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Best Practice & Research. Clinical... May 2021Preoperative risk evaluation scores are used prior to surgery to predict perioperative risks. They are also a useful tool to help clinicians communicate the risk-benefit... (Review)
Review
Preoperative risk evaluation scores are used prior to surgery to predict perioperative risks. They are also a useful tool to help clinicians communicate the risk-benefit balance of the procedure to patients. This review identifies and assesses the existing preoperative risk evaluation scores (also called prediction scores) of postoperative mortality in all types of surgery (emergency or scheduled) in an adult population. We systematically identified studies using the MEDLINE, Ovid EMBASE and Cochrane databases and published studies reporting the development and validation of preoperative predictive scores of postoperative mortality. We assessed usability, the level of evidence of the studies performed for external validation, and the predictive accuracy of the scores identified. We found 26 scores described within 60 different reports. The most suitable scores with the highest validity identified for anaesthesia practice were the Preoperative Score to Predict Postoperative Mortality (POSPOM), the Universal ACS NSQIP surgical risk calculator (ACS-NSQUIP), the Clinical Frailty Scale (CFS) and the American Society of Anesthesiologists Physical Status (ASA-PS) classification system. While other scores identified in this review could also be endorsed, their level of validity and generalizability to the general surgical population should be carefully considered.
Topics: Anesthesia Recovery Period; Humans; Mortality; Postoperative Complications; Preoperative Care; Risk Assessment; Risk Factors
PubMed: 33742572
DOI: 10.1016/j.bpa.2020.12.005 -
Anesthesiology Clinics Dec 2018Anemia is a decrease in red blood cell mass, which hinders oxygen delivery to tissues. Preoperative anemia has been shown to be associated with mortality and morbidity... (Review)
Review
Anemia is a decrease in red blood cell mass, which hinders oxygen delivery to tissues. Preoperative anemia has been shown to be associated with mortality and morbidity following major surgery. The preoperative care clinic is an ideal place to start screening for anemia and discussing potential interventions in order to optimize patients for surgery. This article (1) reviews the relevant literature and highlights consequences of preoperative anemia in the surgical setting, and (2) suggests strategies for screening and optimizing anemia in the preoperative setting.
Topics: Anemia; Blood Transfusion; Humans; Iron; Length of Stay; Postoperative Complications; Preoperative Care
PubMed: 30390789
DOI: 10.1016/j.anclin.2018.07.017 -
Best Practice & Research. Clinical... Jun 2020Preoperative laboratory testing is often necessary and can be invaluable for diagnosis, assessment, and treatment. However, performing routine laboratory tests for... (Review)
Review
Preoperative laboratory testing is often necessary and can be invaluable for diagnosis, assessment, and treatment. However, performing routine laboratory tests for patients who are considered otherwise healthy is not usually beneficial and is costly. It is estimated that $18 billion (U.S.) is spent annually on preoperative testing, although how much is wasteful remains unknown. Ideally, a targeted and comprehensive patient history and physical exam should largely determine whether preprocedure laboratory studies should be obtained. Healthcare providers, primarily anesthesiologists, should remain cost-conscious when ordering specific laboratory or imaging tests prior to surgery based on available literature. We review the overall evidence and key points from the Choosing Wisely guidelines, the identification of potential wasteful practices, possible harms of testing, and key clinical findings associated with preoperative laboratory testing.
Topics: Cross-Sectional Studies; Diagnostic Tests, Routine; Humans; Practice Guidelines as Topic; Preoperative Care; Retrospective Studies; Societies, Medical
PubMed: 32711836
DOI: 10.1016/j.bpa.2020.04.006 -
Current Opinion in Anaesthesiology Jun 2015Management of the postoperative response to surgical stress is an important issue in major surgery. Avoiding preoperative fasting using preoperative oral carbohydrates... (Review)
Review
PURPOSE OF REVIEW
Management of the postoperative response to surgical stress is an important issue in major surgery. Avoiding preoperative fasting using preoperative oral carbohydrates (POC) has been suggested as a measure to prevent and reduce the extent to which such derangements occur. This review summarizes the current evidence and rationale for this treatment.
RECENT FINDINGS
A recent review from the Cochrane Collaboration reports enhanced gastrointestinal recovery and shorter hospital stay with the use of POC with no effect on postoperative complication rates. Multiple randomized controlled trials demonstrate improved postoperative metabolic response after POC administration, including reduced insulin resistance, protein sparing, improved muscle function and preserved immune response. Cohort studies in patients undergoing major abdominal surgery have shown that the use of POC as part of an enhanced recovery after surgery protocol is a significant predictor for improved clinical outcomes.
SUMMARY
Avoiding preoperative fasting with POC is associated with attenuated postoperative insulin resistance, improved metabolic response, enhanced perioperative well-being, and better clinical outcomes. The impact is greatest for patients undergoing major surgeries.
Topics: Administration, Oral; Carbohydrates; Fasting; Humans; Insulin Resistance; Postoperative Period; Preoperative Care
PubMed: 25827282
DOI: 10.1097/ACO.0000000000000192 -
Anasthesiologie, Intensivmedizin,... Jan 2017
Review
Topics: Acidosis, Lactic; Drug Administration Schedule; Evidence-Based Medicine; Humans; Hypoglycemic Agents; Intraoperative Complications; Metformin; Practice Guidelines as Topic; Preoperative Care; Treatment Outcome
PubMed: 28076875
DOI: 10.1055/s-0042-121635 -
Dermatologic Surgery : Official... Apr 2020Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but... (Review)
Review
BACKGROUND
Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but none, to the authors' knowledge, within dermatologic surgery.
OBJECTIVE
To provide a review of the applications of telemedicine within dermatologic surgery.
MATERIALS AND METHODS
A PubMed search of articles published on teledermatology was conducted in July 2018. Articles were selected based on their relevance to dermatologic surgery and reviewed for their discussion of the applications of telemedicine in surgical and cosmetic dermatology.
RESULTS
The initial search resulted in 156 articles. Eleven ultimately met inclusion criteria: 2 in referral and consultation, 5 in telepathology, 2 in intraoperative uses, and 2 in postprocedural care.
CONCLUSION
For preoperative consultation, teledermatology enables the surgeon to plan ahead and increases access to care by reducing the number of clinic visits. Telepathology has the potential to allow intraoperative consultation with a dermatopathologist to achieve accurate tumor clearance without delay. Smartglasses represent a promising technology for greater care coordination and a teaching tool. Postprocedural monitoring via text messaging provides convenient access to expert advice and early detection of postoperative complications. With increasing technologic advancements, telemedicine holds great potential to augment the dermatologic surgeon's daily practice.
Topics: Cosmetic Techniques; Dermatologic Surgical Procedures; Dermatology; Humans; Intraoperative Care; Preoperative Care; Referral and Consultation; Smart Glasses; Telemedicine
PubMed: 31688234
DOI: 10.1097/DSS.0000000000002230 -
British Journal of Nursing (Mark Allen... Jun 2016The enhanced recovery pathway is an evidence-based surgical care pathway that includes preoperative, perioperative and postoperative care and results in fewer... (Review)
Review
The enhanced recovery pathway is an evidence-based surgical care pathway that includes preoperative, perioperative and postoperative care and results in fewer complications and a shorter length of stay in hospital. There are a variety of elements associated with this pathway and one is the use of a preoperative carbohydrate-loading drink. The consumption of this drink, which is specifically designed to be safely consumed a few hours before surgery, is discussed with a review of the literature on the topic.
Topics: Critical Pathways; Diet, Carbohydrate Loading; Humans; Insulin Resistance; Postoperative Complications; Preoperative Care; Stress, Physiological; Surgical Procedures, Operative
PubMed: 27345069
DOI: 10.12968/bjon.2016.25.12.669 -
Journal of General Internal Medicine Jul 2017Cataract surgery poses minimal systemic medical risk, yet a preoperative general medical history and physical is required by the Centers for Medicare and Medicaid... (Review)
Review
Cataract surgery poses minimal systemic medical risk, yet a preoperative general medical history and physical is required by the Centers for Medicare and Medicaid Services and other regulatory bodies within 1 month of cataract surgery. Based on prior research and practice guidelines, there is professional consensus that preoperative laboratory testing confers no benefit when routinely performed on cataract surgical patients. Such testing remains commonplace. Although not yet tested in a large-scale trial, there is also no evidence that the required history and physical yields a benefit for most cataract surgical patients above and beyond the screening performed by anesthesia staff on the day of surgery. We propose that the minority of patients who might benefit from a preoperative medical history and physical can be identified prospectively. Regulatory agencies should not constrain medical practice in a way that adds enormous cost and patient burden in the absence of value.
Topics: Cataract; Cataract Extraction; Humans; Medical History Taking; Physical Examination; Preoperative Care
PubMed: 28321549
DOI: 10.1007/s11606-017-4043-9 -
Brazilian Journal of Anesthesiology... 2018Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non-invasive and simple technique for the upper airway... (Review)
Review
Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non-invasive and simple technique for the upper airway management, proving to be a useful tool, not only in the operating room but also in the intensive care unit and emergency department. Indeed, over the years mounting evidence has showed an increasing role of ultrasound in airway management. In this review, the authors will discuss the importance of ultrasound in the airway preoperative assessment as a way of detecting signs of difficult intubation or to define the type and/or size of the endotracheal tube as well as to help airway procedures such as endotracheal intubation, cricothyrotomy, percutaneous tracheal intubation, retrograde intubation as well as the criteria for extubation.
Topics: Airway Management; Humans; Intubation, Intratracheal; Preoperative Care; Ultrasonography
PubMed: 30245096
DOI: 10.1016/j.bjan.2018.06.014 -
BMJ (Clinical Research Ed.) Aug 2019
Topics: Exercise Therapy; Humans; Neoplasms; Nutrition Therapy; Patient Education as Topic; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care; Psychotherapy; Resilience, Psychological; Social Determinants of Health; Social Support; Treatment Outcome
PubMed: 31413000
DOI: 10.1136/bmj.l5120