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Perioperative Medicine

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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
#1
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
#2
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
https://www.readbyqxmd.com/read/28270910/american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-poqi-joint-consensus-statement-on-prevention-of-postoperative-infection-within-an-enhanced-recovery-pathway-for-elective-colorectal-surgery
#3
Stefan D Holubar, Traci Hedrick, Ruchir Gupta, John Kellum, Mark Hamilton, Tong J Gan, Monty G Mythen, Andrew D Shaw, Timothy E Miller
BACKGROUND: Colorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cystitis and superficial wound infections to life-threatening situations such as lobar pneumonia or anastomotic leak with fecal peritonitis. Within an enhanced recovery pathway (ERP), there are multiple approaches that can be used to reduce the risk of postoperative infections...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28228938/physical-activity-levels-in-locally-advanced-rectal-cancer-patients-following-neoadjuvant-chemoradiotherapy-and-an-exercise-training-programme-before-surgery-a-pilot-study
#4
Lisa Loughney, Malcolm A West, Borislav D Dimitrov, Graham J Kemp, Michael Pw Grocott, Sandy Jack
BACKGROUND: The aim of this pilot study was to measure changes in physical activity level (PAL) variables, as well as sleep duration and efficiency in people with locally advanced rectal cancer (1) before and after neoadjuvant chemoradiotherapy (CRT) and (2) after participating in a pre-operative 6-week in-hospital exercise training programme, following neoadjuvant CRT prior to major surgery, compared to a usual care control group. METHODS: We prospectively studied 39 consecutive participants (27 males)...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28228937/predictors-of-total-morbidity-burden-on-days-3-5-and-8-after-cardiac-surgery
#5
Julie Sanders, Jackie Cooper, Michael G Mythen, Hugh E Montgomery
BACKGROUND: Post-operative morbidity affects up to 36% of cardiac surgical patients. However, few countries reliably record morbidity outcome data, despite patients wanting to be informed of all the risks associated with surgery. The Cardiac Post-Operative Morbidity Score (C-POMS) is a new tool for describing and scoring (0-13) total morbidity burden after cardiac surgery, derived by noting the presence/absence of 13 morbidity domains on days 3, 5, 8 and 15. Identifying modifiable C-POMS risk factors may suggest targets for intervention to reduce morbidity and healthcare costs...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28127421/pre-operative-anaemia-is-associated-with-total-morbidity-burden-on-days-3-and-5-after-cardiac-surgery-a-cohort-study
#6
Julie Sanders, Jackie A Cooper, Daniel Farrar, Simon Braithwaite, Updeshbir Sandhu, Michael G Mythen, Hugh E Montgomery
BACKGROUND: Pre-operative anaemia is associated with mortality and red blood cell (RBC) transfusion requirement after cardiac surgery. However, the effect on post-operative total morbidity burden (TMB) is unknown. We explored the effect of pre-operative anaemia on post-operative TMB. METHODS: Data were drawn from the Cardiac Post-Operative Morbidity Score (C-POMS) development study (n = 442). C-POMS describes and quantifies (0-13) TMB after cardiac surgery by noting the presence/absence of 13 morbidity domains on days 3 (D3), 5 (D5), 8 (D8) and 15 (D15)...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/27999663/implementation-of-goal-directed-fluid-therapy-during-hip-revision-arthroplasty-a-matched-cohort-study
#7
Marit Habicher, Felix Balzer, Viktor Mezger, Jennifer Niclas, Michael Müller, Carsten Perka, Michael Krämer, Michael Sander
BACKGROUND: Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. However, very few studies have demonstrated the value of goal-directed therapy (GDT) in patients undergoing orthopaedic surgery and confirmed it is as useful in real-life conditions. Therefore, we initiated a GDFT implementation programme in patients undergoing hip revision arthroplasty in order to assess its effects on postoperative complications (e...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27800156/sarcopenia-and-sarcopenic-obesity-do-they-predict-inferior-oncologic-outcomes-after-gastrointestinal-cancer-surgery
#8
REVIEW
Kimberly L Mei, John A Batsis, Jeannine B Mills, Stefan D Holubar
Sarcopenia, or loss of skeletal muscle mass and quality, has been studied as part of aging and adverse health outcomes in elderly patients but has only recently been evaluated as a separate condition in cancer patients and important indicator of adverse outcomes. Currently, its definition and method of assessment are still being debated. Sarcopenia within an increasingly obese population has led to a subgroup with sarcopenic obesity, at even higher risk of adverse outcomes. Yet, sarcopenia often goes undiagnosed in these patients, hidden beneath higher body mass index...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27777754/associations-between-asa-physical-status-and-postoperative-mortality-at-48%C3%A2-h-a-contemporary-dataset-analysis-compared-to-a-historical-cohort
#9
Thomas J Hopkins, Karthik Raghunathan, Atilio Barbeito, Mary Cooter, Mark Stafford-Smith, Rebecca Schroeder, Katherine Grichnik, Richard Gilbert, Solomon Aronson
BACKGROUND: In this study, we examined the association between American Society of Anesthesiologists Physical Status (ASA PS) designation and 48-h mortality for both elective and emergent procedures in a large contemporary dataset (patient encounters between 2009 and 2014) and compared this association with data from a landmark study published by Vacanti et al. in 1970. METHODS: Patient history, hospital characteristics, anesthetic approach, surgical procedure, efficiency and quality indicators, and patient outcomes were prospectively collected for 732,704 consecutive patient encounters between January 1, 2009, and December 31, 2014, at 233 anesthetizing locations across 19 facilities in two US states and stored in the Quantum™ Clinical Navigation System (QCNS) database...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27777753/coagulative-safety-of-epidural-catheters-after-major-upper-gastrointestinal-surgery-advanced-and-routine-coagulation-analysis-in-38-patients
#10
Owain Thomas, Hampus Rein, Karin Strandberg, Ulf Schött
BACKGROUND: The risk of spinal haematoma in patients receiving epidural catheters is estimated using routine coagulation tests, but guidelines are inconsistent in their recommendations on what to do when results indicate slight hypocoagulation. Postoperative patients are prone to thrombosis, and thromboelastometry has previously shown hypercoagulation in this setting. We aimed to better understand perioperative haemostasis by comparing results from routine and advanced tests, hypothesizing that patients undergoing major upper gastrointestinal surgery would be deficient in vitamin K-dependent coagulation factors because of malnutrition, or hypocoagulative because of accumulation of low molecular weight heparin (LMWH)...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27777752/a-case-management-report-a-collaborative-perioperative-surgical-home-paradigm-and-the-reduction-of-total-joint-arthroplasty-readmissions
#11
Navid Alem, Joseph Rinehart, Brian Lee, Doug Merrill, Safa Sobhanie, Kyle Ahn, Ran Schwarzkopf, Maxime Cannesson, Zeev Kain
BACKGROUND: Efforts to mitigate costs while improving surgical care quality have received much scrutiny. This includes the challenging issue of readmission subsequent to hospital discharge. Initiatives attempting to preclude readmission after surgery require planned and unified efforts extending throughout the perioperative continuum. Patient optimization prior to discharge, enhanced disease monitoring, and seamless coordination of care between hospitals and community providers is integral to this process...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27777751/evidence-based-perioperative-medicine-comes-of-age-the-perioperative-quality-initiative-poqi-the-1st-consensus-conference-of-the-perioperative-quality-initiative-poqi
#12
EDITORIAL
Timothy E Miller, Andrew D Shaw, Michael G Mythen, Tong J Gan
The 1st POQI Consensus Conference occurred in Durham, NC, on March 4-5, 2016, and was supported by the American Society of Enhanced Recovery (ASER) and Evidence-Based Perioperative Medicine (EBPOM). The conference focused on enhanced recovery for colorectal surgery and discussed four topics-perioperative analgesia, perioperative fluid management, preventing nosocomial infection, and measurement and quality in enhanced recovery pathways.
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27660701/american-society-for-enhanced-recovery-aser-and-perioperative-quality-initiative-%C3%A2-poqi-joint-consensus-statement-on-perioperative-fluid-management-within-an-enhanced-recovery-pathway-for-colorectal-surgery
#13
Robert H Thiele, Karthik Raghunathan, C S Brudney, Dileep N Lobo, Daniel Martin, Anthony Senagore, Maxime Cannesson, Tong Joo Gan, Michael Monty G Mythen, Andrew D Shaw, Timothy E Miller
BACKGROUND: Enhanced recovery may be viewed as a comprehensive approach to improving meaningful outcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) is strong in patients undergoing colorectal surgery. There is some controversy about the adoption of specific elements in enhanced recovery "bundles" because the relative importance of different components of ERPs is hard to discern (a consequence of multiple simultaneous changes in clinical practice when ERPs are initiated)...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27594991/from-nela-to-epoch-and-beyond-enhancing-the-evidence-base-for-emergency-laparotomy
#14
EDITORIAL
Peter M Odor, Michael P W Grocott
Around 35,000 patients undergo emergency laparotomy surgery in the UK each year with an in-hospital 30-day mortality estimated as between 11 and 15 %. The recent publication of the First Patient Report of the National Emergency Laparotomy Audit (NELA) has provided a detailed description of individual hospital performance against national standards of care in emergency laparotomy in England and Wales. Although the standards used for audit purposes in NELA are based upon the best currently available evidence, none of the source data derives from randomised controlled studies...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27594990/preoperative-discussion-with-patients-about-delirium-risk-are-we-doing-enough
#15
EDITORIAL
Judith H Tomlinson, Judith S L Partridge
Postoperative delirium is a common complication in the older surgical population, occurring in 10-50 % of cases. It is thought to be more common if an individual is identified as frail. Postoperative delirium is associated with poor outcome including higher mortality rates, prolonged length of hospital stay, increased care needs on discharge and longer term post-traumatic stress disorder. Guidelines from the American Geriatric Society and the National Institute for Health and Care Excellence highlight the importance of risk assessment at the time of the preoperative visit...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27540479/coagulation-during-elective-neurosurgery-with-hydroxyethyl-starch-fluid-therapy-an-observational-study-with-thromboelastometry-fibrinogen-and-factor-xiii
#16
Caroline Ulfsdotter Nilsson, Karin Strandberg, Martin Engström, Peter Reinstrup
BACKGROUND: Several studies have described hypercoagulability in neurosurgery with craniotomy for brain tumor resection. In this study, hydroxyethyl starch (HES) 130/0.42 was used for hemodynamic stabilization and initial blood loss replacement. HES can induce coagulopathy with thromboelastographic signs of decreased clot strength. The aim of this study was to prospectively describe perioperative changes in coagulation during elective craniotomy for brain tumor resection with the present fluid regimen...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27486512/postoperative-respiratory-failure-necessitating-transfer-to-the-intensive-care-unit-in-orthopedic-surgery-patients-risk-factors-costs-and-outcomes
#17
Roman Melamed, Lori L Boland, James P Normington, Rebecca M Prenevost, Lindsay Y Hur, Leslie F Maynard, Molly A McNaughton, Tyler G Kinzy, Adnan Masood, Mehdi Dastrange, Joseph A Huguelet
BACKGROUND: Postoperative pulmonary complications in orthopedic surgery patients have been associated with worse clinical outcomes. Identifying patients with respiratory risk factors requiring enhanced monitoring and management modifications is an important part of postoperative care. Patients with unanticipated respiratory decompensation requiring transfer to the intensive care unit (ICU) have not been studied in sufficient detail. METHODS: A retrospective case-control study of elective orthopedic surgery patients (knee, hip, shoulder, or spine, n = 51) who developed unanticipated respiratory failure (RF) necessitating transfer to the ICU over a 3-year period was conducted...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27413530/significant-discrepancies-exist-between-clinician-assessment-and-patient-self-assessment-of-functional-capacity-by-validated-scoring-tools-during-preoperative-evaluation
#18
John Whittemore Stokes, Jonathan Porter Wanderer, Matthew David McEvoy
BACKGROUND: Preoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage regarding functional capacity could be useful for discerning which patients benefit from a clinician evaluation at a Preoperative Evaluation Center prior to the day of surgery. We evaluated the feasibility of preoperative, patient self-triage regarding functional capacity...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27313846/a-randomized-double-blind-placebo-controlled-safety-tolerability-and-pharmacokinetic-dose-escalation-study-of-a-gentamicin-vancomycin-gel-in-patients-undergoing-colorectal-surgery
#19
Elliott Bennett-Guerrero, Harold S Minkowitz, Alvaro M Segura-Vasi, Jorge E Marcet, Jennifer A White, G Ralph Corey, Kent S Allenby
BACKGROUND: Despite numerous interventions promulgated by the Surgical Care Improve Project (SCIP) and other organizations, surgical site infection (SSI) continues to be a significant medical problem. DFA-02 is a novel bioresorbable modified-release gel consisting of both gentamicin (16.8 mg/mL) and vancomycin (18.8 mg/mL) to be applied during surgical incision closure for the prevention of SSIs. The following double-blind phase 2a trial was designed to test the safety and tolerability of DFA-02...
2016: Perioperative Medicine
https://www.readbyqxmd.com/read/27313845/primum-non-nocere-is-shared-decision-making-the-answer
#20
Ramai Santhirapala, Ramani Moonesinghe
Surgical ambition is rising, with the Royal College of Surgeons reporting an increase in the number of procedures by a million over the past decade (Royal College of Surgeons. Surgery and the NHS in Numbers. Available from https://www.rcseng.ac.uk). Underpinning, this is a rapidly growing population, especially those in the over 85 age group, coupled with rising perioperative expertise; options for surgery are now present where conditions were once managed conservatively. Matching the right patient to the right procedure has never been so pertinent (Bader, Am Soc Anesthesiol 78(6), 2014)...
2016: Perioperative Medicine
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