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Ambulatory surgery

Ahilan Sivaganesan, Brandon Hirsch, Frank M Phillips, Matthew J McGirt
Here, we systematically review clinical studies that report morbidity and outcomes data for cervical and lumbar surgeries performed in ambulatory surgery centers (ASCs). We focus on anterior cervical discectomy and fusion (ACDF), posterior cervical foraminotomy, cervical arthroplasty, lumbar microdiscectomy, lumbar laminectomy, and minimally invasive transforaminal interbody fusion (TLIF) and lateral lumbar interbody fusion, as these are prevalent and surgical spine procedures that are becoming more commonly performed in ASC settings...
March 12, 2018: Neurosurgery
Raymond T Hino
No abstract text is available yet for this article.
March 2018: Journal of Healthcare Management / American College of Healthcare Executives
Samantha Tayne, Christian A Merrill, Rajeev C Saxena, Caitlin King, Karthik Devarajan, Stefan Ianchulev, Jon Chilingerian
Given the rising costs of healthcare delivery and reimbursement constraints, large academic medical centers (AMCs) must improve efficiency while delivering high-quality care. With standardized cases and high volumes, ambulatory surgery is a high-value target for efficiency improvement. Mining a data set of more than 7,500 cases consisting of the three highest-volume ambulatory procedures in orthopedics, otolaryngology-head and neck surgery, and urology, we analyzed process times and wait times involved in patient flow...
March 2018: Journal of Healthcare Management / American College of Healthcare Executives
Kevin Taliaferro, Alexander Crawford, Justin Jabara, Jonathan Lynch, Edward Jung, Raimonds Zvirbulis, Trevor Banka
BACKGROUND: Intraarticular steroid injections are a common first-line therapy for severe osteoarthritis, which affects an estimated 27 million people in the United States. Although topical, oral, intranasal, and inhalational steroids are known to increase intraocular pressure in some patients, the effect of intraarticular steroid injections on intraocular pressure has not been investigated, to the best of our knowledge. If elevated intraocular pressure is sustained for long periods of time or is of sufficient magnitude acutely, permanent loss of the visual field can occur...
March 9, 2018: Clinical Orthopaedics and related Research
Justin Ralph Abbatemarco, Mary Alissa Willis, Robert G Wilson, Sean J Nagel, Andre G Machado, Francois A Bethoux
OBJECTIVES: Stiff-person syndrome (SPS) is associated with axial rigidity superimposed on sustained muscle spasms. These symptoms commonly interfere with the performance of activities of daily living including ambulation. This retrospective case series evaluates the outcomes of screening tests and chronic infusion of intrathecal baclofen (ITB) in patients diagnosed with SPS treated in our spasticity clinic. MATERIALS AND METHODS: Patients were identified from an institutional review board-approved clinical registry of ITB therapy...
March 13, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Simon James Howell
Purpose of Review: This review will examine the implications for perioperative management of new hypertension guidelines and place these in the context of findings from recent large observational studies. Recent Findings: Recent hypertension guidelines highlight the role of ambulatory blood pressure measurement with the implication that isolated preoperative blood pressure measurements are of limited value. There is emerging evidence from large observational studies that both preoperative and intraoperative hypotension are associated with increased risk...
2018: Current Anesthesiology Reports
M Gaullier, T Tricard, P Mouracade, C Saussine
INTRODUCTION: The intravesical instillation of dimethyl sulfoxide (iDMSO), performed without anesthestic, is a therapeutic option for the painful bladder syndrome/interstial cystitis (PBS/IC). Some patients are against those iDMSO because of bad tolerance. Our study evaluates the tolerance and the outcome of the iDMSO under general anesthetic (GA) after the failure of the iDMSO without anesthetic. PATIENTS AND METHODS: From May 2013 to April 2016, 11 patients with a PBS, 9 women (81...
March 8, 2018: Progrès en Urologie
Hisashi Ikutomo, Koutatsu Nagai, Keiichi Tagomori, Namika Miura, Norikazu Nakagawa, Kensaku Masuhara
BACKGROUND: We investigated the incidence and circumstances related to falls in patients before and after total hip arthroplasty (THA), and compared them with those in an age-matched control group. METHODS: This is a prospective cohort study. A total of 140 women with severe hip osteoarthritis (OA) who underwent THA (OA group) and a control cohort of 319 age-matched healthy women were analyzed. We investigated the incidence and circumstances of falls before THA and during the first year after surgery...
February 12, 2018: Journal of Arthroplasty
Volker Gebhardt, Vera Zawierucha, Oliver Schöffski, Anke Schwarz, Christel Weiss, Marc D Schmittner
BACKGROUND: Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE: The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs...
March 7, 2018: European Journal of Anaesthesiology
Daniel Constantin Brănişteanu, Andreea Moraru, Andrei Bîlha
The aim of the report was to evaluate anatomical results and intra and postoperative complications after silicone oil (SIO) removal. Methods: Retrospective, interventional study evaluating consecutive cases with ambulatory SIO removal after vitrectomy for complex retinal detachments. The anatomical result was the main followed parameter. Intra and postoperative complications and also intraocular pressure changes were evaluated. Cases were followed-up for at least 12 months. Results: A total of 98 consecutive cases were reviewed...
October 2017: Romanian Journal of Ophthalmology
N Solheim, I Gregersen, B Halvorsen, V Bjerkeli, A Stubhaug, T Gordh, L A Rosseland
BACKGROUND: Ketorolac is an effective non-steroidal anti-inflammatory drug, commonly used with local anaesthetics as part of local infiltration analgesia protocols following orthopaedic surgery. However, systemic uptake and drug action may be the major mechanism after local infiltration. The aims of this project were to study the effects of a small, systemically ineffective dose of ketorolac given intra-articularly for post-operative pain and also to study synovial inflammatory biomarkers...
March 7, 2018: Acta Anaesthesiologica Scandinavica
Philippe Marty, Fabrice Ferré, Bertrand Basset, Constance Marquis, Benoit Bataille, Martine Chaubard, Mehdi Merouani, Olivier Rontes, Alain Delbos
PURPOSE: Ambulatory process in arthroscopic shoulder surgery has boomed over past decades. Some anesthetic techniques such as interscalene block (ISB) and its surrogates are associated with diaphragmatic paralysis and might compromise outpatient procedure. HYPOTHESIS: This study aims to assess consequences of diaphragmatic paralysis in obese patients. METHODS: This prospective observational study screened patients with body mass index (BMI) ≥ 30 kg/m2 undergoing acromioplasty or supraspinatus tendon repair...
March 6, 2018: Journal of Anesthesia
Johanna Olson-Kennedy, Jonathan Warus, Vivian Okonta, Marvin Belzer, Leslie F Clark
Importance: Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors. Objective: To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery...
March 5, 2018: JAMA Pediatrics
P Maxwell Courtney, Michael E West, William J Hozack
BACKGROUND: With recent healthcare reform efforts focusing on rewarding value instead of volume, it has become important for orthopedic surgeons to partner and align with their hospitals. We report our experience in aligning clinical and financial incentives with 6 health systems in our geographic area. METHODS: By managing the entire episode-of-care continuum for total hip and total knee arthroplasty patients, our standardized, evidence-based protocols have improved the quality of care for our joint arthroplasty patients...
January 31, 2018: Journal of Arthroplasty
Khaled Dajani, Mohammed Almualim, Akshay Menon, Jacqueline Volpi-Abadie, Kierstin Lund
OBJECTIVES: Management of pediatric patients with neurological diagnoses can be challenging for anesthesiologists. We sought to determine whether preexisting neurologic disease could serve as an intrinsic risk factor for prolonged emergence. METHODS: Following institutional review board approval, we conducted a database search from 2012 to 2015. Included were patients aged 0 to 18 years undergoing ambulatory procedures, and carrying neurological diagnoses that profoundly affected their development...
March 2018: Southern Medical Journal
Charles Hubert Blouin-Delisle, Renee Drolet, Serge Gagnon, Stephane Turcotte, Sylvie Boutet, Martin Coulombe, Eric Daneau
Purpose The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward. Design/methodology/approach Two similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ)...
March 12, 2018: International Journal of Health Care Quality Assurance
Joel E Abbott, Julio G Davalos
Background: Percutaneous nephrolithotomy (PNL) is a procedure that has traditionally been performed in an inpatient or hospital setting. Many surgical procedures have evolved over time from an inpatient/hospital setting to outpatient procedures performed in surgical centers. Outpatient PNL has become an accepted standard in select patients, but to date, the procedure has not been performed in an outpatient surgical center. Case Presentation: We describe our initial experience managing large renal stone burden with PNL performed completely outpatient in a freestanding ambulatory surgery center...
2018: Journal of Endourology Case Reports
Nick Jeffery, C Elizabeth Boudreau, Megan Konarik, Travis Mays, Virginia Fajt
Background: Glyburide (also known as glibenclamide) is effective in reducing the severity of tissue destruction and improving functional outcome after experimental spinal cord injury in rodents and so has promise as a therapy in humans. There are many important differences between spinal cord injury in experimental animals and in human clinical cases, making it difficult to introduce new therapies into clinical practice. Spinal cord injury is also common in pet dogs and requires new effective therapies, meaning that they can act as a translational model for the human condition while also deriving direct benefits from such research...
2018: PeerJ
A J Rensing, B M Whittam, K H Chan, M P Cain, A E Carroll, W E Bennett
INTRODUCTION: Surgeons frequently use surgical antibiotic prophylaxis (SAP), despite limited evidence to support its efficacy. Potential adverse events associated with antibiotic use include allergic reaction (including anaphylaxis), Clostridium difficile infection, and selecting for resistant bacteria. Surgical site infections (SSI) are very rare in patients undergoing clean pediatric urologic procedures. Current guidelines are unclear about the efficacy of surgical antibiotic prophylaxis for prevention of SSI in the pediatric population...
February 21, 2018: Journal of Pediatric Urology
G Soto, M Naranjo González, F Calero
Systemic lidocaine used in continuous infusion during the peri-operative period has analgesic, anti-hyperalgesic, as well as anti-inflammatory properties. This makes it capable of reducing the use of opioids and inhalational anaesthetics, and the early return of bowel function, and patient hospital stay. The aim of this narrative review was to highlight the pharmacology and indications for clinical application, along with new and interesting research areas. The clinical applications of peri-operative lidocaine infusion have been reviewed in several recent systematic reviews and meta-analyses in patients undergoing open and laparoscopic abdominal procedures, ambulatory procedures, and other types of surgery...
February 26, 2018: Revista Española de Anestesiología y Reanimación
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