Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study
AbstractBackgroundThe impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation.MethodsA single-center, 2014-2017 retrospective cohort case-control study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative ...
Source: Perioperative Medicine - January 13, 2022 Category: Surgery Source Type: research

Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial
ConclusionsApplication of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge.Trial registrationThe project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date ofIR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the spe...
Source: Perioperative Medicine - January 10, 2022 Category: Surgery Source Type: research

The need for nutritional assessment and interventions based on the prognostic nutritional index for patients with femoral fractures: a retrospective study
AbstractBackgroundThe incidence of adverse perioperative outcomes in surgery for femoral fractures is high and associated with malnutrition. Here, we identified independent factors and assessed the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures.MethodsThis retrospective study included 343 patients who underwent surgery for a single femur fracture. Demographic characteristics, surgery and anaesthesia records and blood test results at admission, 1 day postoperatively and before discharge were evaluated using logistic regression analysis. The di...
Source: Perioperative Medicine - December 20, 2021 Category: Surgery Source Type: research

Comparison of restrictive fluid therapy with goal-directed fluid therapy for postoperative delirium in patients undergoing spine surgery: a randomized controlled trial
AbstractBackgroundPostoperative delirium (POD) is a common phenomenon after spinal surgery. Intraoperative fluid management may affect POD. The aim of this study was to compare the effects of restrictive fluid therapy (RF) with those of goal-directed fluid therapy (GDT) on POD.MethodsA total of 195 patients aged ≥ 50 years who underwent spinal surgery were randomly divided into two groups: the RF group and the GDT group. In group RF, a bolus of lactated Ringer’s solution was administered at a dose of 5 mL·kg-1 before the induction of anesthesia, followed by a dose of 5 mL ·kg-1·h-1 until the e...
Source: Perioperative Medicine - December 15, 2021 Category: Surgery Source Type: research

Readmissions after elective orthopedic surgery in a comprehensive co-management care system —a retrospective analysis
AbstractBackgroundNo surgical intervention is without risk. Readmissions and reoperations after elective orthopedic surgery are common and are also stressful for the patient. It has been shown that a comprehensive ortho-medical co-management model decreases readmission rates in older patients suffering from hip fracture; but it is still unclear if this also applies to elective orthopedic surgery. The aim of the current study was to determine the proportion of unplanned readmissions or returns to operating room (for any reason) across a broad elective orthopedic population within 90 days after elective surgery. All cases to...
Source: Perioperative Medicine - December 15, 2021 Category: Surgery Source Type: research

Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block
AbstractBackgroundContinuous peripheral nerve catheters (PNCs) have been shown to provide superior postoperative analgesia, decrease opioid consumption, and improve patient satisfaction compared with single injection techniques. In order to achieve success and reliability, accurate catheter positioning is an essential element of PNC placement. An agitated solution of normal saline, D5W, or a local anesthetic solution can be produced by the introduction of air to the injectate, creating air bubbles that can enhance ultrasonographic visualization and possibly improve block success.MethodsEighty-three patients were enrolled. ...
Source: Perioperative Medicine - December 15, 2021 Category: Surgery Source Type: research

New surgical realities: implementation of an enhanced recovery after surgery protocol for gynecological laparoscopy —a prospective study
ConclusionsThe ERAS protocol is applicable in laparoscopic gynecological surgery and can be implemented with good adherence. This can allow optimization of patient recovery by reducing the hospital stay duration, without increasing the rates of morbidity, mortality, or readmission. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 15, 2021 Category: Surgery Source Type: research

The potential for artificial intelligence to predict clinical outcomes in patients who have acquired acute kidney injury during the perioperative period
AbstractAcute kidney injury (AKI) is a common medical problem in hospitalised patients worldwide that may result in negative physiological, social and economic consequences. Amongst patients admitted to ICU with AKI, over 40% have had either elective or emergency surgery prior to admission. Predicting outcomes after AKI is difficult and the decision on whom to initiate RRT with a goal of renal recovery or predict a long-term survival benefit still poses a challenge for acute care physicians. With the increasing use of electronic healthcare records, artificial intelligence may allow postoperative AKI prognostication and aid...
Source: Perioperative Medicine - December 15, 2021 Category: Surgery Source Type: research

The association of multimodal analgesia and high-risk opioid discharge prescriptions in opioid-naive surgical patients
ConclusionProviders should account for pre-discharge opioid consumption and use of multimodal analgesia when considering the total and daily OME ’s that may be appropriate for an individual surgical patient on the discharge opioid prescription. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 15, 2021 Category: Surgery Source Type: research

Mortality and associated risk factors in perioperative acute kidney injury treated with continuous renal replacement therapy
We examined long-term mortality and fact ors associated with poor outcome in a broad surgical population requiring CRRT for perioperative AKI during a 10-year period.MethodsSurgical patients admitted to the intensive care unit (ICU) of academic tertiary hospital requiring CRRT between years 2010 –2019 were included. CRRT was performed using regional citrate-calcium-anticoagulation. Extracted data included patient demographics, comorbidities, and clinical parameters at ICU admission and at the initiation of CRRT. Creatinine and estimated glomerular filtration rate (eGFR) were measured at 1 year after ICU admission.Res...
Source: Perioperative Medicine - December 14, 2021 Category: Surgery Source Type: research

The efficacy and safety of antimuscarinics for the prevention or treatment of catheter-related bladder discomfort: a systematic review and meta-analysis of randomized controlled trials
AbstractObjectivesThis meta-analysis aimed to evaluate the efficacy and safety of antimuscarinics for the prevention or treatment of catheter related bladder discomfort (CRBD).MethodsThe MEDLINE, EMBASE, and Cochrane Controlled Trials Register (from 1987 to July 2021) were used to search randomized controlled trials. The PRISMA checklists were followed. RevMan5.4.0 was used for statistical analysis.ResultsEleven studies involving 1165 patients were involved in the analysis. The study reported that the incidence of CRBD observed in the antimuscarinics group was significantly lower than that of the control group at 0-, 1-, 2...
Source: Perioperative Medicine - December 14, 2021 Category: Surgery Source Type: research

Comparison of different scales for the evaluation of anxiety and compliance with anesthetic induction in children undergoing scheduled major outpatient surgery
ConclusionsStandard anxiety assessment scales do not predict the quality of anesthetic induction. m-YPAS scale can detect increasing anxiety in children as they approach the surgical procedure and this correlates strongly with a worse anesthetic induction, defined by higher score on ICC scale. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 14, 2021 Category: Surgery Source Type: research

Gestational hemostasis: a natural model for hemostasis resuscitation of major periprocedural blood loss
AbstractEarly goal-directed treatment is an evidence-based approach to guide hemostatic therapy during major periprocedural bleeding. If viscoelastic coagulation tests are not available, an algorithm, termed the pyramid of hemostatic interventions, can help manage severe bleeding. Pregnant women accumulate huge reserves of prothrombotic and antifibrinolytic hemostatic elements to avoid peripartum blood loss. We provide comparison of therapeutic hemostatic approaches and natural gestational process and identified remarkable analogy between early goal-directed management of bleeding and hemostatic adaptation of pregnant woma...
Source: Perioperative Medicine - December 13, 2021 Category: Surgery Source Type: research

Risk factors and outcomes associated with postoperative ileus following ileostomy formation: a retrospective study
AbstractBackgroundPostoperative ileus (POI) is associated with increased patient discomfort, length of stay (LOS), and healthcare cost. There is a paucity of literature examining POI in patients who have an ileostomy formed at the time of surgery. We aimed to identify risk factors for and outcomes associated with POI following ileostomy formation.MethodsWe included 261 consecutive non-emergent cases that included formation of an ileostomy by a board-certified colorectal surgeon at our institution from July 1, 2015, to June 30, 2020. Demographic, clinical, and intraoperative factors associated with increased odds of POI wer...
Source: Perioperative Medicine - December 13, 2021 Category: Surgery Source Type: research

Influences of remote ischemic preconditioning on postoperative delirium and cognitive dysfunction in adults after cardiac surgery: a meta-analysis of randomized controlled trials
ConclusionsCurrent evidence from RCTs did not support that RIPC could prevent the incidence of POD or POCD in adults after cardiac surgery. Although these findings may be validated in large-scale RCTs, particularly for the results of POCD, based on these findings, RIPC should not be routinely used as a preventative measure for POD and POCD in adult patients after cardiac surgery. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 10, 2021 Category: Surgery Source Type: research

Comparison of the TOFscan and the TOF-Watch SX during pediatric neuromuscular function recovery: a prospective observational study
ConclusionsTOFscan reliably demonstrated lack of bias and good concordance with TOF-Watch SX throughout the neuromuscular recovery, especially when normalized. Despite technical limitations, the two devices were unbiased along the path of spontaneous and pharmacological reversal in pediatric patients.Trial registrationClinicalTrials.gov NCT03775603. Registered on 13 March 2018 (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 10, 2021 Category: Surgery Source Type: research

Electroencephalography-demonstrated mechanisms of dexmedetomidine-mediated deepening of propofol anesthesia: an observational study
ConclusionsProfound EEG changes support the supposition that Dex enhances propofol-induced GA from a moderate to a deeper state. The present findings provide a theoretical basis and reference regarding protocols aimed at reducing anesthetic/sedative dosage while maintaining sufficient depth of GA.Clinical trial registrationChiCTR,ChiCTR1900026955. Registered on 27 October 2019 (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 9, 2021 Category: Surgery Source Type: research

Deep neuromuscular block reduces the incidence of intra-operative complications during laparoscopic donor nephrectomy: a pooled analysis of randomized controlled trials
AbstractStudy objectiveTo assess whether different intensities of intra-abdominal pressure and deep neuromuscular blockade influence the risk of intra-operative surgical complications during laparoscopic donor nephrectomy.DesignA pooled analysis of ten previously performed prospective randomized controlled trials.SettingLaparoscopic donor nephrectomy performed in four academic hospitals in the Netherlands: Radboudumc, Leiden UMC, Erasmus MC Rotterdam, and Amsterdam UMC.PatientsFive hundred fifty-six patients undergoing a transperitoneal, fully laparoscopic donor nephrectomy enrolled in ten prospective, randomized controlle...
Source: Perioperative Medicine - December 9, 2021 Category: Surgery Source Type: research

Preoperative anxiety as predictor of perioperative clinical events following carotid surgery: a prospective observational study
ConclusionsThe present study indicates that preoperative anxiety is associated with the occurrence of intra- and postoperative neurological events in patients undergoing CEA. Patients who had a preoperative HADS-A score of 6 or less had a very low probability of experiencing these complications. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 8, 2021 Category: Surgery Source Type: research

5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery
Conclusion5-HT3 receptor antagonists may be related with a significantly reduced risk for POD in older patients undergoing orthopedic lower limb surgery. Notably, palonosetron was more effective for POD prevention. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 8, 2021 Category: Surgery Source Type: research

Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital
In this study, we determined the incidence and risk factors of PPCs in elderly Thai patients who underwent upper abdominal procedures, and we investigated whether the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score helps to predict PPCs in Thais.MethodsA retrospective study was conducted on upper abdominal surgical patients aged over 65 years who had been admitted to the surgical ward of Siriraj Hospital, Mahidol University, Thailand, between January 2016 and December 2019. Data were collected on significant PPCs using the European Perioperative Clinical Outcome definitions. To identify risk facto...
Source: Perioperative Medicine - December 8, 2021 Category: Surgery Source Type: research

High-flow nasal oxygenation reduces the risk of desaturation in adults receiving procedural sedation: a meta-analysis of randomized controlled trials
AbstractBackgroundProcedural sedation reduces patients ’ discomfort and anxiety, facilitating performance of the examination and intervention. However, it may also cause adverse events, including airway obstruction and hypoxia. We conducted this systematic review and meta-analysis to evaluate the efficacy of high-flow nasal oxygenation (HFNO) compared with that of standard oxygen therapy in adult patients undergoing procedural sedation.MethodsWe identified randomized controlled trials published before November 2020 based on PubMed, Embase, and Cochrane Library databases andClinicalTrials.gov registry. Intraprocedural...
Source: Perioperative Medicine - December 6, 2021 Category: Surgery Source Type: research

Hyperspectral imaging for perioperative monitoring of microcirculatory tissue oxygenation and tissue water content in pancreatic surgery — an observational clinical pilot study
The objective of this study was to assess the capacity of HSI to monitor skin microcirculation and possible relations to perioperative organ dysfunction in patients undergoing pancreatic surgery.MethodsThe hyperspectral imaging TIVITA ® Tissue System was used to evaluate superficial tissue oxygenation (StO2), deeper layer tissue oxygenation (near-infrared perfusion index (NPI)), haemoglobin distribution (tissue haemoglobin index (THI)) and tissue water content (tissue water index (TWI)) in 25 patients undergoing pancreatic surge ry. HSI parameters were measured before induction of anaesthesia (t1), after induction of a...
Source: Perioperative Medicine - December 1, 2021 Category: Surgery Source Type: research

Feasibility of a randomized hypertension screening initiative in the perioperative setting
ConclusionsThis feasibility study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment.Trial registrationClinicaltrials.gov,NCT03634813. Registered 16 of August 2018. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 22, 2021 Category: Surgery Source Type: research

Enhanced recovery after surgery protocol and postoperative opioid prescribing for cesarean delivery: an interrupted time series analysis
AbstractIntroductionEnhanced recovery after surgery (ERAS) pathways have emerged as a promising strategy to reduce postoperative opioid use and decrease the risk of developing new persistent opioid use in surgical patients. However, the association between ERAS implementation and discharge opioid prescribing practices is unclear.Study designWe conducted a retrospective observational quasi-experimental study of opioid-na ïve patients aged 18+ undergoing cesarean delivery between February 2015 and December 2019 at a large academic center. An interrupted time series analysis (ITSA) was used to model the changes in pain m...
Source: Perioperative Medicine - November 15, 2021 Category: Surgery Source Type: research

Association between preoperative serum homocysteine and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a prospective observational study
ConclusionsElderly patients with high homocysteine levels who underwent general anesthesia for non-cardiac surgery have an increased risk of dNCR. This knowledge could potentially assist in the development of preventative and/or therapeutic measures.Trial registrationNCT03084393 (https://www.clinicaltrials.gov) (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 8, 2021 Category: Surgery Source Type: research

The effect of the family presence on anxiety and agitation of patients under mechanical ventilation after open heart surgery: a randomized clinical trial
ConclusionAccording to the findings of the present study, the presence of a family member does not reduce the level of anxiety and agitation of patients undergoing cardiac surgery. However, it can be concluded that this intervention is feasible in acute and complex situations after open heart surgeries.Trial registrationThis study has been registered in the Iranian Registry of Clinical Trials with the codeIRCT201609014299N4. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 1, 2021 Category: Surgery Source Type: research

Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial
ConclusionsPreoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions.Trial registrationANZCTR12613000664741; 19/06/2013. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 25, 2021 Category: Surgery Source Type: research

Ultrasound-accelerated thrombolysis in high-risk perioperative pulmonary embolism: two case reports and review of literature
ConclusionCurrent guidelines on treatment of PE offer no specific therapies for perioperative patients with high-risk PE. However, systemic thrombolysis is often excluded due to the perioperative setting and the risk of major bleeding. Catheter-directed thrombolysis was shown to utilise less thrombolytic agent while obtaining comparable thrombolytic effects. The risk for major bleeding (including intracranial haemorrhage) is also significantly lowered. Until further trials determining the value of adopted treatment strategies of high-risk PE in perioperative patients are available, USAT should be considered in similar case...
Source: Perioperative Medicine - October 18, 2021 Category: Surgery Source Type: research

Distribution of crystalloid fluid infused during onset of anesthesia-induced hypotension: a retrospective population kinetic analysis
ConclusionThe decrease in MAP that accompanies anesthesia induction depresses the blood hemoglobin concentration by inhibiting both the distribution and elimination of infused crystalloid fluid. The report provides mathematical information about the degree of these changes. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 11, 2021 Category: Surgery Source Type: research

Objectively measured preoperative physical activity is associated with time to functional recovery after hepato-pancreato-biliary cancer surgery: a pilot study
ConclusionSeventy-six percent of patients enlisted for resection of HPB (pre)malignancy performed insufficient MVPA. A higher level of MVPA was associated with a shorter time to functional recovery. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 4, 2021 Category: Surgery Source Type: research

Influence of sugammadex versus neostigmine for neuromuscular block reversal on the incidence of postoperative pulmonary complications: a meta-analysis of randomized controlled trials
ConclusionsCompared with neostigmine, the use of sugammadex for reversal of NMB was associated with a lower risk of PPCs, mainly due to a lower incidence of postoperative respiratory failure with the use of sugammadex. (Source: Perioperative Medicine)
Source: Perioperative Medicine - September 20, 2021 Category: Surgery Source Type: research

Enhanced recovery after surgery for hip fractures: a systematic review and meta-analysis
The objective of this review was to investigate the clinical prognosis of ERAS programs in terms of (1) hospital-related endpoints (time to surgery [TTS], length of stay [LOS]), (2) readmission rate, (3) complications, and (4) mortality.MethodsPublished literature was searched in the PubMed, EMBASE, and Cochrane Library databases. All of the included studies met the inclusion criteria. The primary outcomes were TTS and LOS. The secondary outcomes included the 30-day readmission rate, overall complication rate, specific complication rate (delirium and urinary tract infection), and 30-day and 1-year mortality. Language was r...
Source: Perioperative Medicine - September 13, 2021 Category: Surgery Source Type: research

Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey
ConclusionERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach. (Source: Perioperative Medicine)
Source: Perioperative Medicine - September 6, 2021 Category: Surgery Source Type: research

Effect of posture on pulmonary function and oxygenation after fast-tracking video-assisted thoracoscopic surgery (VATS) lobectomy: a prospective pilot study
AbstractBackgroundMinimally invasive surgery combined with enhanced recovery programmes has improved outcomes after lung cancer surgery and where early mobilisation may be an important factor. However, little is known about pulmonary function and oxygenation during mobilisation after video-assisted pulmonary lobectomy. The aim of this prospective pilot cohort study was to explore the effect of postural changes (from supine to sitting to standing) on pulmonary function and oxygen saturation in a well-defined enhanced recovery programmes setting after video-assisted thoracoscopic surgery lobectomy.MethodsA total of 24 patien...
Source: Perioperative Medicine - September 2, 2021 Category: Surgery Source Type: research

Screening, assessment and management of perioperative malnutrition: a survey of UK practice
ConclusionsMalnutrition in the perioperative period is a modifiable risk factor which is common and results in increased morbidity for patients and increased cost to healthcare systems. This survey highlights areas of practice where perioperative clinicians can improve the assessment and management of patients at nutritional risk prior to elective surgery. (Source: Perioperative Medicine)
Source: Perioperative Medicine - August 26, 2021 Category: Surgery Source Type: research

The efficacy of computer-assisted cognitive behavioral therapy (cCBT) on psychobiological responses and perioperative outcomes in patients undergoing functional endoscopic sinus surgery: a randomized controlled trial
AbstractBackgroundFunctional endoscopic sinus surgery (FESS) is required to minimize bleeding to maintain a clear operative field during surgery, so it is important to preoperative anti-anxiety and stable hemodynamics. Initial evidence suggests cognitive behavioral therapy (CBT) is effective to minimize surgery-related stress and to speed up recovery. The study aimed to evaluate the efficacy of a newly developed computer-assisted CBT (cCBT) program on surgery-related psychobiological responses in patients undergoing FESS.MethodsParticipants were allocated to a CCBT group (cCBT;n = 50) or a UC group (usual care;n = 50) by r...
Source: Perioperative Medicine - August 19, 2021 Category: Surgery Source Type: research

The influence of fasting and carbohydrate-enriched drink administration on body water amount and distribution: a volunteer randomized study
AbstractBackgroundFasting prior to anesthesia is considered aspiration prophylaxis. However, prolonged food and drink restrictions may increase the risk of other complications. The aim of this study was to assess whether a carbohydrate-enriched drink (Nutricia ™ preOp®), recommended by the enhanced recovery after surgery (ERAS) protocol, can improve body hydration in fasting healthy individuals.MethodsMeasurements were done with the bioelectric impedance analysis with a Fresenius body composition monitor. Body composition, total body water, water distribution, and hemodynamic parameters were measured at the begin...
Source: Perioperative Medicine - August 10, 2021 Category: Surgery Source Type: research

Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty
AbstractBackgroundHyponatraemia, defined as a serum sodium [Na] concentration below 135 mmol/L, is common following surgery. As inpatient peri-operative stays shorten, there is a need to recognise pre-operative risk factors for post-operative hyponatraemia and complications associated with a peri-operative drop in Na. This audit aimed to investigate the prevalence of, risk factors for, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty.MethodsData were collected within a retrospective audit of inpatient complications and unplanned reattendance or readmission at hospital in ...
Source: Perioperative Medicine - August 3, 2021 Category: Surgery Source Type: research

Emergency Laparotomy Follow-Up Study (ELFUS): prospective feasibility investigation into postoperative complications and quality of life using patient-reported outcome measures up to a year after emergency laparotomy
ConclusionsThis study affirms the feasibility of collecting PROMs and morbidity data successfully at various time points following emergency laparotomy, and is the first longitudinal study to describe quality of life up to a year after surgery. This finding is important in the design of a larger observational study into quality of life and recovery after EL. (Source: Perioperative Medicine)
Source: Perioperative Medicine - July 26, 2021 Category: Surgery Source Type: research

Postoperative atrial fibrillation in paraesophageal hernia repair: can it be prevented?
We report the case of an 85-year-old female with a history of untreated hypertension (HTN) and no prior history of AF, who presented 5 days after an elective repair of a paraesophageal hernia with recurrence of a large type III paraesophageal hiatal hernia, AF, and subsequent acute thromboembolic ischemic stroke. Patient ’s AF resolved shortly after treatment with calcium channel blocker. The risk of stroke is high in patients who develop AF and a period of 48 h after onset of AF is usually considered safe as the risk of stroke is low in this time period. However, this may not be the case during the perioperat...
Source: Perioperative Medicine - July 20, 2021 Category: Surgery Source Type: research

Utility of NT-proBNP as an objective marker of postoperative heart failure after coronary artery bypass surgery: a prospective observational study
AbstractBackgroundPostoperative heart failure (PHF) is the main cause for mortality after cardiac surgery but unbiased evaluation of PHF is difficult. We investigated the utility of postoperative NT-proBNP as an objective marker of PHF after coronary artery bypass surgery (CABG).MethodsProspective study on 382 patients undergoing isolated CABG for acute coronary syndrome. NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A blinded Endpoints Committee used prespecified criteria for PHF. Use of circulatory support was scrutinized.ResultsAfter adjusting for confounders PHF was ass...
Source: Perioperative Medicine - July 13, 2021 Category: Surgery Source Type: research

Perioperative digital behaviour change interventions for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation: a scoping review
ConclusionThis review found high participant satisfaction, but shows recruitment and timing-delivery issues, as well as low retention to interventions post-surgery. Small sample sizes and the use of a variety of feasibility outcome measures prevent the synthesis of results and makes generalisation difficult. Future research should focus on defining standardised outcome measures, enhancing patient engagement and improving adherence to behaviour change prior to scheduled surgery. (Source: Perioperative Medicine)
Source: Perioperative Medicine - July 6, 2021 Category: Surgery Source Type: research

Meta-analysis of AKI to CKD transition in perioperative patients
AbstractBackgroundRecent research shows AKI increases the risk of incident CKD. We hypothesized that perioperative AKI may confer increased risk of subsequent CKD compared to nonperioperative AKI.MethodsA MEDLINE search was performed for “AKI, CKD, chronic renal insufficiency, surgery, and perioperative” and related terms yielded 5209 articles. One thousand sixty-five relevant studies were reviewed. One thousand six were excluded because they were review, animal, or pediatric studies. Fifty-nine studies underwent full manuscript review by two independent evaluators. Seventeen met all inclusion criteria and unde...
Source: Perioperative Medicine - June 29, 2021 Category: Surgery Source Type: research

The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients: a randomised controlled trial (The EMPOWER Trial)
ConclusionA 9-week exercise prehabilitation programme significantly improved fitness following NCRT. These findings have informed the WesFit trial (NCT03509428) which is investigating the effects of community-based multimodal prehabilitation before cancer surgery.Trial registrationClinicalTrials.govNCT01914068. Registered 1 August 2013. (Source: Perioperative Medicine)
Source: Perioperative Medicine - June 22, 2021 Category: Surgery Source Type: research

Surgery school —who, what, when, and how: results of a national survey of multidisciplinary teams delivering group preoperative education
ConclusionIt is recommended that teams work with patients when designing surgery schools and use evidence-based behavior change frameworks and techniques to inform their content. There is a need for high-quality research studies to determine the clinical effectiveness of this type of education intervention. (Source: Perioperative Medicine)
Source: Perioperative Medicine - June 15, 2021 Category: Surgery Source Type: research

The hidden secrets of a neutral pH —blood gas analysis of postoperative patients according to the Stewart approach
In this study, we evaluate metabolic disturbances in patients in the immediate postoperative period focusing on patients with neutral pH, while comparing the Stewart and traditional approach.MethodsWe conducted a single center retrospective observational cohort study. Over a 17-month period, data on arterial blood gas analysis, electrolytes, and albumin on the morning after surgery were retrieved from patients admitted to the postsurgical high dependency unit (HDU). Albumin-corrected anion gap (AG), apparent (SIDa) and effective strong ion difference (SIDe), and strong ion gap (SIG) were calculated.ResultsOut of 1207 HDU a...
Source: Perioperative Medicine - June 8, 2021 Category: Surgery Source Type: research

A U.S. survey of pre-operative carbohydrate-containing beverage use in colorectal enhanced recovery after surgery (ERAS) programs
ConclusionsThis survey finds a high use of CHO-containing beverages in colorectal ERAS programs. More than half of all programs administer a CHO-containing beverage to patients with diabetes, and surprisingly, there is significant use of simple carbohydrate beverages in patients with diabetes receiving insulin. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 28, 2021 Category: Surgery Source Type: research

Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians ’ perception and practice
ConclusionPO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients.Trial registrationClinicalTrials.gov,NCT04341974. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 25, 2021 Category: Surgery Source Type: research

Hydroxyethyl starch 130/0.4 for volume replacement therapy in surgical patients: a systematic review and meta-analysis of randomized controlled trials
ConclusionsThis systematic review and meta-analysis suggests that the use of HES 130/0.4 for volume replacement therapy compared with other fluids resulted in no significant difference in postoperative mortality or kidney dysfunction among surgical patients. Given the absent evidence of confirmed benefit and the potential trend of increased kidney injury, we cannot recommend the routine clinical use of HES 130/0.4 for volume replacement therapy in surgical patients from the perspective of benefit/risk profile. However, the results need to be interpreted with caution due to the limited sample size, and further well-powered ...
Source: Perioperative Medicine - May 11, 2021 Category: Surgery Source Type: research