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the association of perioperative practice

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https://www.readbyqxmd.com/read/28062326/the-impact-of-comorbidity-on-surgical-outcomes-in-older-adults-with-cancer
#1
REVIEW
Virginia Sun, Peggy S Burhenn, Lily Lai, Arti Hurria
OBJECTIVES: To provide an overview of the impact of comorbidity on surgical outcomes and postoperative geriatric events in older adults with cancer, and review key components of quality perioperative nursing care of older adults with cancer. DATA SOURCES: Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations. CONCLUSION: The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults after cancer surgery have a substantial impact on surgical outcomes, quality of life, and health care costs...
January 3, 2017: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/28041996/utilizaton-of-perioperative-systemic-chemotherapy-in-upper-tract-urothelial-carcinoma
#2
Greg E Gin, Nora H Ruel, Steven V Kardos, John P Sfakianos, Edward Uchio, Clayton S Lau, Bertram E Yuh
INTRODUCTION: Evidence for the use of perioperative chemotherapy (PC) in upper tract urothelial carcinoma (UTUC) is largely derived from level I evidence for invasive urothelial carcinoma of the bladder (UCB). There has been an increase in PC for urothelial carcinoma of the bladder, as it has disseminated into clinical practice. Therefore, we sought to not only analyze trends in the utilization of PC in UTUC, but also assess factors associated with its use in a large cancer registry database...
December 29, 2016: Urologic Oncology
https://www.readbyqxmd.com/read/28027086/an-ambulatory-surgery-perioperative-surgical-home-in-kaiser-permanente-settings-practice-and-outcomes
#3
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/28012691/multicentre-survey-on-the-current-surgical-management-of-oesophageal-atresia-in-belgium-and-luxembourg
#4
Helena Reusens, Lucas Matthyssens, Charlotte Vercauteren, Katrien van Renterghem
INTRODUCTION: The surgical management of oesophageal atresia (OA) differs between pediatric surgical teams without consensus. We aimed to describe the current practice of OA treatment in Belgium and Luxembourg and compare this to the literature. MATERIALS AND METHODS: A questionnaire was created and sent to all 18 hospitals (14 pediatric surgical units) performing OA surgery in Belgium and Luxembourg. The results were compared to the literature. RESULTS: Most units treat an average of 2-5 OA+TOF (71%) and ≤1 pure OA (pOA) per year (86%)...
November 14, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28008756/cost-effectiveness-and-robot-assisted-urologic-surgery-does-it-make-dollars-and-sense
#5
Ryan W Dobbs, Brenden P Magnan, Nikita Abhyankar, Ashok K Hemal, Ben Challacombe, Jim Hu, Prokar Dasgupta, Francesco Porpiglia, Simone Crivellaro
INTRODUCTION: The introduction of the robotic surgical platform has led to distinct changes in practice patterns and the utilization of minimally invasive surgery in urology. While use of the robotic system is associated with improvements in perioperative outcomes such as estimated blood loss and hospital stay, there are significant fixed and variable costs with the purchase, maintenance and use of the robotics system that has led many authors to investigate the cost effectiveness of robotic urologic surgery...
December 22, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
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
#6
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/28000183/-operation-key-points-and-efficacy-evaluation-of-jinling-procedure-for-mixed-refractory-constipation
#7
Jun Jiang, Qiyi Chen
For chronic transit constipation (STC), surgery should be considered when all pharmacological interventions, biofeedback, and sacral nerve stimulation failed to relieve severe symptoms. Chronic functional constipation can be subdivided into three subtypes: colonic slow-transit constipation, outlet obstruction and mixed refractory constipation. The pathological changes of colonic slow transit and outlet obstruction constipation can influence each other. Mixed refractory constipation accounts for 90.2% of chronic constipation...
December 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28000025/two-novel-classification-systems-for-uterine-fibroids-and-subsequent-uterine-reconstruction-after-myomectomy
#8
Ingolf Juhasz-Böss, Peter Jungmann, Julia Radosa, Anika von Heesen, Russalina Ströder, Stephanie Juhasz-Böss, Gabriele Meyberg-Solomayer, Erich Solomayer
OBJECTIVE: Laparoscopic approaches are the gold standard surgical treatment for intramural and subserous fibroids, whereas submucosal myomas can be treated via hysteroscopy. Removal of intramural myomas often requires a subsequent reconstruction of the uterine wall that ranges from single- to multiple-layer sutures to complex reconstructions. Several classification systems are currently used to characterize uterine fibroids, all of which focus on the assessment of submucosal fibroids during hysteroscopic myomectomy...
December 20, 2016: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/27993359/perioperative-management-and-outcomes-of-esophageal-atresia-and-tracheoesophageal-fistula
#9
Dave R Lal, Samir K Gadepalli, Cynthia D Downard, Daniel J Ostlie, Peter C Minneci, Ruth M Swedler, Thomas Chelius, Laura Cassidy, Cooper T Rapp, Katherine J Deans, Mary E Fallat, S Maria E Finnell, Michael A Helmrath, Ronald B Hirschl, Rashmi S Kabre, Charles M Leys, Grace Mak, Jessica Raque, Frederick J Rescorla, Jacqueline M Saito, Shawn D St Peter, Daniel von Allmen, Brad W Warner, Thomas T Sato
BACKGROUND/PURPOSE: Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a rare congenital anomaly lacking contemporary data detailing patient demographics, medical/surgical management and outcomes. Substantial variation in the care of infants with EA/TEF may affect both short- and long-term outcomes. The purpose of this study was to characterize the demographics, management strategies and outcomes in a contemporary multi-institutional cohort of infants diagnosed with EA/TEF to identify potential areas for standardization of care...
December 5, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27984342/strategies-to-prevent-periprosthetic-joint-infection-after-total-knee-arthroplasty-and-lessen-the-risk-of-readmission-for-the-patient
#10
Richard Iorio, Feroz Osmani
There is yet to be a standardized total knee arthroplasty (TKA) surgical protocol that has been studied to a sufficient degree to offer evidence-based practices regarding infection and readmission prevention. Although high-level evidence is often sought to provide guidance concerning protocol- and process-level decisions, the literature is often confusing and nondefinitive in its conclusions and recommendations regarding periprosthetic joint infection and readmission prevention. Areas of study that require further investigation include the following: the role of patient optimization and preoperative mitigation of risk; perioperative antibiotics; operating room environment; blood management; operative techniques, implants, and infection prevention measures; wound care management; and post acute care...
December 13, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27956726/effect-of-surgery-start-time-on-day-of-discharge-in-anterior-cervical-discectomy-and-fusion-patients
#11
Benjamin C Mayo, Dustin H Massel, Daniel D Bohl, William W Long, Krishna D Modi, Kern Singh
STUDY DESIGN: Retrospective cohort. OBJECTIVE: To compare time to discharge for anterior cervical discectomy and fusions (ACDF) when performed as either a first case versus later surgical start times. SUMMARY OF BACKGROUND DATA: ACDF is a commonly performed spinal procedure that typically has a short acute recovery period. With an increasing focus on reducing hospital costs and a shift toward outpatient surgical practices, early patient discharge has become a priority for hospitals and physicians alike...
December 15, 2016: Spine
https://www.readbyqxmd.com/read/27939327/survival-implications-of-time-to-surgical-treatment-of-endometrial-cancers
#12
David I Shalowitz, Andrew J Epstein, Lindsey Buckingham, Emily M Ko, Robert L Giuntoli
BACKGROUND: Optimal care for women with endometrial cancers often involves transfer of care from diagnosing physicians (eg, obstetrician-gynecologists) to treating physicians (eg, gynecologic oncologists.) It is critical to determine the effect of time to treatment on cancer outcomes to set best practices guidelines for referral processes. OBJECTIVE: We sought to determine the impact of time from diagnosis of endometrial cancer to surgical treatment on mortality and to characterize those patients who may be at highest risk for worsened survival related to surgical timing...
December 9, 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27935783/the-role-of-pharmacogenomics-in-anesthesia-pharmacology
#13
Brett Morgan, Edwin N Aroke, Jennifer Dungan
The field of pharmacogenomics seeks to identify the impact of genetic variants on drug dosing, response, metabolism, and safety outcomes. The narrow therapeutic indices for anesthesia drugs, variability of patient responses to anesthesia, and the risks associated with surgery make anesthetics and the perioperative period prime targets for pharmacogenetic research. Anesthesia providers strive to optimize anesthesia delivery and patient outcomes and to specifically reduce anesthesia-related risks and negative outcomes...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27922894/antimicrobial-prophylaxis-practice-patterns-in-breast-augmentation-a-national-survey-of-current-practice
#14
Karan Chopra, Arvind U Gowda, Colton H L McNichols, Emile N Brown, Sheri Slezak, Yvonne Rasko
BACKGROUND: Breast augmentation is one of the most commonly performed aesthetic surgery procedures worldwide. Bacterial contamination is of paramount concern due to its role in biofilm formation and capsular contracture. Plastic surgeons have adopted a variety of perioperative interventions in efforts to reduce implant contamination, however definitive evidence supporting these practices is lacking. OBJECTIVE: The goal of this study was to assess current practice patterns aimed at reducing implant-related infections in breast augmentation and comparing them to current evidence-based medicine recommendations...
December 5, 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/27913536/reversal-of-direct-oral-anticoagulants-a-practical-approach
#15
Andrew W Shih, Mark A Crowther
Direct oral anticoagulants (DOACs) have at least noninferior efficacy compared with other oral anticoagulants and have ancillary benefits, including overall better safety profiles, lack of the need for routine monitoring, rapid onset of action, and ease of administration. Reversal of these agents may be indicated in certain situations such as severe bleeding and for perioperative management. DOAC-associated bleeding should be risk stratified: patients with moderate or severe bleeding should have the DOAC discontinued and reversal strategies should be considered...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27906717/spectrum-of-postoperative-complications-in-pulmonary-hypertension-and-obesity-hypoventilation-syndrome
#16
Roop K Kaw
PURPOSE OF REVIEW: The purpose of this review is to identify chronic pulmonary conditions which may often not be recognized preoperatively especially before elective noncardiac surgery and which carry the highest risk of perioperative morbidity and mortality. RECENT FINDINGS: This review discusses some of the most recent studies that highlight the perioperative complications, and their prevention and management strategies. SUMMARY: Pulmonary hypertension is a well recognized risk factor for postoperative complications after cardiac surgery but the literature surrounding noncardiac surgery is sparse...
February 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27905060/perioperative-risk-adjustment-for-total-shoulder-arthroplasty-are-simple-clinically-driven-models-sufficient
#17
David N Bernstein, Aakash Keswani, David Ring
BACKGROUND: There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure...
November 30, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27902502/zika-virus-and-patient-blood-management
#18
Lawrence T Goodnough, Marisa B Marques
Sporadic Zika virus infections had only occurred in Africa and Asia until an outbreak in Micronesia (Oceania) in 2007. In 2013 to 2014, several outer Pacific Islands reported local outbreaks. Soon thereafter, the virus was likely introduced in Brazil from competing athletes from French Polynesia and other countries that participated in a competition there. Transmission is thought to have occurred through mosquito bites and spread to the immunologically naive population. Being also a flavivirus, the Zika virus is transmitted by the Aedes mosquito that is endemic in South and Central America that is also the vector of West Nile virus, dengue, and chikungunya...
January 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27896656/pancreatitis-after-pancreatoduodenectomy-predicts-clinically-relevant-postoperative-pancreatic-fistula
#19
C M Kühlbrey, N Samiei, O Sick, F Makowiec, U T Hopt, U A Wittel
BACKGROUND: Morbidity after pancreas resection is still high with postoperative pancreatic fistulas (POPF) being the most frequent complication. However, exocrine insufficiency seems to protect from POPF. In clinical practice, patients showing increased postoperative systemic amylase concentrations appear to frequently develop POPF. We therefore retrospectively examined the occurrence of systemic amylase increase after pancreas resections and its association with the clinical course. PATIENTS AND METHODS: Perioperative data from 739 consecutive pancreas resections were assessed in a prospectively maintained SPSS database...
November 28, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/27884218/the-current-state-of-perioperative-pain-management-challenges-and-potential-opportunities-for-nurses
#20
Melanie H Simpson, Patricia Bruckenthal
Achievement of adequate postoperative pain management is a critical challenge in health care, with an estimated three out of four adult surgical patients reporting moderate to extreme pain after surgery. Overreliance on opioids in acute care settings has persisted, despite well-known adverse side effects frequently associated with this class of drugs. Furthermore, patients with a history of chronic opioid use present additional challenges in terms of postsurgical pain management. Advances in the development of newer analgesic agents and anesthetic techniques may be useful in surgical patients with a history of chronic opioid use and in the overall surgical patient population...
December 2016: AORN Journal
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