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Perioperative Medicine

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https://www.readbyqxmd.com/read/29238571/immunonutrition-within-enhanced-recovery-after-surgery-eras-an-unresolved-matter
#1
EDITORIAL
Ruchir Gupta, Anthony Senagore
Preoperative malnutrition because of poor oral intake significantly increases the risk of adverse events after surgery and leads to increased length of stay. While immunonutrition has been utilized in the non-ERAS setting, its utility in both minimally invasive surgery and ERAS pathway procedures remain poorly defined. There are at least ten meta-analyses regarding the assessment of immunonutrition, but virtually, all of these were performed in an era prior to minimally invasive surgery, adoption of enhanced recovery protocols, and an understanding of the assessment and physiology of sarcopenia...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29238570/impact-of-asa-score-misclassification-on-nsqip-predicted-mortality-a-retrospective-analysis
#2
Alex Helkin, Sumeet V Jain, Angelika Gruessner, Maureen Fleming, Leslie Kohman, Michael Costanza, Robert N Cooney
Background: The ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ASAs 3 and 4. We hypothesized under-classified ASA scores significantly affect the O/E mortality. Methods: We conducted a retrospective review of NSQIP essential surgery cases from January 2014 to December 2014 (n = 1264) with mortality sub-analysis (n = 33) at our institution...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29204270/comparison-of-risk-scoring-systems-in-the-prediction-of-outcome-after-liver-resection
#3
S Ulyett, G Shahtahmassebi, S Aroori, M J Bowles, C D Briggs, M G Wiggans, G Minto, D A Stell
Background: Risk prediction techniques commonly used in liver surgery include the American Society of Anesthesiologists (ASA) grading, Charlson Comorbidity Index (CCI) and cardiopulmonary exercise tests (CPET). This study compares the utility of these techniques along with the number of segments resected as predictive tools in liver surgery. Methods: A review of a unit database of patients undergoing liver resection between February 2008 and January 2015 was undertaken...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29204269/a-systematic-review-and-overview-of-health-economic-evaluations-of-emergency-laparotomy
#4
Sohail Bampoe, Peter M Odor, S Ramani Moonesinghe, Matthew Dickinson
Background: Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthcare economic and societal costs of EL in adults in different countries. Methods: MEDLINE, EMBASE, ISI Web of Knowledge, Cochrane Central Register Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched for full and partial economic analyses of EL published between 1 January 1991 and 31 December 2015...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29201360/are-physician-assistant-and-patient-airway-assessments-reliable-compared-to-anesthesiologist-assessments-in-detecting-difficult-airways-in-general-surgical-patients
#5
Erin Payne, Jacqueline Ragheb, Elizabeth S Jewell, Betsy P Huang, Angela M Bailey, Laura M Fritsch, Milo Engoren
Background: Airway management remains one of the most important responsibilities of anesthesiologists. Prediction of difficult airway allows time for proper selection of equipment, technique, and personnel experienced in managing patients with difficult airway. Face to face preoperative anesthesia interviews are difficult to conduct as they necessitate patients traveling to the clinics, and, in practice, are usually conducted in the morning of the procedure by the anesthesiologist, when identification of predictors of difficult intubation may lead to schedule delays or case cancelations...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29201359/rationale-for-and-approach-to-preoperative-opioid-weaning-a-preoperative-optimization-protocol
#6
REVIEW
Heath McAnally
The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit ratio and the nation reels from the grim mortality statistics associated with the opioid epidemic. Patients struggling with chronic pain tend to use opioids and also seek out operative intervention for their complaints, which combination may be leading to increased postoperative "acute-on-chronic" pain and fueling worsened chronic pain and opioid dependence...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29201358/association-of-postoperative-nausea-vomiting-and-pain-with-breastfeeding-success
#7
Ramon Abola, Jamie Romeiser, Suman Grewal, Sabeen Rizwan, Rishimani Adsumelli, Ellen Steinberg, Elliott Bennett-Guerrero
Background: Successful breastfeeding is a goal set forth by the World Health Organization to improve neonatal care. Increasingly, patients express the desire to breastfeed, and clinicians should facilitate successful breastfeeding. The primary aim of this study is to determine if postoperative nausea and vomiting (PONV) or postoperative pain are associated with decreased breastfeeding success after cesarean delivery. Methods: This is a historical cohort study using the Stony Brook Elective Cesarean Delivery Database...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29167742/the-effect-of-natural-sounds-on-the-anxiety-of-patients-undergoing-coronary-artery-bypass-graft-surgery
#8
Mohammad Javad Amiri, Tabandeh Sadeghi, Tayebeh Negahban Bonabi
Background: This study aims to investigate the effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery (CABG). Methods: In this clinical trial, 90 patients, who were candidates for CABG in an urban area of Iran, were selected and randomly assigned to intervention and control groups by the minimization method. In the intervention group, natural sounds were broadcast through headphones for 30 min. In the control group, headphones connected to a silent device were used...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29090090/surgeons-views-on-preoperative-medical-evaluation-a-qualitative-study
#9
Kevin R Riggs, Zackary D Berger, Martin A Makary, Eric B Bass, Geetanjali Chander
BACKGROUND: There is substantial variation in the practice of preoperative medical evaluation (PME) and limited evidence for its benefit, which raises concerns about overuse. Surgeons have a unique role in this multidisciplinary practice. The objective of this qualitative study was to explore surgeons' practices and their beliefs about PME. METHODS: We conducted of semi-structured interviews with 18 surgeons in Baltimore, Maryland. Surgeons were purposively sampled to maximize diversity in terms of practice type (academic vs...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29075482/fluid-resuscitation-practices-in-cardiac-surgery-patients-in-the-usa-a-survey-of-health-care-providers
#10
Solomon Aronson, Paul Nisbet, Martin Bunke
BACKGROUND: Fluid resuscitation during cardiac surgery is common with significant variability in clinical practice. Our goal was to investigate current practice patterns of fluid volume expansion in patients undergoing cardiac surgeries in the USA. METHODS: We conducted a cross-sectional online survey of 124 cardiothoracic surgeons, cardiovascular anesthesiologists, and perfusionists. Survey questions were designed to assess clinical decision-making patterns of intravenous (IV) fluid utilization in cardiovascular surgery for five types of patients who need volume expansion: (1) patients undergoing cardiopulmonary bypass (CPB) without bleeding, (2) patients undergoing CPB with bleeding, (3) patients undergoing acute normovolemic hemodilution (ANH), (4) patients requiring extracorporeal membrane oxygenation (ECMO) or use of a ventricular assist device (VAD), and (5) patients undergoing either off-pump coronary artery bypass graft (OPCABG) surgery or transcatheter aortic valve replacement (TAVR)...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29034090/pre-to-postoperative-coagulation-profile-of-307-patients-undergoing-oesophageal-resection-with-epidural-blockade-over-a-10-year-period-in-a-single-hospital-implications-for-the-risk-of-spinal-haematoma
#11
Owain Thomas, Emanuel Lybeck, Per Flisberg, Ulf Schött
BACKGROUND: Epidural anaesthesia and analgesia are indicated for oesophageal surgery. A rare but serious complication is spinal haematoma, which can occur on insertion, manipulation or withdrawal of catheters. Evidence and guidelines are vague regarding which tests are appropriate and how to interpret their results. We aimed to describe how routine coagulation test results change during oesophagectomy's perioperative course. METHODS: Following ethical approval, we retrospectively identified patients who had undergone oesophagectomy between 2002 and 2012...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28948012/enhanced-recovery-protocols-for-colorectal-surgery-and-postoperative-renal-function-a-retrospective-review
#12
Charles R Horres, Mohamed A Adam, Zhifei Sun, Julie K Thacker, Richard E Moon, Timothy E Miller, Stuart A Grant
BACKGROUND: While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied. METHODS: Patients undergoing major colorectal surgery under ERP (February 2010 to March 2013) were compared with a traditional care control group (October 2004 October 2007) at a single institution. Multivariable regression models examined the association of ERP with postoperative creatinine changes and incidence of postoperative acute kidney dysfunction (based on the Risk, Injury, Failure, Loss, and End-stage renal disease criteria)...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28878889/preoperative-fluid-retention-increases-blood-loss-during-major-open-abdominal-surgery
#13
Robert G Hahn, Hans Bahlmann, Lena Nilsson
BACKGROUND: Quantification of renal fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this fluid retention correlates with fluid requirements during major abdominal surgeries that have estimated operating times ≥ 2 h. METHODS: Urine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite "fluid retention index" (FRI) in 97 patients prior to major abdominal surgery...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28852474/the-prevalence-of-pulmonary-complications-after-thoracic-and-abdominal-surgery-and-associated-risk-factors-in-patients-admitted-at-a-government-hospital-in-harare-zimbabwe-a-retrospective-study
#14
Cathrine Tadyanemhandu, Rufaro Mukombachoto, Clement Nhunzvi, Farayi Kaseke, Vasco Chikwasha, Samson Chengetanai, Shamila Manie
BACKGROUND: The burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal anatomy and activity of the respiratory muscles leading to reduced lung volumes and putting the patients at greater risk of developing post-operative pulmonary complications (PPCs). PPCs remain an important cause of post-operative morbidity, mortality, and impacts on the long-term outcomes of patients post hospital discharge...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28852473/evaluation-of-operating-room-reverse-trendelenburg-positioning-and-its-effect-on-postoperative-hypoxemia-aspiration-and-length-of-stay-a-retrospective-study-of-consecutive-patients
#15
C Michael Dunham, Barbara M Hileman, Amy E Hutchinson, Tamara Antonaccio, Elisha A Chance, Gregory S Huang, Gregory Szmaj, Kristen Calabro, Cynthia Bishop, Tyson T Schrickel
BACKGROUND: In 2014, this group published an investigation of surgical patients from 2012 who had substantial rates of postoperative hypoxemia (POH) and perioperative pulmonary aspiration (POPA). Therefore, we investigated whether intraoperative reverse Trendelenburg positioning (RTP) decreases POH and POPA rates. METHODS: Consecutive ASA I-IV surgical patients who had preoperative pulmonary stability requiring general anesthesia with endotracheal intubation were evaluated...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28649376/re-designing-the-pathway-to-surgery-better-care-and-added-value
#16
Michael P W Grocott, James O M Plumb, Mark Edwards, Imogen Fecher-Jones, Denny Z H Levett
The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28413629/american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-poqi-joint-consensus-statement-on-optimal-analgesia-within-an-enhanced-recovery-pathway-for-colorectal-surgery-part-1-from-the-preoperative-period-to-pacu
#17
Matthew D McEvoy, Michael J Scott, Debra B Gordon, Stuart A Grant, Julie K M Thacker, Christopher L Wu, Tong J Gan, Monty G Mythen, Andrew D Shaw, Timothy E Miller
BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia," which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28413628/american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-poqi-joint-consensus-statement-on-optimal-analgesia-within-an-enhanced-recovery-pathway-for-colorectal-surgery-part-2-from-pacu-to-the-transition-home
#18
Michael J Scott, Matthew D McEvoy, Debra B Gordon, Stuart A Grant, Julie K M Thacker, Christopher L Wu, Tong J Gan, Monty G Mythen, Andrew D Shaw, Timothy E Miller
BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia", which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multidisciplinary, international group of experts and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28331608/american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-poqi-joint-consensus-statement-on-measurement-to-maintain-and-improve-quality-of-enhanced-recovery-pathways-for-elective-colorectal-surgery
#19
S Ramani Moonesinghe, Michael P W Grocott, Elliott Bennett-Guerrero, Roberto Bergamaschi, Vijaya Gottumukkala, Thomas J Hopkins, Stuart McCluskey, Tong J Gan, Michael Monty G Mythen, Andrew D Shaw, Timothy E Miller
BACKGROUND: This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement systems and/or theories, and provides an overview of the different approaches for improving clinical monitoring, and enhancing quality improvement or research in varied settings with different levels of available resources. METHODS: Using a structure-process-outcome framework, we make recommendations for three hierarchical tiers of data collection...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28331607/-simplified-international-recommendations-for-the-implementation-of-patient-blood-management-sir4pbm
#20
Patrick Meybohm, Bernd Froessler, Lawrence T Goodnough, Andrew A Klein, Manuel Muñoz, Michael F Murphy, Toby Richards, Aryeh Shander, Donat R Spahn, Kai Zacharowski
BACKGROUND: More than 30% of the world's population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient blood management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63...
2017: Perioperative Medicine
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