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Perioperative surgical home

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https://www.readbyqxmd.com/read/28027086/an-ambulatory-surgery-perioperative-surgical-home-in-kaiser-permanente-settings-practice-and-outcomes
#1
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...
December 22, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28009614/factors-associated-with-patient-initiated-telephone-calls-after-orthopaedic-trauma-surgery
#2
Michael M Hadeed, Abdurrahman Kandil, Vandan Patel, Avery Morrison, Wendy M Novicoff, Seth 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:: 684 patients who underwent surgical treatment by our orthopaedic trauma division between January 1, 2014 and December 31, 2014...
November 7, 2016: 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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/27878478/liver-resection-after-selective-internal-radiation-therapy-with-yttrium-90-is-safe-and-feasible-a-bi-institutional-analysis
#11
G Paul Wright, J Wallis Marsh, Manish K Varma, Michael G Doherty, David L Bartlett, Mathew H Chung
BACKGROUND: Treatment with yttrium-90 (Y90) microspheres has emerged as a viable liver-directed therapy for patients with unresectable tumors and those outside transplantation criteria. A select number of patients demonstrate a favorable response and become candidates for surgical resection. METHODS: Patients who underwent selective internal radiation therapy (SIRT) with Y90 microspheres at two institutions were reviewed. Patients who underwent liver resection were included in the study...
November 22, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27878350/home-return-after-surgery-in-patients-aged-over-85%C3%A2-years-is-associated-with-preoperative-albumin-levels-the-type-of-surgery-and-apache-ii-score
#12
Bora Lee, Sungwon Na, Miran Park, Sungyeon Ham, Jeongmin Kim
BACKGROUND: Owing to an aging society, both the number of operations for patients aged >85 years and the average age of patients admitted to the intensive care unit (ICU) are rapidly increasing. However, mortality is not an appropriate outcome measurement in patients aged >85 years; a more important outcome is home return (HR), because quality of life is valuable to these patients. We identified predictors for HR of patients aged >85 years admitted to the ICU after surgery...
November 22, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27865568/home-discharge-after-primary-elective-total-joint-arthroplasty-postdischarge-complication-timing-and-risk-factor-analysis
#13
Dong-Han Yao, Aakash Keswani, Chirag K Shah, Alex Sher, Karl M Koenig, Calin S Moucha
BACKGROUND: Bundled payment programs for primary total joint arthroplasty (TJA) have identified reducing nonhome discharge as a major area of cost savings. Health care providers must therefore identify, risk stratify, and appropriately care for home-discharged TJA patients. This study aimed to analyze risk factors and timing of postdischarge complications among home-discharged primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients and risk stratify them to identify those who would benefit from higher level care...
August 27, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27861445/electronic-care-coordination-from-the-preoperative-clinic
#14
Vinca W Chow, David L Hepner, Angela M Bader
Fragmented and variable perioperative care exposes patients to unnecessary risks and handoff errors. The perioperative surgical home aims to optimize quality, value-based care. We performed a retrospective evaluation of how a preoperative assessment center could coordinate care through e-mails sent to a patient's healthcare team that initiate discussion on critical clinical information. During 100 clinic days on which 8122 patients were evaluated, 606 triggered e-mails, with a potential impact on 19 elements across the perioperative care spectrum...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27850755/1118-anesthesiology-intensivist-led-perioperative-surgical-home-a-quality-assurance-pilot
#15
Khaldoun Faris, Stephen Heard, Christine Motzkus-Feagans, Masilo Grant, Jennifer Yates, Mitchell Sokoloff, Shubjeet Kaur, Theofilos Matheos
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27822310/anaphylactic-shock-during-cement-implantation-of-a-total-hip-arthroplasty-in-a-patient-with-underlying-mastocytosis-case-report-of-a-rare-intraoperative-complication
#16
Anita Ten Hagen, Pieter Doldersum, Tom van Raaij
BACKGROUND: Cemented total hip arthroplasty (THA) is a safe and common procedure. In rare cases life threatening bone cement implantation syndrome (BCIS) may occur, which is commonly caused by pulmonary embolism (PE). CASE PRESENTATION: We describe the rare case of a 70-year old patient who underwent an elective total hip replacement. Before surgery he was diagnosed with underlying systemic indolent mastocytosis, a rare pathological disorder that may result in anaphylaxis after massive systemic mast cell activation...
2016: Patient Safety in Surgery
https://www.readbyqxmd.com/read/27812286/development-functioning-and-effectiveness-of-a-preoperative-risk-assessment-clinic
#17
REVIEW
Hassan Tariq, Rafeeq Ahmed, Salil Kulkarni, Sana Hanif, Omesh Toolsie, Hafsa Abbas, Sridhar Chilimuri
Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care...
2016: Health Services Insights
https://www.readbyqxmd.com/read/27777752/a-case-management-report-a-collaborative-perioperative-surgical-home-paradigm-and-the-reduction-of-total-joint-arthroplasty-readmissions
#18
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/27753787/best-practices-for-outpatient-anterior-cervical-surgery-results-from-a-delphi-panel
#19
Anita Mohandas, Chris Summa, W Bradley Worthington, Jason Lerner, Kevin T Foley, Robert J Bohinski, Gregory B Lanford, Carol Holden, Richard N W Wohns
STUDY DESIGN: Delphi Panel expert panel consensus and narrative literature review OBJECTIVE.: To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)). SUMMARY OF BACKGROUND DATA: Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics...
October 6, 2016: Spine
https://www.readbyqxmd.com/read/27749348/perioperative-surgical-home-in-pediatric-settings-preliminary-results
#20
Karen Thomson, Sophie R Pestieau, Janish J Patel, Heather Gordish-Dressman, Ariana Mirzada, Zeev N Kain, Matthew E Oetgen
BACKGROUND: The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS). METHODS: A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population...
November 2016: Anesthesia and Analgesia
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