Chronic pain after breast surgery: incidence, associated factors, and impact on quality of life, an observational prospective study
ConclusionsChronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 h postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation.Trial registrationClinicalTrials.gov registrationNCT04309929. (Source: Perioperative Medicine)
Source: Perioperative Medicine - February 24, 2021 Category: Surgery Source Type: research
A prospective cohort study evaluating screening and assessment of six modifiable risk factors in HPB cancer patients and compliance to recommended prehabilitation interventions
ConclusionIt is feasible to screen and assess all patients referred for HPB cancer surgery for six modifiable risk factors. Most of the patients had at least one risk factor that could be optimised. However, compliance with the suggested interventions remains challenging. (Source: Perioperative Medicine)
Source: Perioperative Medicine - February 17, 2021 Category: Surgery Source Type: research
Perioperative risk factors for recovery room delirium after elective non-cardiovascular surgery under general anaesthesia
ConclusionsIdentifying patients at high odds for RRD preoperatively would enable the formation of more timely postoperative delirium management programmes. (Source: Perioperative Medicine)
Source: Perioperative Medicine - February 3, 2021 Category: Surgery Source Type: research
External validation of the Surgical Outcome Risk Tool (SORT) in 3305 abdominal surgery patients in the independent sector in the UK
ConclusionWe externally validated SORT in a large population of abdominal surgery patients. SORT performed well in patients with lower risk profiles, but underpredicted adverse outcomes in the higher risk group. (Source: Perioperative Medicine)
Source: Perioperative Medicine - January 26, 2021 Category: Surgery Source Type: research
Preparing previously COVID-19-positive patients for elective surgery: a framework for preoperative evaluation
We present a preoperative protocol for evaluation of previously COVID-positive patients for elective surgery. (Source: Perioperative Medicine)
Source: Perioperative Medicine - January 7, 2021 Category: Surgery Source Type: research
Postoperative urinary retention: risk factors, bladder filling rate and time to catheterization: an observational study as part of a randomized controlled trial
ConclusionSpinal anesthesia, longer surgery time, and older age are the main risk factors for urinary retention catheterization. Awareness of these risk factors, regularly bladder volume scanning (at least every 3 h) and using the individual maximum bladder capacity as volume threshold for urinary catheterization may avoid unnecessary urinary catheterization and will prevent bladder overdistention with the attendant risk of lower urinary tract injury.Trial registrationDutch Central Committee for Human Studies registered trial database: NL 21058.099.07.Current Controlled Trials database: Preventing Bladder Catheterization a...
Source: Perioperative Medicine - January 4, 2021 Category: Surgery Source Type: research
Clinical physiology aspects of chloremia in fluid therapy: a systematic review
ConclusionsAccording to the latest medical concepts, dyschloremia (both hyperchloremia and hypochloremia) represents a factor indisputably having a negative effect on selected variables of clinical outcome. As infusion therapy can significantly impact chloride homeostasis of the body, the choice of infusion solutions should always take into account the potentially adverse impact of chloride content on chloremia and organ function. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 10, 2020 Category: Surgery Source Type: research
Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review
We examined 2174 papers. Among these, 9 studies were considered eligible for inclusion in this systematic review (1126 patients cumulatively): 8 are randomised controlled trials and 1 is an observational prospective pre/post study.Psychological characteristics widely influence the pathophysiological mechanisms underlying the neuroendocrine and inflammatory response to surgical stress, potentially interfering with surgical outcomes. Psychological interventions are technically feasible and realistically applicable perioperatively during abdominal and/or urologic surgery; they influence the pathophysiological mechanisms under...
Source: Perioperative Medicine - December 8, 2020 Category: Surgery Source Type: research
Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care
ConclusionsThese recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve. (Source: Perioperative Medicine)
Source: Perioperative Medicine - December 1, 2020 Category: Surgery Source Type: research
A guide for pre-procedural imaging for transcatheter aortic valve replacement patients
AbstractSafe and accurate pre-procedural assessment of cardiovascular anatomy, physiology, and pathophysiology prior to TAVR procedures can mean the difference between success and catastrophic failure. It is imperative that clinical care team members share a basic understanding of the preprocedural imaging technologies available for optimizing the care of TAVR patients. Herein, we review current imaging technology for assessing the anatomy, physiology, and pathophysiology of the aortic valvular complex, ventricular function, and peripheral vasculature, including echocardiography, cardiac catheterization, cardiac computed t...
Source: Perioperative Medicine - November 26, 2020 Category: Surgery Source Type: research
Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
ConclusionPerioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery. Surgeons should carefully consider the practice of routine bridging. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 23, 2020 Category: Surgery Source Type: research
The effect of adding goal-directed hemodynamic management for elective patients in an established enhanced recovery program for colorectal surgery: results of quasi-experimental pragmatic trial
ConclusionsThere was no evidence that addition of goal-directed hemodynamic therapy for all patients in an enhanced recovery program for colorectal surgery affects the risk of SSI, composite complications, or 30-day readmission. Further research is needed to investigate whether there is benefit of goal-directed hemodynamic therapy for select high-risk populations.Trial registrationNCT03189550. Registered 16 June 2017 –Retrospectively registered,https://www.clinicaltrials.gov/ct2/results?cond=&term=NCT03189550&cntry=&state=&city=&dist= (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 23, 2020 Category: Surgery Source Type: research
Improving agreement of ASA physical status class between pre-anesthesia screening and day of surgery by adding institutional-specific and ASA-approved examples: a quality improvement project
ConclusionsASA-approved examples do not address all medical conditions that account for differences in the assignment of ASA PS between pre-anesthesia screening and day of anesthesia evaluation at our institution. The process of developing institutional-specific examples addressed the medical conditions that caused differences in assignment at one institution. The implementation of ASA PS examples improved consistency of assignment, and therefore communication of medical conditions of patients presenting for anesthesia care. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 19, 2020 Category: Surgery Source Type: research
Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study
ConclusionsCurrent literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 16, 2020 Category: Surgery Source Type: research
Incidence and risk factors of postdural puncture headache: prospective cohort study design
ConclusionsA recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache. In addition, frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage were associated with the events. In view of this, we recommend the use of a small spinal needle to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture. (Source: Perioperative Medicine)
Source: Perioperative Medicine - November 9, 2020 Category: Surgery Source Type: research
