor
- Infanta Leonor University Hospital, Madrid, Spain.
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain.
- Universidad Complutense de Madrid, Madrid, Spain.
| | - Laura Carrasco-Sánchez
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Doctoral Program in Medicine and Biomedical Sciences, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institut de Recerca I Innovació en Ciències de La Vida I de La Salut a La Catalunya Central (IRIS-CC), Vic, Spain
| | - José L Tomé-Roca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Virgen de las Nieves University Hospital, Granada, Spain
| | - César Aldecoa
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Río Hortega University Hospital, Valladolid, Spain
| | - Andres Zorrilla-Vaca
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Brigham and Women's Hospital, Boston, USA
| | - Juan V Lorente-Olazábal
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Juan Ramón Jiménez University Hospital, Huelva, Spain
| | - María J Colomina
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Bellvitge University Hospital, Barcelona, Spain
| | - Ana Pérez
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Elche University Hospital, Elche, Spain
| | - Juan I Jiménez-López
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Virgen del Rocío University Hospital, Seville, Spain
| | - Rosalía Navarro-Pérez
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Clinico San Carlos University Hospital, Madrid, Spain
| | - Alfredo Abad-Gurumeta
- Infanta Leonor University Hospital, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel I Monge-García
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR), Madrid, Spain
- Jerez de La Frontera University Hospital, Jerez de la Frontera, Spain
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Fuchs TI, Pfab C, Kiselev J, Schaller SJ, Spies C, Rombey T. Barriers and facilitators to the implementation of prehabilitation for elderly frail patients prior to elective surgery: a qualitative study with healthcare professionals. BMC Health Serv Res 2024; 24:536. [PMID: 38671446 PMCID: PMC11046874 DOI: 10.1186/s12913-024-10993-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Prehabilitation aims to enhance functional capacity before surgery, minimise complications and achieve a better postoperative outcome. This can be particularly useful for older, frail patients to better tolerate surgery. The aim of this study was to identify what barriers and facilitators healthcare professionals in Germany experienced in the implementation and delivery of the multimodal prehabilitation programme "PRAEP-GO" for (pre-)frail adults aged 70 years and older to inform the implementation of prehabilitation into standard care. METHODS A nested descriptive qualitative study was conducted using semi-structured face-to-face interviews with healthcare professionals involved in the PRAEP-GO trial from the Berlin and Brandenburg region in Germany. Transcripts were analysed using Kuckartz' qualitative content analysis. Results were interpreted and synthesised using the Consolidated Framework for Implementation Research, a theoretical framework to allow their application to a more general context. RESULTS A total of 14 interviews were conducted. Seven therapists (physio-, ergo-, sports therapy), five physicians and two employees from other professions with mainly administrative and organisational tasks in the project. All identified barriers and facilitating factors could be assigned to the themes of organisation, prehabilitation, cooperation and communication between healthcare professionals and with patients. Much optimisation potential was found regarding organisational aspects, e.g. addressing perceived staff shortages and optimising the patient pathway. Furthermore, it became apparent that communication and cooperation between professionals but also with patients need to be improved. More evidence regarding prehabilitation should be provided to convince professionals more. Prehabilitation should be multimodal and individualised, including the programme duration. Officially introducing prehabilitation into standard care would facilitate its delivery. DISCUSSION These findings underscore the fact that successful implementation of prehabilitation programmes, such as PRAEP-GO, requires sufficient organisational infrastructure, human resources, access to knowledge, an adaptable and individualised programme design as well as good communication among professionals and with patients. The transferability of the findings is limited by the absence of nutritionists and resulting overrepresentation of other therapists in the sample. To further convince professionals and patients of the concept of prehabilitation, more research is needed to build a solid evidence base that will ensure greater awareness and, thus, more motivation and cooperation among professionals and patients. TRIAL REGISTRATION Open Science Framework (osf.io/ksfgj).
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Affiliation(s)
- Tamina Isabel Fuchs
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carina Pfab
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Federal Institute for Occupational Safety and Health (BAuA), Nöldnerstraße 40-42, 10317, Berlin, Germany
| | - Jörn Kiselev
- Department for Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Department for Health Sciences, Hochschule Fulda University of Applied Sciences, Fulda, Germany
| | - Stefan J Schaller
- Department for Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Ismaninger Str.22, 81675, München, Germany
| | - Claudia Spies
- Department for Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
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Wiesenberger R, Müller J, Kaufmann M, Weiß C, Ghezel-Ahmadi D, Hardt J, Reissfelder C, Herrle F. Influence of motivational interviewing on postoperative mobilization in the enhanced recovery after surgery (ERAS®) pathway in elective colorectal surgery - a randomized patient-blinded pilot study. Langenbecks Arch Surg 2024; 409:134. [PMID: 38644386 PMCID: PMC11033226 DOI: 10.1007/s00423-024-03321-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE Early mobilization is an essential component of the Enhanced Recovery after Surgery (ERAS®)-pathway. However, a large percentage of patients fail to achieve the ERAS® recommended goal (360 min out of bed from post-operative day 1/POD1). Motivational Interviewing (MI) is an evidence-based type of patient-centered consultation to promote intrinsic motivation. This study aims to evaluate if MI can improve postoperative mobilization. METHODS This two-arm, patient-blinded pilot randomized controlled trial included ERAS®-patients undergoing elective bowel resections. Conversations were validated by MI Treatment Integrity. Two validated motion sensors (movisens) and self-assessments were used to measure mobilization (POD1-POD3: Time out of bed, time on feet and step count). RESULTS 97 patients were screened, 60 finally included and randomized. Cumulatively across POD1-3, the intervention group (IG) was longer out of bed than the control group (CG) (median: 685 vs. 420 min; p=0.022). The IG achieved the ERAS®-goal of 360 min/day more frequently across POD1-3 (27.4% vs. 10.61%; p=0.013). Time on feet was 131.5 min/day (median per POD) in IG vs. 95.8 min/day in the CG (p=0.212), step count was 1347 in IG vs. 754 steps/day in CG (p=0.298). CONCLUSION MI could be conducted low threshold and was well accepted by patients. MI can improve mobilization in the context of ERAS®. Despite better performance, it should be noted that only 27.4% of the IG reached the ERAS®-compliance goal of 360 min/day. The findings of this pilot study stipulate to further test the promising perioperative effects of MI within a multicenter superiority trial. REGISTRATION This study was registered prospectively in the German Clinical Trials Register on 25.02.2022. Trial registration number is "DRKS00027863".
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Affiliation(s)
- Rico Wiesenberger
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Julian Müller
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mario Kaufmann
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christel Weiß
- Institute for Medical Statistics, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - David Ghezel-Ahmadi
- Department of Anaesthesiology and Critical Care Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Julia Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Kaiser R, Svoboda N, Waldauf P, Netuka D. The economic and psychological impact of cancellations of elective spinal surgeries in the COVID-19 era. Br J Neurosurg 2024; 38:322-326. [PMID: 33459075 DOI: 10.1080/02688697.2020.1868404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/13/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The adoption of health care restrictions due to the COVID-19 pandemic led to the cancellation of elective surgical care. However, the impact on patients is unknown. OBJECTIVE To evaluate the psychological and economic impact of the cancellation of scheduled spinal operations. METHODS We identified 50 patients with cancelled surgeries between 16 March 2020 and 24 April 2020. Forty-nine (98%) participants were contacted, with whom the modified WES-Pi questionnaire was filled in during a telephone interview. RESULTS Of the 49 respondents, 28 (57.2%) were aged <65 years. The most often reported problem (85.7%) was an ongoing limitation in basic daily activities. At least moderate sadness was experienced by 65.3% and disappointment by 73.5% of the patients. More than 80% reported concerns about the continuation and 73.5% about the progression of their symptoms. Out of 27 employees (55.1%), 63% could not work due to severe pain or movement limitation (p < .001). The inability to work was associated with anger (p = .037). The work-related impact of the cancellation was associated with stress (p < .0001) and concerns about continuing the symptoms (p = .004). Two-third of patients would undergo immediate surgery despite the current epidemic situation. CONCLUSIONS The cancellations of elective spinal surgeries have a serious psychological impact on patients. This together with potential economic consequences is especially evident in employees unable to work due to pain or movement disability. The information is beneficial for health management. Every effort should be made to resume planned surgical treatment if the epidemiological situation allows it.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Norbert Svoboda
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University and Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
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Youshani AS, Whittle C, Ghosh K. A risk assessment strategy to re-introduce elective neurosurgery patients during COVID-19. Br J Neurosurg 2024; 38:476-480. [PMID: 33829937 DOI: 10.1080/02688697.2021.1900540] [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] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To demonstrate the utilisation of a risk assessment protocol designed to prioritise elective neurosurgical patients against the risks of COVID-19. This tool can be applied to all other surgical specialties. DESIGN Prospective case series of 166 patients. SETTING Single-centre tertiary neurosurgical department. PARTICIPANTS All patients awaiting an elective neurosurgical procedure were included in this study. All emergency or life-threatening neurosurgical pathologies affecting patients were excluded. MAIN OUTCOME MEASURES The risk assessment tool identified patients with progressive neurology and stratified need for surgery against risk of harm during the COVID-19 pandemic. RESULTS Using our risk stratification tool, 6.6% patients required expedited surgery and a further 11.4% patients were removed completely from the waiting list. The majority of patients 47%, required surgery within 3 months. CONCLUSIONS This simple tool encourages surgical departments to establish contact with patients during COVID-19. The clinician acquires up-to-date information regarding patient symptomatology and subsequently determines surgical priority, a timescale required for surgery and overall uses of NHS resources efficiently. We recommend the use of this tool for all neurosurgical departments, with a wider application to other surgical specialties during the ongoing pressures of elective backlogs secondary to the persistent COVID-19 pandemic.
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Affiliation(s)
- Amir Saam Youshani
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Greater Manchester Neurosciences Centre, Manchester, UK
- Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Chelsea Whittle
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Kaushik Ghosh
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Kumar N, Akosman I, Mortenson R, Kumar A, Xu G, Lathrop C, Bakhmat K, Amen TB, Hussain I. Gender disparities in postoperative outcomes following elective spine surgery: a systematic review and meta-analysis. J Neurosurg Spine 2024; 40:420-427. [PMID: 38157525 DOI: 10.3171/2023.11.spine23979] [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: 09/01/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Several studies have described disparities between male and female patients following spine surgery, but no pooled analyses have performed a robust review characterizing differences in postoperative outcomes based on gender. The purpose of this study was to broadly assess the effects of gender on postoperative outcomes following elective spine surgery. METHODS Between November 2022 and March 2023, PubMed, MEDLINE, ERIC, and Embase were queried using artificial intelligence-assisted software for relevant cohort studies. Cohort studies with a minimum sample of 100 patients conducted in the United States since 2010 were eligible. Studies related to trauma, tumors, infections, and spinal cord pathology were excluded. Independent extraction by multiple reviewers was performed using Nested Knowledge software. A fixed- or random-effects model was used if heterogeneity among included studies in a meta-analysis was < 50% or ≥ 50%, respectively. Risk of bias was assessed independently by multiple reviewers using the Newcastle-Ottawa Scale. Pooled effect sizes were calculated for readmission, nonroutine discharge (NRD), length of stay (LOS), extended LOS, reoperation, mortality, all medical complications (individual analyses for cardiovascular, deep venous thrombosis/pulmonary embolism, genitourinary, neurological, respiratory, and systemic infection complications), and wound-related complications. For each outcome, two subanalyses were performed with studies that used either center-based (single- or multi-institution) or high-volume (national or state-wide) databases. RESULTS Across 124 included studies, male patients had an increased incidence of mortality (OR 0.54, p < 0.0001) and all medical complications (OR 0.80, p = 0.0114), specifically cardiovascular (OR 0.68, p < 0.0001) and respiratory (OR 0.76, p = 0.0008) complications. Female patients were more likely to experience a wound-related surgical complication (OR 1.16, p = 0.0183). These findings persisted in the high-volume database subanalyses. Only center-based subanalyses showed that female patients were at greater odds of experiencing an NRD (OR 1.18, p = 0.0476), longer LOS (SMD 0.23, p = 0.0036), and extended LOS (OR 1.28, p < 0.0001). CONCLUSIONS Males are more likely to experience death and medical complications, whereas females were more likely to face wound-related surgical complications. At the institution level, females more often experience NRD and longer hospital stays. These findings may better inform preoperative expectation management and provide more detailed postoperative risk assessments based on the patient's gender.
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Affiliation(s)
- Neerav Kumar
- 1Weill Cornell Medical College, New York, New York
| | | | | | | | - Grace Xu
- 4Princeton University, Princeton, New Jersey
| | - Cooper Lathrop
- 5Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Troy B Amen
- 7Hospital for Special Surgery, New York, New York; and
| | - Ibrahim Hussain
- 8Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
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18
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Ishida A, Ida M, Kinugasa Y, Nakatani H, Uyama K, Kawaguchi M. Early Quality of Recovery after Elective Cardiothoracic and Aortic Surgeries in Adult Patients: A Pilot Report. Ann Card Anaesth 2024; 27:144-148. [PMID: 38607878 DOI: 10.4103/aca.aca_183_23] [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] [Received: 11/17/2023] [Accepted: 01/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Patient-centered outcome measures should be evaluated postoperatively as the recovery after surgery varies between patients. We aimed to evaluate the feasibility, reliability, and trajectory of the quality of recovery-15 (QoR-15) in patients undergoing cardiothoracic and aortic surgeries. MATERIALS AND METHODS This retrospective study included adult patients who underwent elective cardiothoracic and aortic surgeries. The primary outcome was the QoR-15, with a minimal clinically important difference of 6.8, assessed on postoperative days (POD) 2, 4, and 7. The final analysis included patients with at least one valid outcome. Feasibility and reliability were assessed by the successful completion rate on each POD and using Cronbach's alpha of the QoR-15 on POD 4. A linear mixed model was used to evaluate the trajectory of the postoperative QoR-15 scores. RESULTS Of the 36 eligible patients, 30 with a mean age of 70 years were included in the final analysis. The successful completion rates on POD 2, 4, and 7 were 72.7%, 87.8%, and 87.8%, respectively. The mean QoR-15 scores on POD 2, 4, and 7 were 89.9, 98.0, and 108.3, respectively. The QoR-15 scores on POD 2 and 4 were not statistically different (P = 0.06) but were clinically significant. The QoR-15 score on POD 7 was statically (P < 0.001) and clinically higher than the QoR-15 score on POD 2. Cronbach's alpha for the QoR-15 score measured on POD 4 was 0.85. CONCLUSION The QoR-15 is a feasible and valid measurement after elective cardiothoracic surgery, which increases significantly over time after surgery.
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Affiliation(s)
- Ayu Ishida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Yuki Kinugasa
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
- Department of Medical Technical Center, Nara Medical University, Kashihara, Japan
| | - Hitomi Nakatani
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
- Department of Resource Nurse Center, Nara Medical University, Kashihara, Japan
| | - Kayo Uyama
- Department of Nursing, Nara Prefecture General Medical Center, Shichijo Nishimachi, Nara, Japan
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Shah P, Navarro Y, Thawanyarat K, Moody R, Ahmed A, Collar J, Holmes K, Yu J. Shifts in Reduction Mammaplasty Surgical Volumes With the Emergence of a Global Pandemic. Ann Plast Surg 2024; 92:e14-e18. [PMID: 38527343 DOI: 10.1097/sap.0000000000003807] [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: 03/27/2024]
Abstract
INTRODUCTION The onset of the COVID-19 pandemic resulted in significant changes to the surgical caseload for various surgery departments across the United States. As medical institutions prioritized resources for the expected increase in patient volumes due to the SARS-CoV-2 viral infection, surgical departments saw a decrease in nonemergent and elective surgical procedures. Reduction mammoplasties, which are largely covered by insurance, are among the elective procedures that provide significant revenue to the hospital. This expected decline in procedures suggests a potential decline in revenue provided by the plastic surgery department of a hospital. The purpose of this study was to analyze the loss of revenue experienced by a single academic medical institution due to changes in breast reduction mammoplasty volumes during the COVID-19 pandemic. METHODS Upon institutional review board approval, using the Augusta University Medical Center's Financial Billing Data, 373 patients who underwent bilateral reduction mammoplasty were queried. A time horizon of March 2019 to February 2022 was used to determine the pre- and post-COVID case load and charges that were incurred. Statistical analysis to compare the prior 12 months and after 24 months of COVID was conducted using 2 samples of equal variance t test and F test confirming equal variance. RESULTS There was a statistically significant increase in the number of reduction mammoplasties performed per month from the year before the onset of COVID-19 (March 2020) to the 2 years after (6.6-11.4 per month, P = 0.0024). There was a statistically significant increase in the per-month charges from the AU Health system for reduction mammoplasties for the same period ($31,780.92-$52,113.34 per month, P = 0.0054). Although there was an increase in per-month revenue from reduction mammoplasties, this increase failed to reach statistical significance ($7,059.95-$10,423.51 per month, P = 0.064). CONCLUSIONS The plastic surgery department saw a statistically significant increase in reduction mammoplasty cases and subsequent charges in the post-COVID cohort. These findings suggest that the emergence of a nationwide pandemic did not necessarily lead to a decrease in the volume of nonemergent surgical cases despite an expected decrease in caseload due to the need to reallocate hospital resources. On the contrary, there was an increase in caseload suggesting that there may be other factors contributing to patients' pursuance of reduction mammoplasty post-COVID including convenience, resulting from time off due to pandemic, meeting insurance-covered reduction criteria, and projected recovery time.
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Affiliation(s)
- Pearl Shah
- From the Medical College of Georgia at Augusta University, Augusta, GA
| | - Yelissa Navarro
- From the Medical College of Georgia at Augusta University, Augusta, GA
| | | | - Robert Moody
- From the Medical College of Georgia at Augusta University, Augusta, GA
| | - Asim Ahmed
- From the Medical College of Georgia at Augusta University, Augusta, GA
| | - John Collar
- Division of Plastic & Reconstructive Surgery, Yale School of Medicine, New Haven, CT
| | | | - Jack Yu
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Medical College of Georgia at Augusta University, Augusta, GA
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Joyner J, Ayyaz FM, Cheetham M, Briggs TWR, Gray WK. Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data. Hernia 2024; 28:555-565. [PMID: 38347244 DOI: 10.1007/s10029-023-02949-y] [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: 10/20/2023] [Accepted: 12/16/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery. METHODS This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. The primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level. RESULTS A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%. CONCLUSIONS There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.
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Affiliation(s)
- J Joyner
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK.
- Department of General Surgery, Croydon Health Services NHS Trust, Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK.
| | - F M Ayyaz
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M Cheetham
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - T W R Briggs
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
- Royal National Orthopaedic Hospital, London, UK
| | - W K Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, London, UK
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Chen M, Santa Mina D, Au D, Karkouti K, Alibhai S, Zywiel M, Randall I. Hospital-perspective cost-analysis of a nonrandomized trial of prehabilitation before major elective surgery. Can J Anaesth 2024; 71:550-552. [PMID: 38347312 DOI: 10.1007/s12630-024-02693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 04/01/2024] Open
Affiliation(s)
- Maggie Chen
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Darren Au
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shabbir Alibhai
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michael Zywiel
- Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ian Randall
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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22
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Grande L, Gimeno M, Jimeno J, Pera M, Sancho-Insenser J, Pera M. Continuous monitoring of adverse effects improves surgical outcomes. Cir Esp 2024; 102:209-215. [PMID: 38342137 DOI: 10.1016/j.cireng.2023.11.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/23/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registry in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department. MATERIALS AND METHODS All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded. RESULTS Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35.0% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1.0%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%). CONCLUSION A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital.
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Affiliation(s)
- Luis Grande
- Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departmento de Cirugía, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain.
| | - Marta Gimeno
- Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Jaime Jimeno
- Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain; Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Pera
- Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departmento de Cirugía, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
| | - Joan Sancho-Insenser
- Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departmento de Cirugía, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
| | - Miguel Pera
- Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departmento de Medicina y Ciencias de la Salud (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
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23
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Spath P, Campana F, Gallitto E, Pini R, Mascoli C, Sufali G, Caputo S, Sonetto A, Faggioli G, Gargiulo M. Impact of iliac access in elective and non-elective endovascular repair of abdominal aortic aneurysm. J Cardiovasc Surg (Torino) 2024; 65:85-98. [PMID: 38635284 DOI: 10.23736/s0021-9509.24.12987-4] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Endovascular aortic repair (EVAR) is nowadays the establishment treatment for patients with abdominal aortic aneurysm (AAA) both in elective and urgent setting. Despite the large applicability and satisfactory results, the presence of hostile iliac anatomy affects both technical and clinical success. This narrative review aimed to report the impact of iliac access and related adjunctive procedures in patients undergoing EVAR in elective and non-elective setting. Hostile iliac access can be defined in presence of narrowed, tortuous, calcified, or occluded iliac arteries. These iliac characteristics can be graded by the anatomic severity grade score to quantitatively assess anatomic complexity before undergoing treatment. Literature shows that iliac hostility has an impact on device navigability, insertion and perioperative and postoperative results. Overall, it has been correlated to higher rate of access issues, representing up to 30% of the first published EVAR experience. Recent innovations with low-profile endografts have reduced large-bore sheaths related issues. However, iliac-related complications still represent an issue, and several adjunctive endovascular and surgical strategies are nowadays available to overcome these complications during EVAR. In urgent settings iliac hostility can significantly impact on particular time sensitive procedures. Moreover, in case of severe hostility patients might be written off for EVAR repair might be inapplicable, exposing to higher mortality/morbidity risk in this urgent/emergent setting. In conclusion, an accurate anatomical evaluation of iliac arteries during preoperative planning, materials availability, and skilled preparation to face iliac-related issues are crucial to address these challenges.
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Affiliation(s)
- Paolo Spath
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy -
- Unit of Vascular Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy -
| | - Federica Campana
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Enrico Gallitto
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Vascular Surgery, IRCCS University Hospital S. Orsola, Bologna, Italy
| | - Rodolfo Pini
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Vascular Surgery, IRCCS University Hospital S. Orsola, Bologna, Italy
| | - Chiara Mascoli
- Unit of Vascular Surgery, IRCCS University Hospital S. Orsola, Bologna, Italy
| | - Gemmi Sufali
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefania Caputo
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessia Sonetto
- Unit of Vascular Surgery, IRCCS University Hospital S. Orsola, Bologna, Italy
| | - Gianluca Faggioli
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Vascular Surgery, IRCCS University Hospital S. Orsola, Bologna, Italy
| | - Mauro Gargiulo
- Unit of Vascular Surgery, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Vascular Surgery, IRCCS University Hospital S. Orsola, Bologna, Italy
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24
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De Simone B, Agnoletti V, Abu-Zidan FM, Biffl WL, Moore EE, Chouillard E, Coccolini F, Sartelli M, Podda M, Di Saverio S, Kaafarani H, Balogh ZJ, Bala M, Leppäniemi AK, Kirkpatrick AW, Pikoulis E, Rasa K, Rosato C, Sawyer R, Ansaloni L, de'Angelis N, Damaskos D, Stahel PF, Kluger Y, Coimbra R, Catena F. The Operating Room management for emergency Surgical Activity (ORSA) study: a WSES international survey. Updates Surg 2024; 76:687-698. [PMID: 38190080 DOI: 10.1007/s13304-023-01668-4] [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: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Despite advances and improvements in the management of surgical patients, emergency and trauma surgery is associated with high morbidity and mortality. This may be due in part to delays in definitive surgical management in the operating room (OR). There is a lack of studies focused on OR prioritization and resource allocation in emergency surgery. The Operating Room management for emergency Surgical Activity (ORSA) study was conceived to assess the management of operating theatres and resources from a global perspective among expert international acute care surgeons. METHOD The ORSA study was conceived as an international web survey. The questionnaire was composed of 23 multiple-choice and open questions. Data were collected over 3 months. Participation in the survey was voluntary and anonymous. RESULTS One hundred forty-seven emergency and acute care surgeons answered the questionnaire; the response rate was 58.8%. The majority of the participants come from Europe. One hundred nineteen surgeons (81%; 119/147) declared to have at least one emergency OR in their hospital; for the other 20/147 surgeons (13.6%), there is not a dedicated emergency operating room. Forty-six (68/147)% of the surgeons use the elective OR to perform emergency procedures during the day. The planning of an emergency surgical procedure is done by phone by 70% (104/147) of the surgeons. CONCLUSIONS There is no dedicated emergency OR in the majority of hospitals internationally. Elective surgical procedures are usually postponed or even cancelled to perform emergency surgery. It is a priority to validate an effective universal triaging and scheduling system to allocate emergency surgical procedures. The new Timing in Acute Care Surgery (TACS) was recently proposed and validated by a Delphi consensus as a clear and reproducible triage tool to timely perform an emergency surgical procedure according to the clinical severity of the surgical disease. The new TACS needs to be prospectively validated in clinical practice. Logistics have to be assessed using a multi-disciplinary approach to improve patients' safety, optimise the use of resources, and decrease costs.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France.
| | - Vanni Agnoletti
- Department of General and Emergency surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, USA
| | - Elie Chouillard
- Unit of Metabolic and General Surgery, Clinique St Louis, Poissy, France
| | - Federico Coccolini
- Department of General and Trauma Surgery, University Hospital of Pisa, Pisa, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Mauro Podda
- Department of General Surgery, University Hospital of Cagliari, Cagliari, Italy
| | - Salomone Di Saverio
- Department of General Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Haytham Kaafarani
- Department of Emergency and Trauma Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, USA
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Ari K Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Chiara Rosato
- Department of Emergency and General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Robert Sawyer
- General Surgery Department, Western Michigan University, Kalamazoo, MI, USA
| | - Luca Ansaloni
- Department of General Surgery, University Hospital of Pavia, Pavia, Italy
| | - Nicola de'Angelis
- Colorectal and Digestive Surgery Unit, DIGEST Department Beaujon University Hospital (AP-HP), University Paris Cité, Paris, France
| | - Dimitris Damaskos
- Department of General Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Raul Coimbra
- Riverside University Health System Medical Center and Loma Linda University School of Medicine, Loma Linda, USA
| | - Fausto Catena
- Department of General and Emergency surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy
- eCampus University, CREAS, Ser.In.Ar. Bologna University, Bologna, Italy
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25
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Althans AR, Kumpati B, Lavage DR, Esper SA, Subramaniam K, Boisen ML, Holder-Murray J. Use of Perioperative Intravenous Lidocaine as Part of an Abdominal Surgery Enhanced Recovery Pathway Does Not Significantly Impact Postoperative Pain. Am Surg 2024; 90:624-630. [PMID: 37786239 DOI: 10.1177/00031348231204916] [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] [Indexed: 10/04/2023]
Abstract
BACKGROUND The utility of perioperative intravenous lidocaine in improving postoperative pain control remains unclear. We aimed to compare postoperative pain outcomes in ERP abdominal surgery patients who did vs did not receive intravenous lidocaine. We hypothesized that patients receiving lidocaine would have lower postoperative pain scores and consume fewer opioids. METHODS We performed a retrospective cohort study of patients undergoing elective abdominal surgery at a single institution via an ERP from 2017 to 2018. Patients who received lidocaine in the 6 months prior to a lidocaine shortage were compared to those who did not receive lidocaine for 6 months following the shortage. The primary outcome measures were pain scores as measured on the visual analogue scale and opioid consumption as measured by oral morphine equivalents (OME). RESULTS We identified 1227 consecutive ERP abdominal surgery patients for inclusion (519 patients receiving lidocaine and 708 patients not receiving lidocaine). Demographics between the two cohorts were similar, with the following exceptions: more females, and more patients with a history of psychiatric diagnoses in the group that did not receive lidocaine. Adjusted, mixed linear models for both OME (P = .23) and pain scores (P = .51) found no difference between the lidocaine and no lidocaine groups. DISCUSSION In our study of ERP abdominal surgery patients, perioperative intravenous lidocaine did not offer improvement in postoperative pain scores or OME consumed. We therefore do not recommend the use of intravenous lidocaine as part of an ERP multimodal pain management strategy in abdominal surgery patients.
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Affiliation(s)
- Alison R Althans
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Danielle R Lavage
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen A Esper
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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26
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Cook TM, Kane AD, Bouch C, Armstrong RA, Kursumovic E, Soar J. Independent sector and peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:380-388. [PMID: 38173350 DOI: 10.1111/anae.16175] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 01/05/2024]
Abstract
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest including those that occurred in the independent healthcare sector, which provides around 1 in 6 NHS-funded care episodes. In total, 174 (39%) of 442 independent hospitals contacted agreed to participate. A survey examining provider preparedness for cardiac arrest had a response rate of 23 (13%), preventing useful analysis. An activity survey with 1912 responses (from a maximum of 45% of participating hospitals) showed that, compared with the NHS caseload, the independent sector caseload was less comorbid, with fewer patients at the extremes of age or who were severely obese, and with a large proportion of elective orthopaedic surgery undertaken during weekday working hours. The survey suggested suboptimal compliance rates with monitoring recommendations. Seventeen reports of independent sector peri-operative cardiac arrest comprised 2% of NAP7 reports and underreporting is likely. These patients were lower risk than NHS cases, reflecting the sector's case mix, but included cases of haemorrhage, anaphylaxis, cardiac arrhythmia and pulmonary embolus. Good and poor quality care were seen, the latter including delayed recognition and treatment of patient deterioration, and poor care delivery. Independent sector outcomes were similar to those in the NHS, though due to the case mix, improved outcomes might be anticipated. Assessment of quality of care was less often favourable for independent sector reports than NHS reports, though assessments were often uncertain, reflecting poor quality reports. Overall, NAP7 is unable to determine whether peri-operative care relating to cardiac arrest is more, equally or less safe than in the NHS.
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Affiliation(s)
- T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- Royal College of Anaesthetists, London, UK
| | - C Bouch
- Department of Anaesthesia and Critical Care Medicine, Leicester Royal Infirmary, Leicester, UK
| | - R A Armstrong
- Royal College of Anaesthetists, London, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Royal College of Anaesthetists, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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27
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Joshi A, Shrestha D. Surgical Service Utilization and In-Patient Satisfaction in Surgical Service. J Nepal Health Res Counc 2024; 21:667-671. [PMID: 38616600 DOI: 10.33314/jnhrc.v21i4.5011] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The patient satisfaction study is an important and commonly used valid indicator for service quality improvement in healthcare institutions. The aim of this study was to assess the service utilization and patient satisfaction in patients admitted under surgical service in Bir Hospital. METHODS A prospective cross sectional analytical study was conducted in Bir Hospital, National Academy of Medical Sciences from February 2021 till June 2023. The patient satisfaction data was collected using the SAPS scale after obtaining ethical clearance from the Institutional Review Board. Data were entered and analyzed in Statistical Package for the Social Sciences version 20.0. RESULTS There were 152 patients included in the study categorized into conservative treatment group, elective surgery group and emergency surgery group. 32.9%(50) patients were "very satisfied", 62.5%(95) patients were "satisfied", 2.6%(4) were "neither satisfied nor dissatisfied" and 2%(3) were "dissatisfied" with the effect of their treatment/care. The mean satisfaction score in conservative treatment group was 22.13 ±2.53 as compared to the mean satisfaction in elective surgery group which was 21.11± 2.55 (P=0.036) and the mean satisfaction score in emergency surgery group which was 21.66 ±2.68 (P=0.64). CONCLUSIONS The mean score and proportion of patient satisfaction regarding service utilization in patients admitted under surgical service were high with satisfaction score higher in emergency surgery group among the operative groups in Bir Hospital, National Academy of Medical Sciences.
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Affiliation(s)
- Anip Joshi
- Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Deepa Shrestha
- Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
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28
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Hill AG, Jin J. Enhanced recovery after surgery: an update for the generalist. Med J Aust 2024; 220:229-230. [PMID: 38311817 DOI: 10.5694/mja2.52224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Andrew G Hill
- Te Whatu Ora Counties Manukau, University of Auckland, Auckland, New Zealand
| | - James Jin
- Te Whatu Ora Counties Manukau, University of Auckland, Auckland, New Zealand
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29
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Pazin-Filho A, do Valle Dallora MEL, Velasco TR, Cardoso Dos Santos RDO, Volpe GJ, Moroço DM, de Souza DA, Canabrava CM, Garcia LV, Joviliano EE, Maciel BC. Surgical waiting lists and queue management in a Brazilian tertiary public hospital. BMC Health Serv Res 2024; 24:290. [PMID: 38448876 PMCID: PMC10916210 DOI: 10.1186/s12913-024-10735-4] [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: 07/09/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.
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Affiliation(s)
- Antonio Pazin-Filho
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | | | - Tonicarlo Rodrigues Velasco
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Gustavo Jardim Volpe
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Diego Marques Moroço
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Danilo Arruda de Souza
- Clinical Hospital - Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Luis Vicente Garcia
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | - Benedito Carlos Maciel
- Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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30
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McCahon JAS, Lynch JC, Radack T, Austin LS. Surprise Billing in Elective Shoulder Surgery and Its Effect on Patient Satisfaction. Orthopedics 2024; 47:123-127. [PMID: 37757751 DOI: 10.3928/01477447-20230922-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Patients often receive multiple bills following surgery, which may come as a surprise to them if they are not appropriately informed or educated prior to surgery. The purpose of this study was to identify whether surprise billing occurs following shoulder rotator cuff repair and its effect on patient satisfaction. The study surveyed adult patients who underwent elective rotator cuff repair from January 2020 to October 2021. Patients were asked if they received unexpected bills after their surgery, as well as about details regarding those bills. Additionally, patients were asked about their medical insurance carrier, knowledge of the billing process prior to surgery, and how they felt the process could be improved. Finally, patients were asked how these bills and the overall billing process affected their surgical satisfaction. Of the 158 responses, 25% of the patients stated they received at least one surprise bill following their rotator cuff surgery, with 57% of these bills being greater than $1000. Patients who received surprise bills reported being significantly less satisfied with their surgery (P<.001) and felt their billing experience affected their surgical satisfaction (64% vs 9%, P<.001). One in 4 patients undergoing elective rotator cuff repair received a surprise bill following surgery. These bills were monetarily substantial and significantly affected surgical satisfaction. Although surgeons may be unable to limit the amount of bills patients receive postoperatively, increased communication and education regarding the perioperative billing process may prove to be beneficial for both patient satisfaction and the physician-patient relationship. [Orthopedics. 2024;47(2):123-127.].
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31
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Simurda T, Drotarova M, Skornova I, Dobrotova M, Brunclikova M, Necas L, Cibula Z, Kubisz P, Stasko J. Perioperative Monitoring with Rotational Thromboelastometry in a Severe Hemophilia A Patient Undergoing Elective Ankle Surgery. Semin Thromb Hemost 2024; 50:310-313. [PMID: 37075775 DOI: 10.1055/s-0043-57009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Tomas Simurda
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Miroslava Drotarova
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Ingrid Skornova
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Miroslava Dobrotova
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Monika Brunclikova
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Libor Necas
- Department of Orthopedics, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Zoltan Cibula
- Department of Orthopedics, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Peter Kubisz
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
| | - Jan Stasko
- National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Martin, Slovakia
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Singh M, Wells K, Leary OP, Guglielmo MA. Reliance on Pain Medications Following Elective Spinal Surgery. World Neurosurg 2024; 183:257-258. [PMID: 38245483 DOI: 10.1016/j.wneu.2023.12.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
- Manjot Singh
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Katrina Wells
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Owen P Leary
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Maria A Guglielmo
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Schaefer SL, Dualeh SHA, Kunnath N, Scott JW, Ibrahim AM. Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage Areas, 2015-19. Health Aff (Millwood) 2024; 43:363-371. [PMID: 38437607 DOI: 10.1377/hlthaff.2023.00843] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Primary care physicians are often the first to screen and identify patients with access-sensitive surgical conditions that should be treated electively. These conditions require surgery that is preferably planned (elective), but, when access is limited, treatment may be delayed and worsening symptoms lead to emergency surgery (for example, colectomy for cancer, abdominal aortic aneurysm repair, and incisional hernia repair). We evaluated the rates of elective versus emergency surgery for patients with three access-sensitive surgical conditions living in primary care Health Professional Shortage Areas during 2015-19. Medicare beneficiaries in more severe primary care shortage areas had higher rates of emergency surgery compared with rates in the least severe shortage areas (37.8 percent versus 29.9 percent). They were also more likely to have serious complications (14.9 percent versus 11.7 percent) and readmissions (15.7 percent versus 13.5 percent). When we accounted for areas with a shortage of surgeons, the findings were similar. Taken together, these findings suggest that residents of areas with greater primary care workforce shortages may also face challenges in accessing elective surgical care. As policy makers consider investing in Health Professional Shortage Areas, our findings underscore the importance of primary care access to a broader range of services.
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Affiliation(s)
- Sara L Schaefer
- Sara L. Schaefer , University of Michigan, Ann Arbor, Michigan
| | | | | | - John W Scott
- John W. Scott, University of Washington, Seattle, Washington
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Chilaka S, Samuel EMK, Mude NN, G B, Badhe B, Nagarajan RK. Comparison of conventional unstained lymph nodal harvesting vs methylene blue-stained lymph nodal harvesting in colorectal specimen in staging left-sided colorectal carcinoma: a randomized controlled trial. J Gastrointest Surg 2024; 28:199-204. [PMID: 38445909 DOI: 10.1016/j.gassur.2023.11.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/19/2023] [Accepted: 11/04/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND The management and prognosis of colorectal carcinomas (CRCs) are related to the stage of the disease, which, in turn, relies on the lymph node harvest from the surgical specimen. The guidelines recommend that at least 12 lymph nodes are required, which is not achieved in most resections. In this study, we propose a method to improve the lymph node yield in such cases. This study aimed to determine whether ex vivo injection of methylene blue into the inferior mesenteric artery or its branches improves lymph node retrieval in left-sided CRCs. METHODS This study was conducted as a single-center, double-blinded, superiority randomized controlled trial. Patients who underwent elective surgery for left-sided CRCs with curative intent were randomized into 2 groups: stained and unstained. The sample size was calculated as 66. In all patients, details of disease stage, history of neoadjuvant therapy, and number of isolated lymph nodes were recorded. RESULTS The mean number of lymph nodes extracted from the stained group was significantly higher than that from the unstained group (15.9 ± 5.2 vs 9.1 ± 5.7, respectively; P < .001). Among the patients who had received neoadjuvant therapy, the yield was higher in the stained group (P < .001). The yield was found to be greater in patients who had undergone upfront surgery than in those who had undergone neoadjuvant therapy, even in the stained group (100% vs 66.7%, respectively). CONCLUSION The use of methylene blue injection into resected specimens of left-sided CRCs significantly improved the lymph node yield.
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Affiliation(s)
- Suresh Chilaka
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Naveen Naik Mude
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balasubramanian G
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Bhawana Badhe
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raj Kumar Nagarajan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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Huynh D, Shao J. Tobacco cessation prior to elective abdominal wall reconstruction: A smoking gun? Am J Surg 2024; 229:50-51. [PMID: 38123385 DOI: 10.1016/j.amjsurg.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Desmond Huynh
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jenny Shao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Sather K, Popma E, Masten C, Diaz J, Brunsvold M, D'Emilia J, Tuttle TM. Global surgery in our own backyard: The creation and implementation of an elective general surgery resident rotation at the northern Navajo medical center. Am J Surg 2024; 229:179-181. [PMID: 37926669 DOI: 10.1016/j.amjsurg.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Kristiana Sather
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Minneapolis, MN, 55455, United States.
| | - Emily Popma
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Minneapolis, MN, 55455, United States
| | - Cristina Masten
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Minneapolis, MN, 55455, United States
| | - Jessica Diaz
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Minneapolis, MN, 55455, United States
| | - Melissa Brunsvold
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Minneapolis, MN, 55455, United States
| | - John D'Emilia
- Northern Navajo Medical Center, Department of Surgery, US-491, Shiprock, NM, 87420, United States
| | - Todd M Tuttle
- University of Minnesota, Department of Surgery, 420 Delaware Street SE, Minneapolis, MN, 55455, United States
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Bräuner KB, Tsouchnika A, Mashkoor M, Williams R, Rosen AW, Hartwig MFS, Bulut M, Dohrn N, Rijnbeek P, Gögenur I. Prediction of 30-day, 90-day, and 1-year mortality after colorectal cancer surgery using a data-driven approach. Int J Colorectal Dis 2024; 39:31. [PMID: 38421482 PMCID: PMC10904562 DOI: 10.1007/s00384-024-04607-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To develop prediction models for short-term mortality risk assessment following colorectal cancer surgery. METHODS Data was harmonized from four Danish observational health databases into the Observational Medical Outcomes Partnership Common Data Model. With a data-driven approach using the Least Absolute Shrinkage and Selection Operator logistic regression on preoperative data, we developed 30-day, 90-day, and 1-year mortality prediction models. We assessed discriminative performance using the area under the receiver operating characteristic and precision-recall curve and calibration using calibration slope, intercept, and calibration-in-the-large. We additionally assessed model performance in subgroups of curative, palliative, elective, and emergency surgery. RESULTS A total of 57,521 patients were included in the study population, 51.1% male and with a median age of 72 years. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.88, 0.878, and 0.861 for 30-day, 90-day, and 1-year mortality, respectively, and a calibration-in-the-large of 1.01, 0.99, and 0.99. The overall incidence of mortality were 4.48% for 30-day mortality, 6.64% for 90-day mortality, and 12.8% for 1-year mortality, respectively. Subgroup analysis showed no improvement of discrimination or calibration when separating the cohort into cohorts of elective surgery, emergency surgery, curative surgery, and palliative surgery. CONCLUSION We were able to train prediction models for the risk of short-term mortality on a data set of four combined national health databases with good discrimination and calibration. We found that one cohort including all operated patients resulted in better performing models than cohorts based on several subgroups.
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Affiliation(s)
- Karoline Bendix Bräuner
- Center for Surgical Science, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Andi Tsouchnika
- Center for Surgical Science, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - Maliha Mashkoor
- Center for Surgical Science, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | - Ross Williams
- Department of Medical Informatics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Holland, Netherlands
| | - Andreas Weinberger Rosen
- Center for Surgical Science, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark
| | | | - Mustafa Bulut
- Center for Surgical Science, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark
- University of Copenhagen, The Faculty of Health Science, Blegdamsvej 6, 2200, Copenhagen N, Denmark
| | - Niclas Dohrn
- Center for Surgical Science, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark
- Department of Surgery, Copenhagen University Hospital, Herlev & Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Holland, Netherlands
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Køge, Lykkebækvej 1, 4600, Køge, Denmark
- University of Copenhagen, The Faculty of Health Science, Blegdamsvej 6, 2200, Copenhagen N, Denmark
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Khanderia E, Aggarwal R, Bouras G, Patel V. Quality of life after emergency laparotomy: a systematic review. BMC Surg 2024; 24:73. [PMID: 38409008 PMCID: PMC10898072 DOI: 10.1186/s12893-024-02337-y] [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: 11/05/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Emergency laparotomy is a commonly performed surgical procedure that has higher post-operative morbidity and mortality than elective surgery. Previous research has identified that patients valued postoperative quality of life (QoL) more than the risk of mortality when deciding to undergo emergency surgery. Current pre-operative scoring and risk stratification systems for emergency laparotomy do not account for or provide prediction tools for post-operative QoL. This study aims to systematically review previous literature to determine post-operative QoL in patients who undergo emergency laparotomy. METHODS A literature search was undertaken in Medline, EMBASE and the Cochrane Library to identify studies measuring post-operative QoL in patients who have had emergency laparotomy up to 29th April 2023. Mean QoL scores from the studies included were combined to calculate the average effect of emergency laparotomy on QoL. The primary outcome of the review was postoperative QoL after emergency laparotomy when compared with a comparator group. Secondary outcomes included the quality of included studies. RESULTS Ten studies in the literature assessing the QoL of patients after emergency laparotomy were identified. Three studies showed that patients had improved QoL and seven showed worse QoL following emergency laparotomy. Length of time for QoL to return to baseline varied ranged from 3 to 12 months post-operatively. Length of hospital stay was identified as an independent risk factor for poorer QoL post-surgery. CONCLUSIONS Outcome reporting for patients who undergo emergency laparotomy should be expanded further to include QoL. Further work is required to investigate this and elicit factors that can improve QoL post-operatively.
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Affiliation(s)
- Esha Khanderia
- Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK.
| | - Ravi Aggarwal
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - George Bouras
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Vanash Patel
- Watford General Hospital, West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
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Wang Z, Liu M, Men H, Lyu C, Zheng N. Association between preoperative hemoglobin with length of hospital stay among non-cardiac and non-obstetric surgery patients: a secondary analysis of a retrospective cohort study. J Cardiothorac Surg 2024; 19:97. [PMID: 38365787 PMCID: PMC10870523 DOI: 10.1186/s13019-024-02566-5] [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: 07/05/2023] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Previous studies concerning the association between preoperative Hemoglobin (HB) level and the Length Of hospital Stay (LOS) in patients with non-cardiac surgery and non-obstetric surgery remain inconclusive. Herein, the objective of this study was to analyze whether and to what extent the preoperative HB level was connected with the LOS in non-cardiac and non-obstetric surgery patients. METHODS This retrospective cohort study was performed at a single institution, involving patients who underwent elective non-cardiac, non-obstetric surgery from April 2007 to September 2013. Clinical characteristics of patients such as demographics, comorbidities, preoperative HB level, LOS, mortality, procedure length, and pulmonary hypertension (PHTN) Severity Class data were collected. A univariate analysis was used to determine the association between clinical characteristics and LOS. Multivariate regression analysis was conducted to investigate the relationship between preoperative HB level and LOS. RESULTS AND DISCUSSION In this study, 311 patients were included. We observed that compared with the LOS > 7 days group, the average HB level of patients in the LOS ≤ 7 days group was higher (12.04 ± 2.20 g/dl vs. 10.92 ± 2.22 g/dl, p < 0.001). In addition, there were fewer patients with moderate-to-severe anemia in LOS ≤ 7 days group than the LOS > 7 days group (32.74% vs 58.82%, p < 0.001). In addition, we found that patients with LOS ≤ 7 days were accompanied with lower mortality (0.44% vs. 7.06%, p < 0.001) and lower mean combined pulmonary artery systolic pressure (PASP) and right ventricular systolic pressure (RVSP) than that in patients with LOS > 7 days (42.56 ± 11.97 vs. 46.00 ± 12.37, p < 0.05). After controlling for relevant confounders, we discovered a nonlinear association between preoperative HB level and LOS as well as a threshold effect based on LOS. Specifically, when preoperative HB level was less than 11.9 g/dL, LOS decreased by 2 days for each 1 g/dL increase in HB level. However, LOS did not alter substantially with the rise of preoperative HB level when it was higher than 11.9 g/dL. CONCLUSION Our study showed a close non-linear association between preoperative HB level and LOS in patients with non-cardiac surgery and non-obstetric surgery. In particular, for patients with preoperative HB less than 11.9 g/dL, increasing the preoperative HB level can help shorten the LOS after operation.
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Affiliation(s)
- Zhaopeng Wang
- Department of General Medicine, Tianjin Beichen Hospital, Beichen District, Tianjin, 300400, China
| | - Min Liu
- Department of Clinical Laboratory, Tianjin Beichen Hospital, Beichen District, Tianjin, 300400, China
| | - Hengtong Men
- Department of General Medicine, Tianjin Beichen Hospital, Beichen District, Tianjin, 300400, China
| | - Chunfeng Lyu
- Department of General Medicine, Tianjin Beichen Hospital, Beichen District, Tianjin, 300400, China
| | - Ning Zheng
- Department of General Medicine, Tianjin Beichen Hospital, Beichen District, Tianjin, 300400, China.
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Ayalew TL. Case cancellations and associated factors on the day of surgery in hospitals of Wolaita Zone, South Ethiopia. BMC Surg 2024; 24:45. [PMID: 38311751 PMCID: PMC10840272 DOI: 10.1186/s12893-024-02330-5] [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: 08/19/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Cancellations of elective surgery cases are frequent and have significant negative consequences. It causes wasting of valuable resources, patient unhappiness, and psychological stress of patients. Despite this, little is known about the case cancellation and associated factors on the day of surgery in Ethiopia, particularly in the study area. OBJECTIVE This study aimed to assess the magnitude of case cancellation and associated factors on the day of surgery in hospitals in Wolaita zone, South Ethiopia, from May 17 to June 17, 2023. METHODS A hospital-based cross-sectional study involving 322 patients was conducted at Wolaita Sodo Zone, South Ethiopia. All elective surgical cases scheduled during the study period were included. The entire number of participants was selected using a systematic random sampling process. Epidata V.3 was used to enter data, and SPSS V.25 was used to analyze it. Binary logistic regression was used to check for a possible association. P-values < 0.05 and 95% CI were used on multi-variable analysis as the threshold for the significant statistical association. RESULT A total of 313 study participants were scheduled for elective surgical procedures during the study period and gave a response rate of 97.2%. The mean (± SD) age of the study participants was 39.18 (± 10.64) years. The two-third of patients, 53(64%) were rural residents, and more than half (178, or 55.3%) of the participants were female. This finding showed that the case cancellation was 22.4% (95% CI: 19.3 -25.9%). Among the total canceled cases, 49(58.3%) were males. Variables like rural residence (AOR = 3.48 95% CI: 1.22-9.95), Lack of lab result (AOR = 2.33, 95%CI:1.20-4.51), ophthalmology dept. (AOR = 2.53 95% CI:1.52-4.49), HTN (AOR = 2.53, 95% CI:1.52-4.49), patient refusal (AOR = 3.01 95% CI:1.22-5.05), and age b/n 31 and 43 (AOR = 1.50, 95% CI:1.02-2.01) were significantly associated factors with cancellation of elective surgical cases. CONCLUSION In this study schedule of case cancellation was high. The contributing factors of case cancellation were rural residence, Lack of lab results, ophthalmology dept, HTN, patient refusal, and age. To decrease unnecessary cancellations and increase cost efficiency, hospital administration and medical staff must plan ahead carefully, communicate effectively, and make efficient use of hospital resources.
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Affiliation(s)
- Tadele Lankrew Ayalew
- Department of Nursing, College of medicine and health science, Wolaita Sodo University, Wolaita, Ethiopia.
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Lauzier DC, Cler SJ, Chatterjee AR, Osbun JW, Vellimana AK, Derdeyn CP, Cross DT, Moran CJ, Kansagra AP. In-hospital imaging utilization after elective endovascular brain aneurysm treatment: a surrogate metric for the value of hospitalization. J Neurosurg 2024; 140:430-435. [PMID: 37548550 DOI: 10.3171/2023.5.jns23656] [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: 03/23/2023] [Accepted: 05/30/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Despite the adoption of same-day outpatient surgical procedures in some specialties, it remains common practice to admit patients for monitoring after elective endovascular treatment of brain aneurysms to monitor for complications. The necessity of such monitoring has not been fully characterized. Here, the authors reviewed the utilization of imaging during posttreatment hospitalization, a surrogate measure for workup of suspected complications requiring hospital resources, to infer the value of inpatient monitoring after endovascular aneurysm treatment. METHODS Clinical and angiographic data from eligible patients were retrospectively assessed for demographic characteristics, imaging indications, timing of imaging, and imaging findings. Patients were included if they underwent elective endovascular brain aneurysm treatment, and patients were excluded if significant intraprocedural complications occurred. The recorded imaging modalities included CT, MRI, catheter-based imaging, and ultrasound; plain radiographs were excluded. Multivariable logistic regression analysis was performed to identify predictors of the need for posttreatment imaging. RESULTS In total, 1229 elective endovascular procedures for brain aneurysm treatment were included. Patients underwent imaging before discharge in 13.4% (165/1229) of cases, with significant findings in 5.0% (61/1229) of cases. The median (interquartile range) time to first posttreatment imaging was 13.2 (4.2-22.8) hours. The need for imaging during posttreatment hospitalization was positively associated with larger aneurysm size (p < 0.05) and negatively associated with underlying cardiovascular disease (p < 0.05). CONCLUSIONS More than 1 in 8 patients who underwent elective endovascular brain aneurysm treatment required imaging during posttreatment hospitalization, most within the first 24 hours, and 1 in 20 had significant findings. These results suggest the importance of short-term hospitalization after elective endovascular aneurysm treatment.
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Affiliation(s)
- David C Lauzier
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Samuel J Cler
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Arindam R Chatterjee
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- 3Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua W Osbun
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- 3Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Ananth K Vellimana
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- 3Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Colin P Derdeyn
- 4Department of Radiology, University of Iowa School of Medicine, Iowa City, Iowa; and
| | - Dewitte T Cross
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher J Moran
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- Departments of2Neurological Surgery and
| | - Akash P Kansagra
- 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
- 3Neurology, Washington University School of Medicine, St. Louis, Missouri
- 5Department of Neurointerventional Surgery, California Center for Neurointerventional Surgery, San Diego, California
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Tang P, Newton P, Mori K. Impact of COVID-19 on surgical exposure and training for general surgery trainees in Australia: a national audit. ANZ J Surg 2024; 94:78-83. [PMID: 38115547 DOI: 10.1111/ans.18837] [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: 06/05/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The COVID-19 pandemic has caused a major disruption in operative volumes over the last few years, which has directly impacted on surgical training. This study aims to quantify the impact of COVID-19 and the relevant restrictions on General Surgery trainees in Australia. METHODS Logbook data of General Surgery trainees from 2019 to 2021 was analysed and compared to assess the impact of COVID-19 on operative numbers and supervision levels during major operations. RESULTS There was a statistically significant reduction in overall operative numbers in Australia, with a decrease of 2.0% in 2020 (IRR 0.980, 95% CI 0.973-0.986, P < 0.001) and 6.8% in 2021 (IRR 0.932, 95% CI 0.926-0.938, P < 0.001). Elective operations reduced by 6.6% in 2020 (IRR 0.934, 95% CI 0.927-0.942, P < 0.001) and 10.3% in 2021 (IRR 0.934, 95% CI 0.927-0.942, P < 0.001). Victoria and NT were the most affected jurisdictions; while hepatobiliary, trauma and surgical oncology were the most affected subspecialties. The proportion of overall primary operating has significantly decreased (41.8% vs. 40.2%, P < 0.001) between 2019 and 2020, and decreased further to 39.7% in 2021. CONCLUSION The COVID-19 pandemic has had an overall negative impact on surgical training in General Surgery. Efforts should be directed at minimizing detraining of trainees and further disruptions to their training.
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Affiliation(s)
- Patrick Tang
- Department of Surgery, Northern Health, Victoria, Australia
- Department of Surgery, Austin Health, Victoria, Australia
| | - Peter Newton
- Department of Surgery, Northern Health, Victoria, Australia
| | - Krinal Mori
- Department of Surgery, Northern Health, Victoria, Australia
- Northern Clinical School, The University of Melbourne, Epping, Victoria, Australia
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Abdullah HR, Lim DYZ, Ke Y, Salim NNM, Lan X, Dong Y, Feng M. The SingHealth Perioperative and Anesthesia Subject Area Registry (PASAR), a large-scale perioperative data mart and registry. Korean J Anesthesiol 2024; 77:58-65. [PMID: 37935575 PMCID: PMC10834714 DOI: 10.4097/kja.23580] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/28/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area Registry (PASAR) to unify data from the preoperative, intraoperative, and postoperative stages. This study presents the methodology employed to create this database. METHODS Since 2016, data from surgical patients have been collected from the hospital electronic medical record systems, de-identified, and stored securely in compliance with privacy and data protection laws. As a representative sample, data from initiation in 2016 to December 2022 were collected. RESULTS As of December 2022, PASAR data comprise 26 tables, encompassing 153,312 patient admissions and 168,977 operation sessions. For this period, the median age of the patients was 60.0 years, sex distribution was balanced, and the majority were Chinese. Hypertension and cardiovascular comorbidities were also prevalent. Information including operation type and time, intensive care unit (ICU) length of stay, and 30-day and 1-year mortality rates were collected. Emergency surgeries resulted in longer ICU stays, but shorter operation times than elective surgeries. CONCLUSIONS The PASAR provides a comprehensive and automated approach to gathering high-quality perioperative patient data.
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Affiliation(s)
- Hairil Rizal Abdullah
- Department of Anesthesiology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Daniel Yan Zheng Lim
- Duke-NUS Medical School, Singapore
- Department of Gastroenterology, Singapore General Hospital, Singapore
| | - Yuhe Ke
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | | | - Xiang Lan
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| | - Yizhi Dong
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
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Tran BW, Nelson M, Pal N. Association of preoperative anaesthesia consultation before elective noncardiac surgery with patient and health system outcomes. Comment on Br J Anaesth 2023; 131: 937-46. Br J Anaesth 2024; 132:433-434. [PMID: 38042724 DOI: 10.1016/j.bja.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/04/2023] Open
Affiliation(s)
- Bryant W Tran
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
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45
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Zhou HY, Fei YD, Quan X. [Comparison of Two Methods With a Left-Sided Double-Lumen Tube for Endobronchial Intubation]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2024; 46:39-42. [PMID: 38433629 DOI: 10.3881/j.issn.1000-503x.15809] [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] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Objective To compare the success rates of two methods for endobronchial intubation:the left-sided double-lumen tube(DLT) rotated 90° counter-clockwise with the patient head at the mid positon and the tube rotated 180° counter-clockwise with the patient head turned to the right. Methods Six hundred and forty-eight patients were enrolled in this study,who were to undergo elective thoracic surgery by left-sided DLT intubation in the Peking Union Medical College Hospital from December 2021 to June 2022.They were randomized into a 90° group and a 180° group,with 324 patients in each group.In the 90° group,with the patient head kept at the mid position,the left-sided DLT was advanced until the bronchial cuff passed the vocal cords and then rotated 90° counter-clockwise.In the 180°group,with the left mandible angle of each patient in the straight line with the sternum,the tube was advanced until the bronchial cuff passed the vocal cords and then rotated 180° counter-clockwise.The intubation success rate and the intubation-related complications such as carina mucosal injuries were compared between the two groups. Results The 648 patients included 336 males and 312 females,with the age ranging from 39.0 to 75.0 years old and the average age of(54.6±9.0) years old.The success rate of first intubation was 80.3% in the 90° group and 75.0% in the 180° group,which showed no significant difference(P=0.109).The success rate of second intubation was higher in the 180° group than in the 90° group(P<0.001).The rate of carina mucosal injuries was 23.8% in the 90° group and 25.6% in the 180° group,which showed no significant difference(P=0.585). Conclusions Compared with the conventional method(90°),the intubation of the left-sided DLT rotated 180° counter-clockwise with the patient head turned to the right cannot improve the success rate of the first intubation.However,it could improve the success rate of reintubation as a remedy.
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Affiliation(s)
- Hui-Ying Zhou
- Department of Anaesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Yu-da Fei
- Department of Anaesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Xiang Quan
- Department of Anaesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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46
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Chamberland C, Bransi M, Boivin A, Jacques S, Gagnon J, Tremblay S. The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial. Paediatr Anaesth 2024; 34:153-159. [PMID: 37925608 DOI: 10.1111/pan.14793] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND AND AIMS Virtual reality has been shown to be an effective non-pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention. METHODS Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale. RESULTS The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0-10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: -4.2 [-5.2-4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention. CONCLUSION To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.
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Affiliation(s)
| | - Myriam Bransi
- Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Ariane Boivin
- Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Sandra Jacques
- Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Joël Gagnon
- Université Laval, Quebec City, Quebec, Canada
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D'Oria M, Scali S, Stone D. Response to: "Re. Beyond BMI: Exploring Body Composition's Role in Long Term Outcome of Elective Abdominal Aortic Aneurysm Repair". Eur J Vasc Endovasc Surg 2024; 67:358. [PMID: 37689307 DOI: 10.1016/j.ejvs.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste, Italy.
| | - Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - David Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
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Daly S, Mohamed O, Loughrey J, Kearsley R, Drew T. 'Sip 'til Send': a prospective study of the effect of a liberal fluid fasting policy on patient reported and haemodynamic variables at elective caesarean delivery. Int J Obstet Anesth 2024; 57:103956. [PMID: 38030525 DOI: 10.1016/j.ijoa.2023.103956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Affiliation(s)
- S Daly
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - O Mohamed
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - J Loughrey
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - R Kearsley
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - T Drew
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland.
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Kalata S, Schaefer SL, Nuliyahu U, Ibrahim AM, Nathan H. Low-Volume Elective Surgery and Outcomes in Medicare Beneficiaries Treated at Hospital Networks. JAMA Surg 2024; 159:203-210. [PMID: 38150228 PMCID: PMC10753440 DOI: 10.1001/jamasurg.2023.6542] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/09/2023] [Indexed: 12/28/2023]
Abstract
Importance Minimum volume standards have been advocated as a strategy to improve outcomes for certain surgical procedures. Hospital networks could avoid low-volume surgery by consolidating cases within network hospitals that meet volume standards, thus optimizing outcomes while retaining cases and revenue. The rates of compliance with volume standards among hospital networks and the association of volume standards with outcomes at these hospitals remain unknown. Objective To quantify low-volume surgery and associated outcomes within hospital networks. Design, Setting, and Participants This cross-sectional study used Medicare Provider Analysis and Review data to examine fee-for-service beneficiaries aged 66 to 99 years who underwent 1 of 10 elective surgical procedures (abdominal aortic aneurysm repair, carotid endarterectomy, mitral valve repair, hip or knee replacement, bariatric surgery, or resection for lung, esophageal, pancreatic, or rectal cancers) in a network hospital from 2016 to 2018. Hospital volume for each procedure (calculated with the use of the National Inpatient Sample) was compared with yearly hospital volume standards for that procedure recommended by The Leapfrog Group. Networks were then categorized into 4 groups according to whether or not that hospital or another hospital in the network met low-volume standards for that procedure. Data were analyzed from February to June 2023. Exposure Receipt of surgery in a low-volume hospital within a network. Main Outcomes and Measures Primary outcomes were postoperative complications, 30-day readmission, and 30-day mortality, stratified by the volume status of the hospital and network type. The secondary outcome was the availability of a different high-volume hospital within the same network or outside the network and its proximity to the patient (based on hospital referral region and zip code). Results In all, data were analyzed for 950 079 Medicare fee-for-service beneficiaries (mean [SD] age, 74.4 [6.5] years; 621 138 females [59.2%] and 427 931 males [40.8%]) who underwent 1 049 069 procedures at 2469 hospitals within 382 networks. Of these networks, 380 (99.5%) had at least 1 low-volume hospital performing the elective procedure of interest. In 35 137 of 44 011 procedures (79.8%) that were performed at low-volume hospitals, there was a hospital that met volume standards within the same network and hospital referral region located a median (IQR) distance of 29 (12-60) miles from the patient's home. Across hospital networks, there was 43-fold variation in rates of low-volume surgery among the procedures studied (from 1.5% of carotid endarterectomies to 65.0% of esophagectomies). In adjusted analyses, postoperative outcomes were inferior at low-volume hospitals compared with hospitals meeting volume standards, with a 30-day mortality of 8.1% at low-volume hospitals vs 5.5% at hospitals that met volume standards (adjusted odds ratio, 0.67 [95% CI, 0.61-0.73]; P < .001). Conclusions and Relevance Findings of this study suggest that most US hospital networks had hospitals performing low-volume surgery that is associated with inferior surgical outcomes despite availability of a different in-network hospital that met volume standards within a median of 29 miles for the vast majority of patients. Strategies are needed to help patients access high-quality care within their networks, including avoidance of elective surgery at low-volume hospitals. Avoidance of low-volume surgery could be considered a process measure that reflects attention to quality within hospital networks.
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Affiliation(s)
- Stanley Kalata
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Sara L. Schaefer
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Ushapoorna Nuliyahu
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Andrew M. Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Hari Nathan
- Department of Surgery, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
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50
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Westenberg LB, Pol RA. Beyond BMI: Exploring Body Composition's Role in Long Term Outcome of Elective Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2024; 67:357-358. [PMID: 37716471 DOI: 10.1016/j.ejvs.2023.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Lisa B Westenberg
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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