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Perioperative surgical home

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https://www.readbyqxmd.com/read/28323671/codeine-and-opioid-metabolism-implications-and-alternatives-for-pediatric-pain-management
#1
Vidya Chidambaran, Senthilkumar Sadhasivam, Mohamed Mahmoud
PURPOSE OF REVIEW: Use of perioperative opioids for surgical pain management of children presents clinical challenges because of concerns of serious adverse effects including life-threatening respiratory depression. This is especially true for children with history of obstructive sleep apnea. This review will explore current knowledge of clinically relevant factors and genetic polymorphisms that affect opioid metabolism and postoperative outcomes in children. RECENT FINDINGS: Within the past several years, an increasing number of case reports have illustrated clinically important respiratory depression, anoxic brain injuries and even death among children receiving appropriate weight-based dosages of codeine and other opioids for analgesia at home setting particularly following tonsillectomy...
March 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28319519/process-improvement-initiative-for-the-perioperative-management-of-patients-with-a-cardiovascular-implantable-electronic-device
#2
Margaret K Menzel Ellis, Miriam M Treggiari, Jamie M Robertson, Marc A Rozner, Peter F Graven, Michael F Aziz, Matthias J Merkel, Edward A Kahl, Norman A Cohen, Eric C Stecker, Peter M Schulman
BACKGROUND: Economic, personnel, and procedural challenges often complicate and interfere with efficient and safe perioperative care of patients with cardiovascular implantable electronic devices (CIEDs). In the context of a process improvement initiative, we created and implemented a comprehensive anesthesiologist-run perioperative CIED service to respond to all routine requests for perioperative CIED consultations at a large academic medical center. This study was designed to determine whether this new care model was associated with improved operating room efficiency, reduced institutional cost, and adequate patient safety...
March 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28291130/making-the-pediatric-perioperative-surgical-home-come-to-life-by-leveraging-existing-health-information-technology
#3
Izabela C Leahy, Rachel Borczuk, Lynne R Ferrari
PURPOSE OF REVIEW: To design a patient data dashboard for the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital that supports care integration across the healthcare system as described by the pediatric perioperative surgical home (PPSH) initiative. RECENT FINDINGS: By using 360 Technology, patient data was automatically pulled from all available Electronic Health Record sources from 2005 to the present. The PPSH dashboard described in this report provides a guide for implementation of PPSH Clinical Care Pathways...
March 11, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28267070/adherence-to-a-multimodal-analgesic-clinical-pathway-a-within-group-comparison-of-staged-bilateral-knee-arthroplasty-patients
#4
Rachel C Steckelberg, Natasha Funck, T Edward Kim, Tessa L Walters, Gregory Milo Lochbaum, Stavros G Memtsoudis, Nicholas J Giori, Pier F Indelli, Lorrie J Graham, Edward R Mariano
BACKGROUND AND OBJECTIVES: Multimodal analgesic clinical pathways for joint replacement patients often include perineural catheters, but long-term adherence to these pathways has not yet been investigated. Our primary aim was to determine adherence rate to a knee arthroplasty clinical pathway for patients undergoing staged bilateral procedures. METHODS: This study was performed at a hospital with a Perioperative Surgical Home program and knee arthroplasty clinical pathway using multimodal analgesia and adductor canal catheters...
March 6, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28258331/the-role-of-perioperative-surgical-home-on-health-and-longevity-in-society-importance-of-the-surgical-prehabilitation-program
#5
EDITORIAL
Masahiko Kawaguchi, Mitsuru Ida, Yusuke Naito
No abstract text is available yet for this article.
March 3, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28232147/long-term-pain-and-recovery-after-major-pediatric-surgery-a-qualitative-study-with-teens-parents-and-perioperative-care-providers
#6
Jennifer A Rabbitts, Rachel V Aaron, Emma Fisher, Emily A Lang, Caroline Bridgwater, Gabrielle Ghafari Tai, Tonya M Palermo
Research developing targeted treatment focused on coping with children's long-term pain after surgery is needed due to the high prevalence of chronic pain after surgery. This qualitative study aimed to 1) understand the child's and family's experiences of pain over the course of their surgical experience, and 2) gather stakeholder input regarding potential barriers and facilitators of perioperative intervention delivery. Fifteen children ages 10-18 years who underwent recent major surgery, their primary caregivers, and 17 perioperative healthcare providers were interviewed...
February 20, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28151765/necrotizing-soft-tissue-infection-or-sweet-syndrome-surgery-versus-no-surgery-a-case-report
#7
Tiffany M N Otero, Samuel R Barber, D Dante Yeh, Sadeq A Quraishi
The authors report a case of necrotizing Sweet syndrome in a 24-year-old transsexual male who presented with recurrent myonecrosis of the neck/upper chest. On index admission, computer tomography revealed gas and fat stranding of the sternocleidomastoid and pectoralis major muscle-findings suggestive of a necrotizing soft tissue infection. Despite debridement procedures and intravenous antibiotic therapy, myonecrosis of the affected areas persisted. Evaluation of tissue samples by dermatopathology revealed neutrophilic infiltration extending into the dermis and muscle necrosis, findings consistent with necrotizing Sweet syndrome...
February 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28126175/risk-factors-for-30-day-unplanned-readmission-following-infrainguinal-endovascular-interventions
#8
Thomas C F Bodewes, Peter A Soden, Klaas H J Ultee, Sara L Zettervall, Alexander B Pothof, Sarah E Deery, Frans L Moll, Marc L Schermerhorn
OBJECTIVE: Unplanned hospital readmissions following surgical interventions are associated with adverse events and contribute to increasing health care costs. Despite numerous studies defining risk factors following lower extremity bypass surgery, evidence regarding readmission after endovascular interventions is limited. This study aimed to identify predictors of 30-day unplanned readmission following infrainguinal endovascular interventions. METHODS: We identified all patients undergoing an infrainguinal endovascular intervention in the targeted vascular module of the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2014...
February 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28118163/evolving-healthcare-delivery-paradigms-and-the-optimization-of-value-in-anesthesiology
#9
Navid Alem, Zeev Kain
PURPOSE OF REVIEW: Healthcare worldwide is evolving to yield enhanced care provided at a lowered cost. Patient-centric paradigms that hasten surgical recovery and strengthen collaboration amongst medical professionals are gaining impetus. This review will discuss the changing healthcare landscape and outline its implications on anesthesiology practice. RECENT FINDINGS: Anesthesiologists must be nimble and versatile as they adapt to healthcare redesign. An increased responsibility for patient outcomes should be embraced by extending the breadth and depth of clinical practice throughout the surgical care continuum...
April 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28089186/predictors-of-same-day-discharge-in-primary-total-joint-arthroplasty-patients-and-risk-factors-for-post-discharge-complications
#10
Alex Sher, Aakash Keswani, Dong-Han Yao, Michael Anderson, Karl Koenig, Calin S Moucha
BACKGROUND: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population...
December 22, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28027086/an-ambulatory-surgery-perioperative-surgical-home-in-kaiser-permanente-settings-practice-and-outcomes
#11
Chunyuan Qiu, Joseph Rinehart, Vu T Nguyen, Maxime Cannesson, Atef Morkos, Diana LaPlace, Narendra S Trivedi, Philip D Mercado, Zeev N Kain
BACKGROUND: The aim of this study is to describe the design, implementation, and associated outcome changes of a Perioperative Surgical Home (PSH) for patients undergoing ambulatory laparoscopic cholecystectomy in a Kaiser Permanente practice model. METHODS: A multidisciplinary planning committee of 15 individuals developed and implemented a new PSH program. A total of 878 subjects were included in the preimplementation period (T-fast), and 1082 patients were included in the postimplementation period (PSH) based on the date of their surgery...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28009614/factors-associated-with-patient-initiated-telephone-calls-after-orthopaedic-trauma-surgery
#12
Michael M Hadeed, Abdurrahman Kandil, Vandan Patel, Avery Morrison, Wendy M Novicoff, Seth R Yarboro
OBJECTIVES: The primary aim of this study is to investigate the incidence of early patient-initiated postoperative telephone calls and reasons for those calls. Secondary goals are to determine perioperative predictive factors for calls including the procedures most frequently associated with them. DESIGN: Retrospective chart review. SETTING: Academic Level-1 Trauma Center. PATIENTS/PARTICIPANTS: Six hundred eighty-four patients who underwent surgical treatment by our orthopaedic trauma division between 01/01/2014 and 31/12/2014...
March 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28007227/the-perioperative-surgical-home-model-facilitates-change-implementation-in-anesthetic-technique-within-a-clinical-pathway-for-total-knee-arthroplasty
#13
Seshadri C Mudumbai, Tessa L Walters, Steven K Howard, T Edward Kim, Gregory Milo Lochbaum, Stavros G Memtsoudis, Zeev N Kain, Alex Kou, Robert King, Edward R Mariano
BACKGROUND: The challenge of knowledge translation in medical settings is well known, and implementing change in clinical practice can take years. For the increasing number total knee arthroplasty (TKA) patients annually, there is ample evidence to endorse neuraxial anesthesia over general anesthesia. The rate of adoption of this practice, however, is slow at the current time. We hypothesized that a Perioperative Surgical Home (PSH) model facilitates rapid change implementation in anesthesia...
December 2016: Healthcare
https://www.readbyqxmd.com/read/28005112/can-a-total-knee-arthroplasty-perioperative-surgical-home-close-the-gap-between-primary-and-revision-tka-outcomes
#14
Chijioke Iwuchukwu, David Wright, Anna Sofine, Ran Schwarzkopf
Given the steady increase in the number of primary and revision total knee arthroplasties (TKAs) performed in the United States, we wanted to determine if an evidence-based TKA perioperative surgical home could close the perioperative morbidity gap between primary and revision TKAs. We conducted a prospective cross-sectional cohort study comparing outcomes of patients who had primary TKA (n = 235) with outcomes of patients who had revision TKA (n = 50). We measured several perioperative outcomes: length of stay, discharge disposition, 30-day readmission rate, and 30-day reoperation rate...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/27993376/unplanned-readmission-after-lung-resection-complete-follow-up-in-a-1-year-cohort-with-identification-of-associated-risk-factors
#15
Karen J Dickinson, James B Taswell, Mark S Allen, Shanda H Blackmon, Francis C Nichols, Robert Shen, Dennis A Wigle, Stephen D Cassivi
BACKGROUND: Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potentially modifiable risk factors. METHODS: All patients undergoing elective lung resection between August 1, 2013 and July 31, 2014 were contacted directly to determine whether they had been readmitted to any institution within 30 days of discharge from our service...
December 16, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27990189/effects-of-modification-of-pain-protocol-on-incidence-of-post-operative-nausea-and-vomiting
#16
Ran Schwarzkopf, Nimrod Snir, Zachary T Sharfman, Joseph B Rinehart, Michael-David Calderon, Esther Bahn, Brian Harrington, Kyle Ahn
BACKGROUND: A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol...
2016: Open Orthopaedics Journal
https://www.readbyqxmd.com/read/27989374/functional-quality-of-life-and-neurodevelopmental-outcomes-after-congenital-cardiac-surgery
#17
REVIEW
Megan L Ringle, Gil Wernovsky
Throughout the past few decades, advances in cardiology, neonatal intensive care, and surgical techniques have resulted in a growing cohort of thriving school-aged children with previously lethal complex congenital heart diseases. While survival has increased, there remains significant morbidity following repair including neurodevelopmental sequelae. Compared to children with a structurally normal heart, these infants and children have a higher frequency of abnormalities in tone, feeding, and delayed developmental milestones, as well as challenges with speech and learning disabilities, while a higher proportion of adolescents suffer from problems with processing speed, executive function, and a unique set of medical hardships related to exercise intolerance and obesity, medication burden, and mental health comorbidities...
December 2016: Seminars in Perinatology
https://www.readbyqxmd.com/read/27958617/results-of-the-fontan-operation-with-no-early-mortality-in-248-consecutive-patients
#18
Edward Malec, Christoph Schmidt, Anja Lehner, Katarzyna Januszewska
BACKGROUND: Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects AIM: The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy. METHODS: In the years 2007-2015, in 248 children aged 3.7 ± 2.6 years and weigh of 14.6 ± 6.1 kg with a single ventricle the Fontan surgery was performed...
December 13, 2016: Kardiologia Polska
https://www.readbyqxmd.com/read/27898510/the-effect-of-implementation-of-preoperative-and-postoperative-care-elements-of-a-perioperative-surgical-home-model-on-outcomes-in-patients-undergoing-hip-arthroplasty-or-knee-arthroplasty
#19
Thomas R Vetter, Joydip Barman, James M Hunter, Keith A Jones, Jean-Francois Pittet
BACKGROUND: The Perioperative Surgical Home (PSH) seeks to remedy the currently highly fragmented and expensive perioperative care in the United States. The 2 specific aims of this health services research study were to assess the association between the preoperative and postoperative elements of an initial PSH model and a set of (1) clinical, quality, and patient safety outcomes and (2) operational and financial outcomes, in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA)...
November 28, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27890309/patterns-of-ninety-day-readmissions-following-total-joint-replacement-in-a-bundled-payment-initiative
#20
Omar A Behery, Benjamin S Kester, Jarrett Williams, Joseph A Bosco, James D Slover, Richard Iorio, Ran Schwarzkopf
BACKGROUND: Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis...
November 1, 2016: Journal of Arthroplasty
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