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https://www.readbyqxmd.com/read/28943192/preoperative-factors-that-predict-the-need-to-morcellate-in-total-laparoscopic-hysterectomy
#1
Morgan Wolfe, Scott Biest, Nhial Tutlam, Candice Woolfolk, Brooke Winner
STUDY OBJECTIVE: To determine which preoperative factors best predict the need for uterine morcellation at the time of total laparoscopic hysterectomy and to identify cut-offs that can help guide clinical decision-making. DESIGN: Data were collected from a prospective quality assurance database and reviewed retrospectively. Preoperative factors assessed included uterine volume, cross-sectional area, length, size of largest leiomyoma, and bimanual exam. Receiver-operator curves (ROC) were used to establish cut-offs that maximized sensitivity and specificity for each factor...
September 21, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28942855/a-systematic-review-and-meta-analysis-of-factors-for-delirium-in-vascular-surgical-patients
#2
REVIEW
Christopher Oldroyd, Anna F M Scholz, Robert J Hinchliffe, Kathryn McCarthy, Jonathan Hewitt, Terrence J Quinn
BACKGROUND: Delirium is a common syndrome responsible for a large burden of morbidity and mortality. In surgical settings, research into risk factors for postoperative delirium has largely focused on elective orthopedic patients. We performed a systematic review and meta-analysis to evaluate the evidence surrounding risk factors for delirium in vascular surgical populations. METHODS: Two independent reviewers searched five databases (MEDLINE, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO) from January 1987 to December 2015...
October 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28938300/enhancing-the-quality-and-safety-of-the-perioperative-patient
#3
Sven Staender, Andrew Smith
PURPOSE OF REVIEW: Many possible hazards bedevil the perioperative patient. This review focuses on a number of aspects of perioperative management where the patient's quality and safety can be enhanced. RECENT FINDINGS: Our understanding of the relationship between preoperative preparation and postoperative outcomes has improved. There have also been recent developments in our understanding of how to construct useful cognitive aids and make the best use of checklists by understanding the cultural environment supporting their use...
September 21, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28933329/-mid-term-to-long-term-results-of-revision-total-hip-arthroplasty-using-the-oval-shaped-acetabular-cup-tc-type
#4
E Šťastný, T Trč, J Frýdl, Z Kopečný, T Philippou, J Lisý
INTRODUCTION The purpose of our paper is to evaluate the mid-term to long-term results and to confirm the basic criteria of a high-quality revision implant: safe bridging of bone defects, achievement of reliable primary fixation of revision acetabular cup, achievement of good secondary stability with documentable osteointegration of cup and demonstration of remodelling of transplanted bone tissue in the area of defects and in spaces between the implant ribs. MATERIAL AND METHODS Altogether 36 patients (38 cups) were evaluated who had undergone revision hip arthroplasty in the period from 2004 to 2010...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28925271/-the-results-of-five-years-follow-up-prospective-study-of%C3%A2-vaginal-prolapse-repaired-by-prolift-total-mesh-surgery-or%C3%A2-sacrospinous-fixation
#5
P Kraus, L Krofta, M Krčmář, I Urbánková, O Gojiš, K Grogregin, J Feyereisl
OBJECTIVE: The aim of the study is to compare the results of five years follow-up prospective study of vaginal prolapse repaired by prolift total mesh surgery or sacrospinous fixation. STUDY DESIGN: A single-center prospective, cohort study, in patients with defect grade II and more by POP-Q. SETTING: The Institute for the Care of Mather and Child; 3rd Medical Faculty Charles university, Prague. METHODS: Comparison of the preoperative state and the five years after the operation according POP Q, ICIQ-SF, PISQ 12, VAS...
2017: Ceská Gynekologie
https://www.readbyqxmd.com/read/28919125/multi-institution-analysis-of-infection-control-practices-identifies-the-subset-associated-with-best-surgical-site-infection-performance-a-texas-alliance-for-surgical-quality-collaborative-project
#6
Catherine H Davis, Lillian S Kao, Jason B Fleming, Thomas A Aloia
BACKGROUND: In an effort to reduce surgical site infection (SSI) rates, a large number of infection control practices (ICPs), including operating room attire policies, have been recommended. However, few have proven benefits and many are costly, time-consuming, and detrimental to provider morale. The goal of this multi-institution study was to determine which ICPs are associated with lower postoperative SSI rates. STUDY DESIGN: Twenty American College of Surgeons NSQIP and Texas Alliance for Surgical Quality-affiliated hospitals completed this Quality Improvement Assessment Board-approved study...
August 16, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28913487/perioperative-surgical-home-meeting-tomorrow-s-challenges
#7
REVIEW
Teodora O Nicolescu
New healthcare models pose a variety of changes for anesthesiologists, ranging from the need to improve quality and to cost containment: as such, the concept of Perioperative Surgical Home (PSH) has been developed. Modelled after the UK's Enhanced Recovery After Surgery (ERAS), PSH takes a step further by coordinating care starting from the time a surgical decision is made for the patient to as many as 30 days postoperatively, taking a logical evidenced-based approach to judicious preoperative testing. Perioperative surgical home also relies heavily on engineering imported strategies such as the use of Lean Six Sigma methodologies, and involves active participation of all stakeholders...
October 2016: Rom J Anaesth Intensive Care
https://www.readbyqxmd.com/read/28910436/integrating-data-collection-into-office-work-flow-and-electronic-health-records-for-clinical-outcomes-research
#8
C Alessandra Colaianni, Patricia A Levesque, Robin W Lindsay
Meticulous collection of clinical outcomes metrics in patients undergoing elective surgery is important to ensure quality care; it is also increasing in importance as the Centers for Medicare & Medicaid Services moves to tie reimbursement to outcomes and insurance approval. This study assesses a systematic method for gathering preoperative and postoperative data on patients with nasal obstruction who undergo functional septorhinoplasty that was developed at the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts...
September 14, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/28910357/the-quality-of-invasive-breast-cancer-care-for-low-reimbursement-rate-patients-a-retrospective-study
#9
Shaofei Su, Han Bao, Xinyu Wang, Zhiqiang Wang, Xi Li, Meiqi Zhang, Jiaying Wang, Hao Jiang, Wenji Wang, Siyang Qu, Meina Liu
Though evidence-based treatments have been recommended for breast cancer, underuse of the treatments was still observed. To certain extent, patients' access to care, which can be enhanced by increasing the coverage of health insurance, could account for the current underuse in recommended care. This study aimed to examine the association between different proportions of reimbursement and quality of recommended breast cancer care, as well as length of hospital stay. In this retrospective study, 3669 patients diagnosed with invasive breast cancer between 1 June, 2011 and 30 June, 2013 were recruited...
2017: PloS One
https://www.readbyqxmd.com/read/28899986/perioperative-spending-on-spinal-fusion-for-scoliosis-for-children-with-medical-complexity
#10
Jay G Berry, Michael Glotzbecker, Jonathan Rodean, Izabela Leahy, Joanne Cox, Sara J Singer, Margaret O'Neill, Matt Hall, Lynne Ferrari
BACKGROUND: Global payment is used with surgeries to optimize health, lower costs, and improve quality. We assessed perioperative spending on spinal fusion for scoliosis to inform how this might apply to children. METHODS: Retrospective analysis of 1249 children using Medicaid and aged ≥5 years with a complex chronic condition undergoing spinal fusion in 2013 from 12 states. From perioperative health services measured 6 months before and 3 months after spinal fusion, we simulated a spending reallocation with increased preoperative care and decreased hospital care...
September 12, 2017: Pediatrics
https://www.readbyqxmd.com/read/28895895/effects-of-sleep-quality-on-melatonin-levels-and-inflammatory-response-after-major-abdominal-surgery-in-an-intensive-care-unit
#11
Necdet Fatih Yaşar, Bartu Badak, Ağgül Canik, Sema Şanal Baş, Sema Uslu, Setenay Öner, Ersin Ateş
Disruption of nocturnal sleep in an intensive care unit may remarkably affect production of melatonin, which is also known to have anti-inflammatory properties. In the present study, we aimed to investigate the effect of sleep quality on melatonin levels and inflammation after surgery. Thus, we compared the patients, who were screened in the side-rooms where the lights were dimmed and noise levels were reduced, with the patients who received usual care. Preoperative and postoperative urine 6-sulphatoxymelatonin, serum interleukin-1 (IL-1), interleukin-6 (IL-6), and c-reactive protein (CRP) levels were measured and data on sleep quality was collected using the Richards-Campbell Sleep Questionnaire...
September 12, 2017: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/28894658/prioritization-for-plastic-surgery-procedures-aimed-to-improve-quality-of-life-moral-considerations
#12
Gennaro Selvaggi, Lars Kolby, Anna Elander
BACKGROUND: Different health conditions are treated in a Plastic Surgery unit, including those cases whose main goal is to enable patients to feel and integrate better within society and therefore improving quality of life, rather then physical functions. METHODS: We discuss moral principles that can be used as a guide for health professionals to revise and create policies for plastic surgery patients presenting with non-life-threatening conditions. RESULTS: A specific anatomical feature is not always an indicator of patient's well-being and quality of life, and therefore it cannot be used as the sole parameter to identify the worst-off and prioritize the provision of health care...
August 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28891854/racial-and-socioeconomic-differences-manifest-in-process-measure-adherence-for-enhanced-recovery-after-surgery-pathway
#13
Ira L Leeds, Yewande Alimi, Deborah R Hobson, Jonathan E Efron, Elizabeth C Wick, Elliott R Haut, Fabian M Johnston
BACKGROUND: Adherence to care processes and surgical outcomes varies by population subgroups for the same procedure. Enhanced recovery after surgery pathways are intended to standardize care, but their effect on process adherence and outcomes for population subgroups is unknown. OBJECTIVE: This study aims to demonstrate the association between recovery pathway implementation, process measures, and short-term surgical outcomes by population subgroup. DESIGN: This study is a pre- and post-quality improvement implementation cohort study...
October 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28891032/the-need-for-unique-risk-adjustment-for-surgical-site-infections-at-a-high-volume-tertiary-care-center-with-inherent-high-risk-colorectal-procedures
#14
E Gorgun, C Benlice, J Hammel, T Hull, L Stocchi
BACKGROUND: The aim of the present study was to create a unique risk adjustment model for surgical site infection (SSI) in patients who underwent colorectal surgery (CRS) at the Cleveland Clinic (CC) with inherent high risk factors by using a nationwide database. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent CRS between 2005 and 2010. Initially, CC cases were identified from all NSQIP data according to case identifier and separated from the other NSQIP centers...
September 11, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28885412/outcomes-associated-with-a-five-point-surgical-site-infection-prevention-bundle-in-women-undergoing-surgery-for-ovarian-cancer
#15
Melissa H Lippitt, Melissa Gerardi Fairbairn, Rayna Matsuno, Rebecca L Stone, Edward J Tanner, Elizabeth C Wick, Ana C Angarita, Kara Long Roche, Kimberly L Levinson, Jennifer E Bergstrom, Abdulrahman K Sinno, Melanie S Curless, Stephanie Wethington, Sarah M Temkin, Jonathan Efron, Deborah Hobson, Amanda N Fader
OBJECTIVE: To identify risk factors for surgical site infection and to define rates associated with cytoreductive surgery before and after implementation of an infection prevention bundle. METHODS: We conducted a prospective quality improvement study. Patients who underwent ovarian, fallopian tube, or peritoneal cancer cytoreductive surgery at an academic tertiary care center from April 2014 to April 2016 were prospectively enrolled. Patient demographics, surgical variables, and surgical site infection rates were compared with a historical cohort after introduction of a 5-point infection prevention bundle, including: 1) preoperative and intraoperative skin preparation with 4% chlorhexidine and intraoperative vaginal preparation with 4% chlorhexidine; 2) preoperative use of oral antibiotics and mechanical bowel preparation; 3) appropriate timing of intraoperative antibiotics; 4) adoption of enhanced sterile surgical techniques for colon procedures and incisional closure; and 5) perioperative incision management...
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28877807/independent-preoperative-predictors-of-prolonged-length-of-stay-after-laparoscopic-appendectomy-in-patients-over-30-years-of-age-experience-from-a-single-institution
#16
Eric S Wise, Stephen P Gadomski, Annette M Ilg, Camilo Bermudez, Emily W Chan, Michelle L Izmaylov, Samantha J Gridley, Jessica V Kaczmarek, Sir Norman T Melancon, Sarwat Ahmad, Kyle M Hocking, Jose J Diaz, Stephen M Kavic
Prompt discharge after laparoscopic appendectomy (LA) is a marker of quality of care, fiscally desirable and feasible in select patients. Patients over 30 comprise a more heterogeneous cohort known to experience worse outcomes after LA. We aimed to identify easily available preoperative risk factors portending a postoperative length of stay ≥2 days among patients above age 30. In this investigation, 296 included patients from a single institution who underwent LA for acute appendicitis from 2010 to 2014 were retrospectively reviewed for preoperative demographics, laboratory studies, comorbidities, presentation characteristics, radiographic finding, and other rationally selected factors for association with postoperative length of stay ≥2 days...
November 1, 2016: American Surgeon
https://www.readbyqxmd.com/read/28877308/incidence-of-myocardial-infarction-after-high-risk-vascular-operations-in-adults
#17
Yen-Yi Juo, Aditya Mantha, Ramin Ebrahimi, Boback Ziaeian, Peyman Benharash
Importance: Advances in perioperative cardiac management and an increase in the number of endovascular procedures have made significant contributions to patients and postoperative myocardial infarction (POMI) risk following high-risk vascular procedures. Whether these changes have translated into real-world improvements in POMI incidence remain unknown. Objective: To examine the temporal trends of myocardial infarction (MI) following high-risk vascular procedures...
September 6, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28875139/a-comparative-study-of-quality-of-life-of-families-with-children-born-with-cleft-lip-and-or-palate-before-and-after-surgical-treatment
#18
Christian I Emeka, Wasiu L Adeyemo, Akinola L Ladeinde, Azeez Butali
OBJECTIVES: The aim of this study was to compare the quality of life (QoL) of parents/caregivers of children with cleft lip and/or palate before and after surgical repair of an orofacial cleft. MATERIALS AND METHODS: Families of subjects who required either primary or secondary orofacial cleft repair who satisfied the inclusion criteria were recruited. A preoperative and postoperative health-related QoL questionnaire, the 'Impact on Family Scale' (IOFS), was applied in order to detect the subjectively perceived QoL in the affected family before and after surgical intervention...
August 2017: Journal of the Korean Association of Oral and Maxillofacial Surgeons
https://www.readbyqxmd.com/read/28853044/consensus-statement-for-clinical-pathway-development-for-perioperative-pain-management-and-care-transitions
#19
REVIEW
Alan D Kaye, Erik M Helander, Nalini Vadivelu, Leandro Lumermann, Thomas Suchy, Margaret Rose, Richard D Urman
The perioperative surgical home (PSH) model has been created with the intention to reduce costs and to improve efficiency of care and patient experience in the perioperative period. The PSH is a comprehensive model of care that is team-based and patient-centric. The team in each facility should be multidisciplinary and include the input of perioperative services leadership, surgical services, and support personnel in order to provide seamless care for the patient from the preoperative period when decision to undergo surgery is initially made to discharge and, if needed after discharge from the hospital, until full recovery is achieved...
August 29, 2017: Pain and Therapy
https://www.readbyqxmd.com/read/28839990/short-term-high-intensity-rehabilitation-in-radically-treated-lung-cancer-a-three-armed-randomized-controlled-trial
#20
Jian Huang, Yutian Lai, Xudong Zhou, Shuangjiang Li, Jianhua Su, Mei Yang, Guowei Che
BACKGROUND: The feasibility and practicality of preoperative rehabilitation (PR) programs remains quite controversial in the treatment of lung cancer (LC). This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training (IMT). METHODS: A three-armed randomized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients...
July 2017: Journal of Thoracic Disease
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