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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Abstract OBJECTIVEThe Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide, multicenter quality improvement initiative. Using MSSIC data, the authors sought to identify 90-day adverse events and their associated risk factors (RFs) after cervical spine surgery.METHODSA total of 8236 cervical spine surgery cases were analyzed. Multivariable generalized estimating equation regression models were constructed to identify RFs for adverse events; variables tested included age, sex, diabetes mellitus, disc herniation, foraminal stenosis, central stenosis, American Society of Anesthesiologists Physical C...
Source: Journal of Neurosurgery.Spine - Category: Neurosurgery Authors: Tags: J Neurosurg Spine Source Type: research
This study determines differences in complication rates in patients with IT fractures treated with intramedullary versus extramedullary devices. METHODS: Using the National Surgical Quality Improvement Program database, patients aged ≥55 years with an isolated IT fracture and an American Society of Anesthesiologists score of
Source: The Journal of the American Academy of Orthopaedic Surgeons - Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research
We describe a novel IVC filter extraction technique using pacemaker lead extraction tools. A 26-year-old woman, diagnosed with deep vein thrombosis by computed tomography, received an IVC filter (Gunther Tulip, Cook Medical, Bloomington, IN, USA) implantation for prevention of pulmonary thromboembolism. Eleven weeks later, extraction of the IVC filter by a manual method and snaring technique was unsuccessful because of adhesion to the blood vessel wall. The patient was referred to our hospital for filter removal using pacemaker lead extraction tools. Extraction was performed in an operation room under general anesthesia in...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Abstract BACKGROUND: Deep venous thrombosis (DVT) and pulmonary embolus (PE) remain an important cause of morbidity and mortality after THA and TKA. Prior recommendations have advocated for more aggressive prophylaxis for patients with obesity, whereas the evidence supporting these recommendations is conflicting and often based on underpowered studies. QUESTIONS/PURPOSES: (1) What is the association between obesity and DVT and PE after primary and revision THA and TKA? (2) Is there a body mass index (BMI) threshold beyond which DVT and PE risk is elevated? METHODS: We reviewed the American College of Sur...
Source: Clinical Orthopaedics and Related Research - Category: Orthopaedics Authors: Tags: Clin Orthop Relat Res Source Type: research
This study aimed to survey cases in which enoxaparin administration was performed within 24 hours of CS and to evaluate patient outcomes with or without epidural anaesthesia. The number of eligible cases were 578: 328 patients received an epidural anaesthesia (epidural group), and 250 did not (non-epidural group). In both groups, no patient developed a spinal epidural haematoma. A wound or a subcutaneous bleeding occurred in 22 (6.7%) and 20 (8.0%) cases in the epidural and non-epidural groups, respectively. One patient developed a mild pulmonary embolism, and one case of asymptomatic deep vein thrombosis was detect...
Source: Journal of Obstetrics and Gynaecology - Category: OBGYN Tags: J Obstet Gynaecol Source Type: research
Acute pulmonary embolism is a life-threatening event. The most frequent source of pulmonary embolism is iliofemoral deep venous thrombosis, shown in the femoral vein sonogram, as an echogenic density within the lumen with no intraluminal flow (arrow in imageA). Supplemental Digital Content 1 ( shows significant emboli occluding the right upper and middle lobe pulmonary arteries with near complete lack of perfusion of these two lobes (arrows in imageB) on a pulmonary angiogram, a gold standard test for detecting pulmonary embolism. Supplemental Digital Content 2 ( ...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Abstract OBJECTIVE: Returning home after surgery is a desirable patient-centered outcome associated with decreased costs compared to non-home discharge. Our objective was to develop a preoperative risk-scoring model predicting non-home discharge after surgery for gynecologic malignancy. METHODS: Women who underwent surgery involving hysterectomy for gynecologic malignancy from 2013 to 2015 were identified from the Michigan Surgical Quality Collaborative database. Patients were divided by discharge destination, and a multivariable logistic regression model was developed to create a nomogram to assign case-spec...
Source: Gynecologic Oncology - Category: Cancer & Oncology Authors: Tags: Gynecol Oncol Source Type: research
CONCLUSIONS:: Our study shows a low risk of complications when using cemented and hybrid BTHRs for selected patients and the risk of complications compares favourably with published results. Available functional scores compared favourably to a comparison group of patients undergoing bilateral staged procedures, and a positive impression on treatment experience from a subgroup of interviewed BTHR patients was noticeable. PMID: 30450975 [PubMed - as supplied by publisher]
Source: Hip International - Category: Orthopaedics Authors: Tags: Hip Int Source Type: research
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
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