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Perioperative volume management

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https://www.readbyqxmd.com/read/28097305/enhanced-recovery-after-surgery-a-review
#1
Olle Ljungqvist, Michael Scott, Kenneth C Fearon
Importance: Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Observations: Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient...
January 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28092401/randomized-clinical-trial-of-preoperative-oral-versus-intravenous-iron-in-anaemic-patients-with-colorectal-cancer
#2
B D Keeler, J A Simpson, O Ng, H Padmanabhan, M J Brookes, A G Acheson
BACKGROUND: Treatment of preoperative anaemia is recommended as part of patient blood management, aiming to minimize perioperative allogeneic red blood cell transfusion. No clear evidence exists outlining which treatment modality should be used in patients with colorectal cancer. The study aimed to compare the efficacy of preoperative intravenous and oral iron in reducing blood transfusion use in anaemic patients undergoing elective colorectal cancer surgery. METHODS: Anaemic patients with non-metastatic colorectal adenocarcinoma were recruited at least 2 weeks before surgery and randomized to receive oral (ferrous sulphate) or intravenous (ferric carboxymaltose) iron...
January 16, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28027816/pancreatic-anastomosis-after-pancreatoduodenectomy-a-position-statement-by-the-international-study-group-of-pancreatic-surgery-isgps
#3
REVIEW
Shailesh V Shrikhande, Masillamany Sivasanker, Charles M Vollmer, Helmut Friess, Marc G Besselink, Abe Fingerhut, Charles J Yeo, Carlos Fernandez-delCastillo, Christos Dervenis, Christoper Halloran, Dirk J Gouma, Dejan Radenkovic, Horacio J Asbun, John P Neoptolemos, Jakob R Izbicki, Keith D Lillemoe, Kevin C Conlon, Laureano Fernandez-Cruz, Marco Montorsi, Max Bockhorn, Mustapha Adham, Richard Charnley, Ross Carter, Thilo Hackert, Werner Hartwig, Yi Miao, Michael Sarr, Claudio Bassi, Markus W Büchler
BACKGROUND: Clinically relevant postoperative pancreatic fistula (grades B and C of the ISGPS definition) remains the most troublesome complication after pancreatoduodenectomy. The approach to management of the pancreatic remnant via some form of pancreatico-enteric anastomosis determines the incidence and severity of clinically relevant postoperative pancreatic fistula. Despite numerous trials comparing diverse pancreatico-enteric anastomosis techniques and other adjunctive strategies (pancreatic duct stenting, somatostatin analogues, etc), currently, there is no clear consensus regarding the ideal method of pancreatico-enteric anastomosis...
December 24, 2016: Surgery
https://www.readbyqxmd.com/read/28027231/the-lipo-body-lift-a-new-circumferential-body-contouring-technique-useful-after-bariatric-surgery
#4
Nicolas Bertheuil, Benoit Chaput, Antoine De Runz, Paul Girard, Raphael Carloni, Eric Watier
BACKGROUND: After bariatric surgery, lifting of the lower body involves a contouring technique used to achieve optimal lower trunk reconstruction. The authors describe an innovative procedure applicable after massive weight loss: the lipo-body lift method. The authors describe their experience with this novel, safe procedure. METHODS: Twenty-five abdominal body-contouring reconstructions following massive weight loss were treated by means of circumferential lipo-body lift...
January 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28018896/factors-influencing-neurodevelopment-after-cardiac-surgery-during-infancy
#5
REVIEW
Hedwig Hubertine Hövels-Gürich
Short- and long-term neurodevelopmental (ND) disabilities with negative impact on psychosocial and academic performance, quality of life, and independence in adulthood are known to be the most common sequelae for surviving children after surgery for congenital heart disease (CHD). This article reviews influences and risk factors for ND impairment. For a long time, the search for independent risk factors was focused on the perioperative period and modalities of cardiopulmonary bypass (CPB). CPB operations to ensure intraoperative vital organ perfusion and oxygen supply with or without circulatory arrest or regional cerebral perfusion bear specific risks...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28008466/perioperative-hemorrhagic-complications-after-laparoscopic-sleeve-gastrectomy-four-year-experience-of-a-bariatric-center-of-excellence
#6
Francesco De Angelis, Mohamed Abdelgawad, Mario Rizzello, Consalvo Mattia, Gianfranco Silecchia
BACKGROUND: Bleeding and gastric fistula are the most common postoperative complications after laparoscopic sleeve gastrectomy (LSG). The long stapler line represents the most frequent source of bleeding, which ranges between 0 and 20%. The aim of this retrospective study was to analyze the 4-year experience of a high-volume center with respect to the prevention and management of perioperative LSG bleeding. METHODS: The prospectively maintained database from June 2012 to June 2016 was reviewed...
December 23, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27996995/-acute-aortic-dissection-type-a-from-the-past-to-the-present
#7
Claudio F Russo, Giovanni Mariscalco, Pasquale Santé
Acute aortic dissection type A (AADA) is a disease that has a catastrophic impact on a patient's life. Although refinements in perioperative and surgical care have translated into improved outcomes for patients affected by AADA, hospital mortality after surgery still remains very high, ranging from 15% to 30%. The management of AADA is complex and dictated by the modality of presentation, extent and location of the disease. Attempts to formulate consensus statements and relevant guidelines have identified significant gaps in the AADA knowledge with reference to pathogenesis, appropriate management and configuration for clinical services...
November 2016: Giornale Italiano di Cardiologia
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
#8
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/27987219/relative-efficacy-of-tranexamic-acid-and-preoperative-anemia-treatment-for-reducing-transfusions-in-total-joint-arthroplasty
#9
Joseph F Styron, Alison K Klika, Caleb R Szubski, Deborah Tolich, Wael K Barsoum, Carlos A Higuera
BACKGROUND: This study aimed to evaluate the efficacy of a perioperative blood management (PBM) protocol at a large, tertiary hospital at reducing blood transfusions after total hip or knee arthroplasty (THA or TKA). STUDY DESIGN AND METHODS: A retrospective review of the PBM for patients undergoing THA or TKA was performed. Adjusted multiple logistic and Poisson regression models examined the effect of patient characteristics and preoperative, intraoperative, and postoperative factors on the likelihood of transfusion and units transfused...
December 17, 2016: Transfusion
https://www.readbyqxmd.com/read/27977460/perioperative-outcomes-and-management-in-pediatric-complex-cranial-vault-reconstruction-a-multicenter-study-from-the-pediatric-craniofacial-collaborative-group
#10
Paul A Stricker, Susan M Goobie, Franklyn P Cladis, Charles M Haberkern, Petra M Meier, Srijaya K Reddy, Thanh T Nguyen, Lingyu Cai, Marcia Polansky, Peter Szmuk, John Fiadjoe, Codruta Soneru, Ricardo Falcon, Timothy Petersen, Courtney Kowalczyk-Derderian, Nicholas Dalesio, Stefan Budac, Neels Groenewald, Daniel Rubens, Douglas Thompson, Rheana Watts, Katherine Gentry, Iskra Ivanova, Mali Hetmaniuk, Vincent Hsieh, Michael Collins, Karen Wong, Wendy Binstock, Russell Reid, Kim Poteet-Schwartz, Heike Gries, Rebecca Hall, Jeffrey Koh, Carolyn Bannister, Wai Sung, Ranu Jain, Allison Fernandez, Gerald F Tuite, Ernesto Ruas, Oleg Drozhinin, Lisa Tetreault, Bridget Muldowney, Karene Ricketts, Patrick Fernandez, Lisa Sohn, John Hajduk, Brad Taicher, Jessica Burkhart, Allison Wright, Jane Kugler, Lea Barajas-DeLoa, Meera Gangadharan, Veronica Busso, Kayla Stallworth, Susan Staudt, Kristen L Labovsky, Chris D Glover, Henry Huang, Helena Karlberg-Hippard, Samantha Capehart, Cynthia Streckfus, Kim-Phuong T Nguyen, Peter Manyang, Jose Luis Martinez, Jennifer K Hansen, Heather Mitzel Levy, Alyssa Brzenski, Franklin Chiao, Pablo Ingelmo, Razaz Mujallid, Olutoyin A Olutoye, Tariq Syed, Hubert Benzon, Adrian Bosenberg
BACKGROUND: The Pediatric Craniofacial Collaborative Group established the Pediatric Craniofacial Surgery Perioperative Registry to elucidate practices and outcomes in children with craniosynostosis undergoing complex cranial vault reconstruction and inform quality improvement efforts. The aim of this study is to determine perioperative management, outcomes, and complications in children undergoing complex cranial vault reconstruction across North America and to delineate salient features of current practices...
February 2017: Anesthesiology
https://www.readbyqxmd.com/read/27958191/wet-or-dry-a-review-of-intravenous-fluid-administration-in-anesthesia-practice
#11
Matthew D'Angelo, R Kyle Hodgen
Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27940452/perioperative-goal-directed-haemodynamic-therapy-based-on-flow-parameters-a-concept-in-evolution
#12
L Meng, P M Heerdt
Haemodynamic management incorporating direct or surrogate stroke volume monitoring has experienced a rapid evolution, because of emergence of the "goal-directed therapy" concept and technological developments aimed at providing a parameter leading to the goal. Nonetheless, consensus on both definitions of the ideal "goal" and strategies for achieving it remain elusive. For this review, we first consider basic physiological and patient monitoring factors relevant to the concept of "fluid responsiveness", and then focus upon randomized controlled trials and meta-analyses involving goal-directed haemodynamic therapy based on various flow parameters...
December 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27935782/wet-or-dry-a-review-of-intravenous-fluid-administration-in-anesthesia-practice
#13
Matthew D'Angelo, R Kyle Hodgen
Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27931033/low-positive-airway-pressure-without-positive-end-expiratory-pressure-decreases-blood-loss-during-hepatectomy-in-living-liver-donors
#14
Tomohiro Iguchi, Toru Ikegami, Tetsuhiro Fujiyoshi, Tomoharu Yoshizumi, Ken Shirabe, Yoshihiko Maehara
BACKGROUND/AIMS: Despite the development of strategies to minimize blood loss during hepatectomy challenges remain. Our aim was to determine whether low positive airway pressure (PAP) without positive end-expiratory pressure (PEEP) could minimize blood loss during hepatectomy. METHODS: Forty-one living liver donors who underwent extended left lobectomy or right lobectomy between December 2012 and November 2013 were retrospectively analyzed. In the standard PAP group (n = 18), tidal volume was 8-10 ml/kg, respiratory rate was 10-12/min and PEEP was maintained at 5 cm H2O...
December 9, 2016: Digestive Surgery
https://www.readbyqxmd.com/read/27905691/is-volume-important-in-aneurysm-treatment-outcome
#15
Athanasios Katsargyris, Chris Klonaris, Eric L Verhoeven
Several studies have suggested that surgical procedures performed at high-volume centers may result in superior outcome. Technically more demanding procedures such as aortic aneurysm repair appear to demonstrate a stronger relationship with volume. The present chapter reviewed the literature using the MEDLINE database to identify studies investigating the effect of volume in aortic aneurysm repair outcomes. The great majority of studies identified shows an advantage for high-volume hospitals with regard to perioperative mortality of abdominal (AAA), thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair...
December 1, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27900630/current-delivery-of-hyperthermic-intraperitoneal-chemotherapy-with-cytoreductive-surgery-cs-hipec-and-perioperative-practices-an-international-survey-of-high-volume-surgeons
#16
Allison H Maciver, Eisar Al-Sukhni, Jesus Esquivel, Joseph J Skitzki, John M Kane, Valerie A Francescutti
BACKGROUND: Cytoreductive surgery and heated intraperitoneal chemotherapy (CS/HIPEC) is performed for selected indications at a limited number of specialized centers worldwide. Currently there is no standardized approach to the perioperative care process. We sought to capture current practices in the perioperative management of patients who undergo CS/HIPEC at high-volume centers. METHODS: Surgeon members of the American Society of Peritoneal Surface Malignancies working at high-volume CS/HIPEC centers (>10 cases/year) were invited to complete an online survey...
November 29, 2016: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/27876245/perioperative-medicine-and-taiwan-national-health-insurance-research-database
#17
REVIEW
C C Chang, C C Liao, T L Chen
"Big data", characterized by 'volume', 'velocity', 'variety', and 'veracity', being routinely collected in huge amounts of clinical and administrative healthcare-related data are becoming common and generating promising viewpoints for a better understanding of the complexity for medical situations. Taiwan National Health Insurance Research Database (NHIRD), one of large and comprehensive nationwide population reimbursement databases in the world, provides the strength of sample size avoiding selection and participation bias...
September 2016: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
https://www.readbyqxmd.com/read/27871683/perioperative-support-not-volume-is-necessary-to-optimize-outcomes-in-surgical-management-of-necrotizing-enterocolitis
#18
Adrienne N Cobb, Yee M Wong, Sarah A Brownlee, Barbara A Blanco, Yoshiki Ezure, Heather N Paddock, Paul C Kuo, Anai N Kothari
BACKGROUND: This study examines the relationship between hospital volume of surgical cases for necrotizing enterocolitis (NEC) and patient outcomes. METHODS: A retrospective cross-sectional review was performed using the HCUP SID for California from 2007 to 2011. Patients with NEC who underwent surgery were identified using ICD-9CM codes. Risk-adjusted models were constructed with mixed-effects logistic regression using patient and demographic covariates. RESULTS: 23 hospitals with 618 patients undergoing NEC-related surgical intervention were included...
November 9, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27842750/ventilatory-management-of-the-noninjured-lung
#19
REVIEW
David L Bowton, Louis Keith Scott
This article reviews aspects of mechanical ventilation in patients without lung injury, patients in the perioperative period, and those with neurologic injury or disease including spinal cord injury. Specific emphasis is placed on ventilator strategies, including timing and indications for tracheostomy. Lung protective ventilation, using low tidal volumes and modest levels of positive end-expiratory pressure, should be the default consideration in all patients requiring mechanical ventilatory support. The exception may be the patient with high cervical spinal cord injuries who requires mechanical ventilatory support...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27830448/estimating-the-effect-of-intravenous-acetaminophen-for-postoperative-pain-management-on-length-of-stay-and-inpatient-hospital-costs
#20
E Eve Shaffer, An Pham, Robert L Woldman, Andrew Spiegelman, Scott A Strassels, George J Wan, Thomas Zimmerman
INTRODUCTION: The provision of safe, effective, cost-efficient perioperative inpatient acute pain management is an important concern among clinicians and administrators within healthcare institutions. Overreliance on opioid monotherapy in this setting continues to present health risks for patients and increase healthcare costs resulting from preventable adverse events. The goal of this study was to model length of stay (LOS), potential opioid-related complications, and costs for patients reducing opioid use and adding intravenous acetaminophen (IV APAP) for management of postoperative pain...
January 2017: Advances in Therapy
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