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Perioperative Home

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
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...
October 3, 2016: Anesthesia and Analgesia
S Sachin, M C Rajesh, E K Ramdas
Surgical removal of the kidney tumor outside the body, (ex vivo renal bench surgery) followed by auto transplantation is an emerging and often done procedure to reconstruct the urinary tract. It possesses immense challenges to both the anesthesiologists and the surgeons. The risks are multiplied if you are performing the surgery on a solitary functioning kidney. Here, we are describing the anesthetic management of 70-year-old male post nephrectomy patient undergoing renal auto transplantation by bench surgery...
September 2016: Anesthesia, Essays and Researches
Yaw A Nyame, Helen Liang, Hans C Arora, Bradley C Gill, Peter Caputo, Daniel Ramirez, Matthew J Maurice, Khaled Fareed, Robert J Stein, Georges-Pascal Haber, Andrew J Stephenson, Amr Fergany, Jihad Kaouk
PURPOSE: Currently no data exists to guide renal surgeons on the perioperative use of renin-angiotensin (RAS) blockers despite their potential cardiorenal benefits. This study aims to assess the impact of resuming RAS blockers on postoperative renal function and adverse cardiac events following partial nephrectomy. PATIENTS AND METHODS: This is an observational analysis of patients undergoing robotic-assisted laparoscopic partial nephrectomy from 2006-2014 at a single institution...
October 13, 2016: Journal of Urology
Jason M Davies, Michael T Lawton
OBJECTIVE Treatment of cerebrovascular malformations has grown in complexity with the development of multimodal approaches, including microsurgery, endovascular treatments, and radiosurgery. In spite of this changing standard of care, the provision of care continues across a variety of settings. The authors sought to determine the risk of adverse outcome after treatment of patients with vascular malformations in the US. Patient, surgeon, and hospital characteristics, including volume, were tested as potential outcome predictors...
October 14, 2016: Journal of Neurosurgery
Jarosław Szefel, Wiesław J Kruszewski, Mariusz Szajewski, Maciej Ciesielski, Ewa Sobczak, Maksymilian Czerepko, Wiesława Łysiak-Szydłowska
INTRODUCTION: Currently there are no established guidelines regarding the use of long-chain triglycerides (LCT) vs. medium-chain triglycerides medium-chain triglycerides (MCT)/long-chain triglycerides (LCT) in total parenteral nutrition (TPN). Severe malnutrition of patients with refractory cachexia (RC) often causes their disqualification from invasive methods of treatment thus decreasing their quality of life and survival time. AIM: To compare the changes in nutritional state of patients with RC receiving PN with LCT and LCT/MCT lipid emulsions and to assess the influence of enteral nutrition on their survival time...
2016: Przegla̜d Gastroenterologiczny
Pertti Pere, Jukka Harju, Pekka Kairaluoma, Veikko Remes, Päivi Turunen, Per H Rosenberg
STUDY OBJECTIVE: Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients. DESIGN: Randomized, prospective trial. SETTING: University hospital day-surgery center. PATIENTS: 156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy...
November 2016: Journal of Clinical Anesthesia
Yin Li
Enhanced recovery after surgery (ERAS) is a patient-centered, surgeon-led system combining anesthesia, nursing, nutrition and psychology. It aims to minimize surgical stress and maintain physiological function in perioperative care, thereby expediting recovery. ERAS theory has been clinically applied for nearly 20 years and it is firstly used in colorectal surgery, then widely used in other surgical fields. However, ERAS is not used commonly in esophagectomy because of its surgical complexity and high morbidity of postoperative complications, which limits the application of ERAS in the field of esophagectomy...
September 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Jared A Shenson, Jennifer N Craig, Sarah L Rohde
OBJECTIVE: Total laryngectomy (TL) is a high-cost procedure with patients at risk for significant postoperative health care use. Face-to-face preoperative counseling provided by speech-language pathologists is a relatively inexpensive intervention that may improve care quality and decrease costs. We evaluated if preoperative counseling for patients undergoing TL was associated with differences in length of stay (LOS), use of the emergency department (ED), or unplanned readmissions within 30 days of discharge...
September 27, 2016: Otolaryngology—Head and Neck Surgery
Esther Lee, JoAnn Daugherty, Joseph Burkard
PURPOSE: To determine if a correlation exists between OSA patient characteristics and the PACU discharge location; and the characteristics of the patients at-risk for low saturation levels, increased number of desaturations, and longer length of stay in the PACU. DESIGN: Retrospective, correlational study design. METHOD: Chart review of OSA patients ≥ 18 years old. Correlational analysis was performed between 15 high risk patient variables and the PACU discharge disposition: home or monitored bed...
October 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Ahmed Kayssi, Steven Dilkas, Derry L Dance, Charles de Mestral, Thomas L Forbes, Graham Roche-Nagle
BACKGROUND: The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs; however, the rehabilitation trends for patients with lower extremity amputations across Canada have not been studied previously. OBJECTIVE: To describe trends in rehabilitation after lower extremity amputations and the factors affecting rehabilitation length of stay in Canada. DESIGN: Retrospective cohort analysis...
September 21, 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Leslie M Garson, Shermeen Vakharia, Angela F Edwards, Mervyn Maze
No abstract text is available yet for this article.
September 16, 2016: Anesthesia and Analgesia
Subramanian Vaidyanathan, Azi Samsudin, Gurpreet Singh, Peter L Hughes, Bakul M Soni, Fahed Selmi
INTRODUCTION: Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case. CASE REPORT: A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications...
2016: International Medical Case Reports Journal
Austin A Woolard, Jesse M Ehrenfeld, Susan S Eagle, Jonathan P Wanderer
STUDY OBJECTIVE: To evaluate perioperative dual antiplatelet therapy management in patients with previously placed coronary stents. DESIGN: Retrospective medical record review. SETTING: Academic medical center. PATIENTS: A total of 1891 surgical cases performed at Vanderbilt University Medical Center in 2012 were evaluated using a perioperative database. Of these, 161 had complete data records that were evaluated using 2 evidence-based and expert opinion-supported protocols...
September 2016: Journal of Clinical Anesthesia
Nisreen Fahmy, Julian Siah, Joanna Umo-Etuk
BACKGROUND: Pain is the commonest reason for delayed discharge and readmission post day surgery with up to 45% of patients reported to suffer moderate-to-severe post-surgical pain 24 hours after discharge. The importance of post-surgical pain management extends beyond the acute phase when one considers that all chronic post-surgical pain was once acute. Although much focus is given to perioperative analgesia, a patient's pain management once discharged can be overlooked, whilst at this time the patient's pain management is within their own hands...
May 2016: British Journal of Pain
Meera R Chappidi, Max Kates, C J Stimson, Michael H Johnson, Phillip M Pierorazio, Trinity J Bivalacqua
PURPOSE: To compare the timing, causes, hospital costs, and perioperative outcomes of index vs. non-index hospital readmissions following radical cystectomy. MATERIALS AND METHODS: The 2013 Nationwide Readmissions Database was queried for bladder cancer patients undergoing cystectomy. Sociodemographic characteristics, hospital costs, and causes of readmission were compared among index and non-index readmitted patients. Univariable and multivariable logistic regression models were used to identify predictors of non-index readmissions, mortality during the first readmission, and subsequent readmission...
August 18, 2016: Journal of Urology
Chunyuan Qiu, Maxime Cannesson, Atef Morkos, Vu T Nguyen, Diana LaPlace, Narendra S Trivedi, Armond Khachatourians, Joseph Rinehart, Zeev N Kain
BACKGROUND: In this article, we report on the implementation and impact of a Perioperative Surgical Home (PSH) model for the total knee arthroplasty at an integrated delivery system (Kaiser Permanente). METHODS: A multidisciplinary committee developed and implemented a series of PSH protocols that included the entire continuum of care from the decision for surgery until 30 days after surgery. Five hundred forty-six subjects were included in the preimplementation phase (Fast Track [T-fast]), and 518 patients were included in the postimplementation phase (PSH)...
September 2016: Anesthesia and Analgesia
Mike Schweitzer, Thomas R Vetter
No abstract text is available yet for this article.
September 2016: Anesthesia and Analgesia
David I Soybel, Kayla Knuf
No abstract text is available yet for this article.
August 10, 2016: JAMA Surgery
P J Zondervan, M Buijs, J J de la Rosette, O van Delden, K van Lienden, M P Laguna
INTRODUCTION: Cryoablation (CA) has been broadly used mostly in the treatment of small renal masses (SRMs). The present review aims to define the current role of CA in the treatment of SRMs by assessing clinical indications and outcomes. METHOD: A comprehensive review on patient selection, procedural details, perioperative complications, and short/long-term oncological and functional outcomes was conducted. For each section, a take-home message was formulated with level of evidence (LoE) according to Cochrane collaboration...
August 5, 2016: International Journal of Surgery
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