Correction to: Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
An amendment to this paper has been published and can be accessed via the original article. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 28, 2020 Category: Surgery Source Type: research
Patient experience of health and care when undergoing colorectal surgery within the ERAS program
ConclusionsThe patients reported many positive aspects and challenges when being cared for within the ERAS program. However, several improvements are needed to satisfy patient wishes regarding their care both in hospital and at home. Laparoscopic surgery affects patient state of health positively in several respects compared with open surgery. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 19, 2020 Category: Surgery Source Type: research
Feasibility of setting up a pre-operative optimisation ‘pre-hab’ service for lung cancer surgery in the UK
AbstractPre-operative optimisation ‘pre-hab’ is a growing area in peri-operative medicine. This is usually undertaken with the aim of reducing post-operative complications. In the case of early-stage lung cancer, surgery is the treatment modality with the best-proven cure rates. With this in mind, we set up a pre-hab service, not merely to reduce the risk of post-operative complications, but to enable patients of borderline fitness for surgery to safely undergo this potentially lifesaving treatment. We believe this service to be one of the first of its kind in the UK, here we describe the challenges we faced in setting...
Source: Perioperative Medicine - May 12, 2020 Category: Surgery Source Type: research
Functional performance and 30-day postoperative mortality after emergency laparotomy —a retrospective, multicenter, observational cohort study of 1084 patients
ConclusionsThis study found ECOG performance score to be independently associated with the postoperative 30-day mortality among patients undergoing high-risk emergency laparotomy. The utility of including functional performance in a preoperative risk assessment model of emergency laparotomy should be evaluated. (Source: Perioperative Medicine)
Source: Perioperative Medicine - May 4, 2020 Category: Surgery Source Type: research
Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance
DiscussionWe discussed the clinical and physiological evidence underlying fluid responsiveness and venous capacitance as relevant factors in fluid management and developed consensus statements with clinical implications for a broad group of clinicians involved in intravenous fluid therapy. Two key concepts emerged as follows: (1) The ultimate goal of fluid therapy and hemodynamic management is to support the conditions that enable normal cellular metabolic function in order to produce optimal patient outcomes, and (2) optimal fluid and hemodynamic management is dependent on an understanding of the relationship between pres...
Source: Perioperative Medicine - April 20, 2020 Category: Surgery Source Type: research
Optimising remote site airway management kit dump using the SCRAM bag —a randomised controlled trial
ConclusionThe SCRAM bag facilitates a quicker, less challenging kit dump with significantly fewer errors. We propose that this would reduce delay to airway management, reduce cognitive load and provide an improved capability to manage anticipated and unanticipated airway events. (Source: Perioperative Medicine)
Source: Perioperative Medicine - April 13, 2020 Category: Surgery Source Type: research
Assessing needs of patients and families during the perioperative period at King Abdullah Medical City
ConclusionSystematically involving the family member in the perioperative care of the patient is advantageous. However, interventions and extent of involvement of the family member to the care of the patient would have to be adapted according to the cultural context. (Source: Perioperative Medicine)
Source: Perioperative Medicine - April 6, 2020 Category: Surgery Source Type: research
Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
ConclusionsIn older and higher risk patients, duration of intraoperative hypotension by a variety of definitions, or PP> 62 mmHg, are associated with increased postoperative CCI and LOS. These findings warrant confirmation in larger databases with evaluation of whether real-time intraoperative intervention could reduce postoperative morbidity. (Source: Perioperative Medicine)
Source: Perioperative Medicine - March 23, 2020 Category: Surgery Source Type: research
Prioritisation of quality indicators for elective perioperative care: a Delphi consensus
ConclusionThe Delphi consensus process was able to reduce the number of recommended indicators to only a modest extent. Further work to evaluate the practicalities of routinely collecting such a comprehensive list of quality indicators is now required. (Source: Perioperative Medicine)
Source: Perioperative Medicine - March 9, 2020 Category: Surgery Source Type: research
Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety
ConclusionOn the review of contemporary literature, no significant difference was found in rates of postoperative VTE or bleeding complications between patients receiving extended duration heparin VTE prophylaxis and those receiving inpatient prophylaxis after open abdominopelvic surgery for malignancy.This raises the question of how extended duration prophylaxis has become common practice in this population, and whether this needs to be re-evaluated. (Source: Perioperative Medicine)
Source: Perioperative Medicine - March 2, 2020 Category: Surgery Source Type: research
Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey
DiscussionMost survey respondents reported providing anesthesia care to older adults, but adherence to recommended practices varied across the six items assessed. Reported rates of screening for common geriatric syndromes, such as frailty, delirium, and dementia, were low among survey respondents. Respondents identified multiple opportunities for ASA initiatives to support efforts to improve care for older surgical patients. (Source: Perioperative Medicine)
Source: Perioperative Medicine - February 24, 2020 Category: Surgery Source Type: research
Natriuretic peptide-directed medical therapy: a systematic review
AbstractNatriuretic peptides (NP) are strongly associated with perioperative cardiovascular events. However, in patients with raised NP, it remains unknown whether treatment to reduce NP levels prior to surgery results in better perioperative outcomes. In this systematic review and meta-analysis, we investigate NP-directed medical therapy in non-surgical patients to provide guidance for NP-directed medical therapy in surgical patients. The protocol was registered with PROSPERO (CRD42017051468). The database search included MEDLINE (PubMed), CINAHL (EBSCO host), EMBASE (EBSCO host), ProQuest, Web of Science, and Cochrane da...
Source: Perioperative Medicine - February 17, 2020 Category: Surgery Source Type: research
The value of teachable moments in surgical patient care and the supportive role of digital technologies
AbstractEvidence strongly supports improved outcomes following surgery when patients are more physically active, have better dietary intake, or are generally fitter prior to surgery. Having an operation is a major life event for patients, and many are not educated around what they can do as individuals to aid a speedier and more successful recovery following their operation. What if there was a time point before surgery where clinicians could inspire patients to adjust their lifestyles for the better, in order to see fewer complications after surgery? This is where the concept of teachable moments comes into play.This comm...
Source: Perioperative Medicine - February 3, 2020 Category: Surgery Source Type: research
Waardenburg-Shah syndrome (WS type IV): a rare case from Pakistan
AbstractWaardenburg-Shah syndrome is a rare autosomal recessive [AR] inherited disorder characterized by the presence of Hirschsprung ’s disease with a high likelihood of aganglionic megacolon, due to which the mortality is high. The management of the condition involves surgical intervention for the removal of the aganglionic segment of the colon. Here, we report a neonate that presented with a white forelock, white eyelashes, i ris hypopigmentation, and sensorineural deafness associated with bilious vomiting, refusal to feed, and failure to pass meconium indicating intestinal obstruction. (Source: Perioperative Medicine)
Source: Perioperative Medicine - January 23, 2020 Category: Surgery Source Type: research
The emerging specialty of perioperative medicine: a UK survey of the attitudes and behaviours of anaesthetists
ConclusionsDespite evidence of emerging services, this survey describes barriers to ongoing development of perioperative medicine. Facilitators may include increased clinical exposure, targeted education and training and collaborative working with other specialties. (Source: Perioperative Medicine)
Source: Perioperative Medicine - January 20, 2020 Category: Surgery Source Type: research
