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https://www.readbyqxmd.com/read/29792232/effect-of-postoperative-goal-directed-therapy-in-cancer-patients-undergoing-high-risk-surgery-a-randomized-clinical-trial-and-meta-analysis
#1
Aline Rejane Muller Gerent, Juliano Pinheiro Almeida, Evgeny Fominskiy, Giovanni Landoni, Gisele Queiroz de Oliveira, Stephanie Itala Rizk, Julia Tizue Fukushima, Claudia Marques Simoes, Ulysses Ribeiro, Clarice Lee Park, Rosana Ely Nakamura, Rafael Alves Franco, Patricia Inês Cândido, Cintia Rosa Tavares, Ligia Camara, Graziela Dos Santos Rocha Ferreira, Elisangela Pinto Marinho de Almeida, Roberto Kalil Filho, Filomena Regina Barbosa Gomes Galas, Ludhmila Abrahão Hajjar
BACKGROUND: Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications. METHODS: A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital...
May 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29791928/the-impact-of-medical-comorbidities-on-primary-total-knee-arthroplasty-reimbursements
#2
Karim G Sabeh, Samuel Rosas, Leonard T Buller, Andrew A Freiberg, Cynthia L Emory, Martin W Roche
Medical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015...
May 23, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29791709/sub-trochanteric-hip-fracture-following-core-decompression-for-osteonecrosis-in-a-patient-with-a-pre-existing-contralateral-occult-femoral-neck-fracture
#3
Ryan J Berger, Assem A Sultan, Connor Cole, Nipun Sodhi, Anton Khlopas, Michael A Mont
We present a unique case of a 62-year-old patient with bilateral osteonecrosis of the femoral heads secondary to corticosteroid use. She presented with an occult right femoral neck fracture and was treated with percutaneous pinning of the right femoral neck and a left-sided percutaneous drilling. Despite apparent appropriate technique, the patient sustained a left sub-trochanteric hip fracture while shifting in bed in the postoperative care unit and was taken back for cephalo-medullary nail fixation. Femoral head osteonecrosis may be an under-reported risk factor for development of pathological neck fractures...
June 1, 2018: Surgical Technology International
https://www.readbyqxmd.com/read/29789971/compliance-with-an-enhanced-recovery-after-a-surgery-program-for-patients-undergoing-gastrectomy-for-gastric-carcinoma-a-phase-2-study
#4
Mi Ran Jung, Seong Yeob Ryu, Young Kyu Park, Oh Jeong
BACKGROUND: Enhanced recovery after surgery (ERAS) programs have gained widespread acceptance in different fields of major surgery. However, most elements of perioperative care in ERAS are based on practices that originated from colorectal surgery. This study investigated compliance with the main elements of ERAS for patients undergoing gastrectomy for gastric carcinoma. METHODS: This phase 2 study enrolled 168 patients undergoing elective gastrectomy for gastric carcinoma...
May 22, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29789186/a-population-based-assessment-of-depression-and-anxiety-in-patients-with-brachial-plexus-injuries
#5
Sarah M Yannascoli, Dustin Stwalley, Mohammed J Saeed, Margaret A Olsen, Christopher J Dy
PURPOSE: Reactive depression and anxiety are common after major life changes such as brachial plexus injuries (BPI). The purpose of this study was to evaluate the incidence and risk factors for coded depression and coded anxiety among patients with BPI using a national database of commercial insurance claims. METHODS: We used the Truven MarketScan database from 2007 to 2013 to identify commercially insured patients aged 18 to 64 years who underwent BPI surgery. For comparison, a control group without BPI was frequency-matched 10:1 by age group, sex, number of provider visits, and length of insurance enrollment...
May 19, 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29789139/medical-and-preoperative-evaluation-of-the-older-adult
#6
REVIEW
Audrey Chun
Because of age, increased rates of multimorbidity, polypharmacy, functional changes, and cognitive impairment, older adults are at higher risk for perioperative complications. Identifying modifiable risk factors and educating patients and families about what to expect can improve surgical outcomes and satisfaction. Comprehensive preoperative evaluation assesses these potential factors and should include recommendations for risk reduction. The optimal preoperative evaluation for older adults should address medical conditions and other areas pertinent to the care of older adults including assessments of cognition, capacity, delirium risk, function, frailty, nutrition, medications, and treatment preferences...
May 19, 2018: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/29788801/perioperative-noninvasive-cardiac-output-monitoring-in-parturients-with-singleton-and-twin-pregnancies-undergoing-caesarean-section-under-spinal-anesthesia-with-prophylactic-phenylephrine-drip-a-prospective-observational-cohort-study
#7
S Orbach-Zinger, E Razinsky, I Bizman, S Firman, R Gat, A Davis, E Ashwal, A Shmueli, M Vaturi, R Gabbay-Benziv, L A Eidelman
INTRODUCTION: Spinal anesthesia is considered the gold standard anesthetic technique for cesarean deliveries (CD) but is associated with a high rate of hypotension. The recent international consensus recommends continuous prophylactic phenylephrine infusion (PPI) administered throughout CD to prevent hypotension. However little information is available on the hemodynamic profiles of women with twin pregnancies as compared to singleton pregnancies perioperatively. Therefore, in this study we aim we compare maternal hemodynamic changes both intraoperatively and postoperatively with the use of the NICAS bio impendence monitor in healthy singleton versus twin parturients undergoing CD deliveries with spinal anesthesia with PPI...
May 22, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29788460/general-principles-for-pial-synangiosis-in-pediatric-moyamoya-patients-2-dimensional-operative-video
#8
David L Penn, Kyle C Wu, Kayla R Presswood, Coleman P Riordan, R Michael Scott, Edward R Smith
Pial synangiosis is a method of indirect surgical revascularization developed at our institution for the treatment of moyamoya disease in pediatric patients. Similar surgical principles are employed in adult cases, often performed because of lack of an adequate donor vessel. Standardized protocols, including preadmission for preoperative intravenous hydration and aspirin administration, as well as intraoperative electroencephalography, are routinely employed to minimize operative risk. Perioperative heparinization is not required...
May 18, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29788437/retromastoid-approach-for-posterior-fossa-skull-base-rosai-dorfman-disease-a-rare-pathology-3-dimensional-operative-video
#9
Anil Nanda, Amey R Savardekar, Devi Prasad Patra, Rimal Hanif Dossani, Maria-Magdalena Georgescu
Rosai-Dorfman disease, originally described by Juan Rosai and Ronald F. Dorfman, is a rare benign histiocytic proliferative disorder, classically presenting with massive lymphadenopathy and a self-limiting clinical course.1 Isolated intracranial skull base involvement is extremely rare and often resembles meningiomas, schwannomas, or other benign skull base lesions.2 The disease is difficult to diagnose radiographically, and tissue diagnosis with open skull base approaches has significant perioperative risks...
May 21, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29787414/perioperative-peripheral-nerve-injury-after-general-anesthesia-a-qualitative-systematic-review
#10
Jason Chui, John M Murkin, Karen L Posner, Karen B Domino
Perioperative peripheral nerve injury (PNI) is a well-recognized complication of general anesthesia that continues to result in patient disability and malpractice claims. However, the multifactorial etiology of PNI is often not appreciated in malpractice claims given that most PNI is alleged to be due to errors in patient positioning. New advances in monitoring may aid anesthesiologists in the early detection of PNI. This article reviews recent studies of perioperative PNI after general anesthesia and discusses the epidemiology and potential mechanisms of injury and preventive measures...
May 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29784265/don-t-ignore-my-snore-reducing-perioperative-complications-of-obstructive-sleep-apnea
#11
Ludy P Lemus, Betty McMullin, Honorata Balinowski
PURPOSE: Obstructive sleep apnea (OSA), a condition associated with decreased muscle tone in the airway, has been linked to postoperative complications. The purpose of the initiative was to develop and implement a guideline for patients identified as high-risk for OSA to reduce complications related to OSA. DESIGN: A multidisciplinary team developed the guideline utilizing the Iowa Model of Evidence-Based Practice to Promote Quality Care. METHODS: PubMed literature search from 2006-2013 and critique of over 40 articles were completed...
June 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29784132/effect-of-the-self-efficacy-enhancing-active-cycle-of-breathing-technique-on-lung-cancer-patients-with-lung-resection-a-quasi-experimental-trial
#12
Mei Yang, Jiu-di Zhong, Jun-E Zhang, Xiao-Xiao Huang, Chuan-Zhen Li, Zhang-Xiang Hong, Si-Wen Zhang
PURPOSE: Enhancing self-efficacy during the active cycle of breathing technique is essential for realizing the full benefit of pulmonary rehabilitation among lung cancer patients. This study aimed to explore the effect of self-efficacy-enhancing active cycle of breathing technique (SEE-ACBT) among patients with lung resection. METHOD: A quasi-experimental trial with a pre-post test design was performed. The control group (n = 81) received routine perioperative care, and the intervention group (n = 81) received SEE-ACBT in addition to routine perioperative care...
June 2018: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
https://www.readbyqxmd.com/read/29783578/re-association-of-robotic-assisted-vs-laparoscopic-radical-nephrectomy-with-perioperative-outcomes-and-health-care-costs-2003-to-2015
#13
Matthew J Resnick
No abstract text is available yet for this article.
June 2018: Journal of Urology
https://www.readbyqxmd.com/read/29782405/the-impact-of-anesthesia-influenced-process-measure-compliance-on-length-of-stay-results-from-an-enhanced-recovery-after-surgery-for-colorectal-surgery-cohort
#14
Michael C Grant, Claro M Pio Roda, Joseph K Canner, Philip Sommer, Daniel Galante, Deborah Hobson, Susan Gearhart, Christopher L Wu, Elizabeth Wick
BACKGROUND: Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. METHODS: From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS)...
May 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29782331/management-challenges-in-an-infant-with-pentalogy-of-cantrell-giant-anterior-encephalocele-and-craniofacial-anomalies-a-case-report
#15
Richard Hubbard, Seth Hayes, Holly Gillis, Spencer Lindsey, Prashant Malhotra, Tariq Wani, Joseph D Tobias, Ralph Beltran
Pentalogy of Cantrell is a rare syndrome consisting of midline abnormalities involving the heart, sternum, abdominal wall, and the anterior and pericardial diaphragm. This combination of defects places patients at particular perioperative risk and requires individualized management during anesthetic care. The following report documents the management of a patient with pentalogy of Cantrell, whose condition was further complicated by severe midline craniofacial abnormalities, including large anterior encephalocele, deficient mandible, tethered tongue, and cleft palate...
May 17, 2018: A&A practice
https://www.readbyqxmd.com/read/29781070/antiplatelet-therapy-for-patients-undergoing-coronary-artery-bypass-surgery
#16
Christine M DeStephan, David J Schneider
Considerable variation in the use and duration of antiplatelet medications during the perioperative and postoperative care of patients undergoing coronary artery bypass grafting (CABG) reflects limited studies focused directly on these patients as well as variation in the results reported. In this review we will highlight the incidence and mechanisms of graft closure as well as the evidence in support of antiplatelet therapy that is balanced by the impact of antiplatelet therapy on the risk of bleeding to provide recommendations for the use of antiplatelet therapy in patients undergoing CABG...
May 21, 2018: Kardiologia Polska
https://www.readbyqxmd.com/read/29780599/perioperative-blood-transfusion-is-associated-with-post-operative-infectious-complications-in-patients-with-crohn-s-disease
#17
Nan Lan, Luca Stocchi, Yi Li, Bo Shen
Background: We have previously demonstrated that blood transfusion (BT) was associated with post-operative complications in patients undergoing surgery for Crohn's disease (CD), based on our institutional data registry. The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Methods: All CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP...
May 2018: Gastroenterology Report
https://www.readbyqxmd.com/read/29779783/readmission-to-the-intensive-care-unit-following-cardiac-surgery-a-derived-and-validated-risk-prediction-model-in-4-869-patients
#18
Rebekah Thomson, Nick Fletcher, Oswaldo Valencia, Vivek Sharma
OBJECTIVE: To derive and validate a clinical risk index that can predict readmission to the intensive care unit (ICU) after cardiac surgery. DESIGN: Retrospective nonrandomized study to determine the perioperative variables associated with risk of readmission to the ICU after cardiac surgery. SETTING: The study was carried out in a single university hospital. PARTICIPANTS: This was an analysis of 4,869 consecutive adult patients...
April 18, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29778507/factors-associated-with-outcomes-and-inpatient-90-day-cost-of-care-in-endometrial-cancer-patients-undergoing-hysterectomy-implications-for-bundled-care-payments
#19
Aimee Rolston, Ryan J Spencer, R Kevin Reynolds, Laurel W Rice, Shitanshu Uppal
OBJECTIVE: To investigate the association of obesity and other comorbidities as well as route of surgery with postoperative outcomes, as well as 30- and 90-day inpatient cost of care after hysterectomy for endometrial cancer. METHODS: From the 2013 National Readmission Database release, patients who underwent hysterectomy for endometrial cancer were included. Obesity was classified as non-obese (body mass index [BMI] < 35 kg/m2 ); class I/II obesity (BMI ≥ 35 but <40 kg/m2 and without obesity related medical condition qualifying it as morbid obesity), class III obesity (BMI ≥ 40 kg/m2 OR BMI ≥ 35 kg/m2 with an obesity-related medical condition)...
May 16, 2018: Gynecologic Oncology
https://www.readbyqxmd.com/read/29778301/behavioral-coping-plans-one-inter-professional-team-s-approach-to-patient-centered-care
#20
Katherine Wittling, Jessica Palumbo Dufur, Ashley McClain, Margaret Gettis
BACKGROUND: Surgical encounters for children with Autism Spectrum Disorder (ASD) are stressful to patients, families and health care providers. It is recognized that parents best anticipate needs of children with ASD. Including a family in the plan of care for the child is imperative. In response to the need for targeted, tailored care, an inter-professional surgical services team convened to determine best practices for addressing a behavioral and developmental plan for children with ASD in the surgical services arena...
May 17, 2018: Journal of Pediatric Nursing
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