Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care
ConclusionsThese recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 23, 2020 Category: Surgery Source Type: research
Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications
ConclusionsThis systematic review and meta-analysis suggests that the use of GDHT using fluids with inotropes and/or vasopressors, but not fluids alone, reduces the development of post-operative pulmonary infections and pulmonary oedema in general, abdominal and cardiothoracic surgical patients. This evidence was graded as moderate.PROSPERO registry reference: CRD42020170361 (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 15, 2020 Category: Surgery Source Type: research
Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery
ConclusionsAlthough early postoperative ONS after CRS was more likely to be utilized in elderly patients with greater comorbidities, the use of early ONS was associated with reduced infectious complications, pneumonia, ICU admission, and gastrointestinal complications. This propensity score-matched study using real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients. (Source: Perioperative Medicine)
Source: Perioperative Medicine - October 4, 2020 Category: Surgery Source Type: research
Documentation of individualized preoperative risk assessment: a multi-center study
ConclusionsThe observed rate of documented ISRA in our sample was extremely low. Surgeons were more likely than anesthesiologists to document ISRA. As these individualized risk assessment discussions form the bedrock of perioperative informed consent, the rate and quality of risk documentation must be improved. (Source: Perioperative Medicine)
Source: Perioperative Medicine - September 20, 2020 Category: Surgery Source Type: research
Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice
AbstractMulticomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas wh...
Source: Perioperative Medicine - September 13, 2020 Category: Surgery Source Type: research
The need for post-operative vasopressor infusions after major gynae-oncologic surgery within an ERAS (Enhanced Recovery After Surgery) pathway
ConclusionsPatients commonly receive vasopressors following major gynae-oncologic surgery, and this can be at relatively high doses. Clinical factors only accounted for a minority of the variability in vasopressor usage —suggesting considerable biological variability. Optimal care of patients having major abdomino-pelvic surgery may include advanced haemodynamic monitoring and ready availability of infused vasopressors, in a suitable environment. (Source: Perioperative Medicine)
Source: Perioperative Medicine - September 6, 2020 Category: Surgery Source Type: research
Pain and haemorrhage are the most common reasons for emergency department use and hospital admission in adults following ambulatory surgery: results of a population-based cohort study
ConclusionsThese findings can assist clinicians in identifying and intervening with patients at risk of healthcare use after ambulatory surgery. Pain management strategies that can be tailored to the patient, and earlier follow-up for some patients may be required. In addition, administrative decision-makers could use the results to estimate the impact of specific ambulatory procedures on hospital resources for planning and allocation of resources. (Source: Perioperative Medicine)
Source: Perioperative Medicine - August 18, 2020 Category: Surgery Source Type: research
Preoperative communication between anaesthetists and patients with obesity regarding perioperative risks and weight management: a structured narrative review
ConclusionsThere are currently no published guidelines for how anaesthetists could most effectively discuss weight in the perioperative period with patients who have obesity. Much of the literature for obesity communication is based on the primary care setting. The perioperative period may represent an increased time of receptiveness for patients. Guidelines for discussions about weight management and associated perioperative risk are suggested. (Source: Perioperative Medicine)
Source: Perioperative Medicine - August 12, 2020 Category: Surgery Source Type: research
Development of a preoperative risk score on admission in surgical intermediate care unit in gastrointestinal cancer surgery
ConclusionsThe feasibility and usefulness of theMyIPOrisk-score have been demonstrated for the evaluation of patients undergoing digestive oncologic surgery. However, it requires further testing through a multicenter prospective study to validate the predictive accuracy of the proposed risk score. (Source: Perioperative Medicine)
Source: Perioperative Medicine - August 5, 2020 Category: Surgery Source Type: research
Postoperative visits by dedicated anesthesiologists in patients with elevated troponin: a retrospective cohort study evaluating postoperative care utility and early detection of complications
ConclusionsStandard consultation of a dedicated anesthesiologist resulted in an early detection of 59% of all myocardial infarctions and involved a change in treatment in a considerable number of patients with postoperative troponin elevation. Whether this may improve patient outcomes remains to be elucidated. (Source: Perioperative Medicine)
Source: Perioperative Medicine - July 15, 2020 Category: Surgery Source Type: research
Using provider-focused education toolkits can aid enhanced recovery programs to further reduce patient exposure to opioids
ConclusionOur multifaceted optimal analgesia program to manage perioperative pain in the hospital was effective and further improved analgesia in the setting of a mature enhanced recovery program. (Source: Perioperative Medicine)
Source: Perioperative Medicine - July 8, 2020 Category: Surgery Source Type: research
The association between low pre-operative step count and adverse post-operative outcomes in older patients undergoing colorectal cancer surgery
ConclusionLow pre-operative step count (< 2500 steps/day) is predictive of an increased risk of post-operative morbidity in patients undergoing elective colorectal surgery. Accurate preoperative identification may allow for treatment modification and tailored perioperative care. The possibility of using a wearable activity tracker as a simple but powerful pre-habilitation tool is raised as an important avenue for future study.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12618000045213). (Source: Perioperative Medicine)
Source: Perioperative Medicine - July 1, 2020 Category: Surgery Source Type: research
Opioid-free anesthesia —caution for a one-size-fits-all approach
AbstractPost-operative pain management should ideally be optimized to ensure patient ’s mobilization and ability to partake in effective pulmonary exercises for patient’s early recovery. Opioids have traditionally been the main mode for analgesia strategy in the perioperative period. However, the recent focus on opioid crisis in the USA has generated a robust discussion on ratio nal use of opioids in the perioperative period and also raised the concept of “opioid-free anesthesia” in certain circles. Opioid-related adverse drug events (ORADE) and questionable role of opioids in cancer progression have further deterr...
Source: Perioperative Medicine - June 17, 2020 Category: Surgery Source Type: research
The impact of preoperative systemic inflammation on the efficacy of intravenous iron infusion to correct anaemia prior to surgery for colorectal cancer
ConclusionsPreoperative intravenous iron is less efficacious in patients with anaemia of inflammation and FID undergoing surgery for CRC, compared with true iron deficiency. Further understanding of the role of perioperative iron infusions is required for maximum gain from therapy. (Source: Perioperative Medicine)
Source: Perioperative Medicine - June 10, 2020 Category: Surgery Source Type: research
Why women are not small men: sex-related differences in perioperative cardiopulmonary exercise testing
ConclusionTo our knowledge, this is the first study to describe differences between males and females in CPET variables used in a perioperative setting. Furthermore, there is a substantial difference between the inclusion rates of males and females in this field. These findings require validation in larger cohorts and may have significant implications for both sexes in the application of CPET in the perioperative setting. (Source: Perioperative Medicine)
Source: Perioperative Medicine - June 3, 2020 Category: Surgery Source Type: research
