Office-based surgery and patient outcomes

Purpose of review The purpose of this review is to provide an update on the current knowledge about patient safety and outcomes in the office-based setting. Ambulatory procedures performed outside the hospital are steadily increasing, resulting in an increasing number and complexity of office-based procedures and patient comorbidities over the past two decades. In this review we focus on most recent outcomes studies encompassing different surgical specialties and patient populations. Recent findings Rates of complications in the office-based surgical (OBS) setting from the latest publications are similar to, or lower than previously reported studies. Many of the studies published were in the field of plastic surgery, with a few publications on office vascular and dental procedures. The most common complications were haematoma, infection and venous thromboembolism (VTE) and pulmonary embolism. Death was a rare finding, though when it occurred, it was often associated with VTE/pulmonary emboli and abdominoplasties. Summary Overall, these studies contribute positively to our current understanding of the safety of office-based anaesthesia. As an increasing number of procedures migrate from the hospital setting to ambulatory and office-based environments, it will be critically important to ensure high quality and safe patient care in these settings.
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

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AbstractSurgery for esophageal cancers carries high rates of morbidity and mortality despite improvements in perioperative care especially with increasingly safe anesthesia and postoperative ICU care. A case control study was conducted on 713 patients operated for esophageal cancer over a period of 8  years (2009–2016). Multiple preoperative, intraoperative, and postoperative clinical and laboratory parameters were compared between patients who succumbed to the surgery, i.e., 30-day mortality, and those who did not. Of the preoperative parameters, age >  58.5 years (p = 0.01),...
Source: Indian Journal of Surgical Oncology - Category: Cancer & Oncology Source Type: research
Heparin-induced thrombocytopenia (HIT) is an autoimmune disorder that involves the formation of antibodies to the heparin-platelet factor 4 complex, thus leading to life-threatening thrombosis.1 Cardiac surgery with cardiopulmonary bypass (CPB) for patients with HIT requires anticoagulation using heparin alternatives and is associated with high postoperative mortality rates.2 Argatroban is a direct thrombin inhibitor used for anticoagulation during CPB in patients with HIT. The authors describe coagulation management for a case of suspected HIT requiring emergency pulmonary embolectomy with CPB.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Report Source Type: research
Publication date: November–December 2018Source: Spine Deformity, Volume 6, Issue 6Author(s): Jun S. Kim, Varun Arvind, Eric K. Oermann, Deepak Kaji, Will Ranson, Chierika Ukogu, Awais K. Hussain, John Caridi, Samuel K. ChoAbstractStudy DesignCross-sectional database study.ObjectiveTo train and validate machine learning models to identify risk factors for complications following surgery for adult spinal deformity (ASD).Summary of Background DataMachine learning models such as logistic regression (LR) and artificial neural networks (ANNs) are valuable tools for analyzing and interpreting large and complex data sets. AN...
Source: Spine Deformity - Category: Orthopaedics Source Type: research
This study was a single-center study. From July 2016 to December 2017, all patients with lung cancer who underwent surgery in our department were enrolled into this study. Except routine preoperative examinations, lower extremity Doppler ultrasound was performed in all patients before and after surgery to determine whether there was any newly developed deep venous thrombosis (DVT). Patients did not receive any prophylactic anticoagulant therapy before and after surgery. Patients were then divided into VTE group and control group according to whether VTE occurred after operation. Baseline data, surgical related data (surger...
Source: Chinese Journal of Lung Cancer - Category: Cancer & Oncology Source Type: research
Access Vascular, based in Massachusetts, has developed a peripherally inserted central venous catheter (PICC) composed of a thromboresistant hydrogel material. The catheter could reduce the incidence of catheter-related thrombi and resulting adverse ...
Source: Medgadget - Category: Medical Devices Authors: Tags: Anesthesiology Emergency Medicine Exclusive Materials Radiology Surgery Vascular Surgery Source Type: blogs
Publication date: Available online 7 August 2018Source: Anaesthesia &Intensive Care MedicineAuthor(s): Ravindra Cooray, Caroline LakeAbstractVenous thromboembolism is a major cause of perioperative morbidity and mortality. Immobilized medical patients are also at risk. Long-term sequelae represent a significant chronic health burden. Hospitalized patients should be assessed for their risk of thromboembolism and bleeding at regular intervals. Risk stratification using recommended models can be used to guide the choice of thromboprophylaxis. Both mechanical and pharmacological interventions reduce the incidence of venous...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
AbstractPurpose of reviewThis manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment.Recent findingsThe obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted.SummaryVTE during pregnancy and the postpartum window occurs at a 6 –10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoag...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Abstract Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation (LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications (intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed ...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
ConclusionsA short course of mechanical VTE prophylaxis may be appropriate for low-risk patients who can immediately mobilize.
Source: Journal of Clinical Orthopaedics and Trauma - Category: Orthopaedics Source Type: research
Publication date: June 2018Source: Anaesthesia &Intensive Care Medicine, Volume 19, Issue 6Author(s): Jonathan Weale, Andrea A. KelleherAbstractContinued advances in the understanding and management of congenital heart disease (CHD) mean that over 90% of children born with CHD now survive to adulthood. This in turn results in greater numbers of adult patients presenting for medical and surgical care at non-specialist centres. A simple classification of adult congenital heart disease (ACHD) according to complexity can help clinicians to understand the implications of the specific cardiac anomaly encountered. Issues rela...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
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