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Journal of Surgical Oncology Oct 2017In this review, we explore the rationale and history behind the practice of preoperative fasting in elective surgery including the gradual move toward longer fasting and... (Review)
Review
In this review, we explore the rationale and history behind the practice of preoperative fasting in elective surgery including the gradual move toward longer fasting and the more recent change in direction of practice. Gastric emptying physiology and the metabolic effects of prolonged fasting and carbohydrate loading are examined. Most recent guidelines related to these topics are discussed and practical recommendations for implementing these guidelines are suggested.
Topics: Fasting; Gastric Emptying; Glucose; Humans; Practice Guidelines as Topic; Preoperative Care; Surgical Procedures, Operative
PubMed: 28846137
DOI: 10.1002/jso.24810 -
Journal of Evaluation in Clinical... Jun 2023Preoperative care is one of the main areas in which to address low-value care. A detailed definition of what low-value care is in this period of the surgical care... (Review)
Review
RATIONALE
Preoperative care is one of the main areas in which to address low-value care. A detailed definition of what low-value care is in this period of the surgical care journey paves the way for new scientific research, clinical improvements, and reduction of unnecessary costs in this field.
AIMS AND OBJECTIVE
To identify how low-value care in low-risk preoperative population has been defined in the scientific literature and propose a low-value care framework with potential consequences in this setting.
METHODS
Scoping review of theoretical studies and peer-reviewed papers, including reviews, commentaries, or expert opinions, were considered eligible for inclusion. The following databases were consulted: MEDLINE (via PubMed), EMBASE, and SCOPUS (from inception to July 24, 2021), using a structured search with the keywords "low value care", "clinical waste", "preoperative", and "elective procedures." Two independent reviewers performed study selection and data extraction. The definition of low-value care in the preoperative period and their consequences were described after extracting previous low-value care concepts and summarising the contents. Also, a visual framework was built with this information.
RESULTS
From 1519 publications identified in the initial searches, 22 underwent full-text assessment, and 11 conceptual studies were included in the review. A total of four studies (36%) presented a general low-value care definition, and all studies report some situations considered low-value care in the preoperative field of low-risk surgeries. The most common example of preoperative low-value care, listed in nine studies (81%), was having asymptomatic patients undergo screening tests before surgery. The main clinical and nonclinical consequences of low-value care in the preoperative phase included false-positive results from exams as well as psychological distress, increased costs, and delay in surgery.
CONCLUSIONS
Revisiting and integrating previous definitions of low-value care in low-risk surgery into a scoping review is a starting point for de-implementing unnecessary care and promoting improvements in surgical pathways.
Topics: Humans; Low-Value Care; Preoperative Care; Bibliometrics
PubMed: 36779241
DOI: 10.1111/jep.13812 -
Journal of Perianesthesia Nursing :... Dec 2018
Topics: Humans; Postoperative Complications; Preoperative Care; Surgical Procedures, Operative
PubMed: 30449429
DOI: 10.1016/j.jopan.2018.09.006 -
Spine Sep 2020Retrospective case control study.
STUDY DESIGN
Retrospective case control study.
OBJECTIVE
The aim of this study was to analyze the appropriate traction period and preoperative halo traction (HT)-related factors in severe scoliosis SUMMARY OF BACKGROUND DATA.: HT can reduce risks involved in severe scoliosis treatment, and its safety and efficacy are well known. However, a lack of evidence exists in guiding the appropriate traction period and other factors involved in HT.
METHODS
We retrospectively reviewed 59 patients who underwent preoperative HT, analyzed correction rate changes over time using HT, and assessed other factors by dividing the patients into two groups according to differences between the post-bending correction angle (PBC) and post-halo traction correction angle (PTC): group A (PBC ≒ PTC) and group B (PBC < PTC). The grouping was determined by whether the difference between PBC and PTC was >8°, the maximum measurement error when measuring the Cobb angle.
RESULTS
The mean Cobb angle improved from 96.9° preoperatively to 72.9° post-bending to 63.3° post-traction and 32.5° postoperatively. The coronal correction of the major curve (change in curve from the start to each week/total change in curve after traction) was 28.2% at 1 week (n = 59), 34.0% at 2 weeks (n = 58), 33.8% at 3 weeks (n = 41), and 32.2% at 4 weeks (n = 13); a difference was noted between the first and second weeks (P < 0.001, <0.001, 0.244, and 0.082, respectively). Compared with group A, group B had a lower height (154.9 vs. 144.4 cm, P = 0.029), lower body weight (49.1 vs. 39.4 kg, P = 0.017), higher traction/body weight ratio (0.41 vs. 0.47, P = 0.025), and more halo-femoral traction (0 vs. 6, P = 0.018).
CONCLUSION
Traction for ≥3 weeks was unnecessary for optimal traction. In patients with low height and weight, halo-femoral traction with a heavy traction weight was effective.
LEVEL OF EVIDENCE
4.
Topics: Adolescent; Adult; Case-Control Studies; Child; Female; Humans; Male; Orthopedic Equipment; Preoperative Care; Retrospective Studies; Scoliosis; Severity of Illness Index; Traction; Treatment Outcome; Young Adult
PubMed: 32341298
DOI: 10.1097/BRS.0000000000003530 -
Revista Espanola de Anestesiologia Y... Mar 2015Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic... (Review)
Review
Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.
Topics: Adult; Child; Fasting; Humans; Practice Guidelines as Topic; Preoperative Care
PubMed: 25443866
DOI: 10.1016/j.redar.2014.09.006 -
Anesthesiology Clinics Sep 2015The elderly preoperative patient benefits from an assessment that includes more than a routine physical examination and electrocardiogram. Such an assessment includes... (Review)
Review
The elderly preoperative patient benefits from an assessment that includes more than a routine physical examination and electrocardiogram. Such an assessment includes domains likely to affect the elderly: cognition, functionality, frailty, polypharmacy, nutrition, and social support. This fosters decisions based on functional age rather than chronologic age and on each patient as an individual. One such assessment is that promulgated by the American College of Surgeons National Surgery Quality Improvement Program/American Geriatrics Society Best Practice Guidelines. We should not miss any opportunity to improve results in this growing population of surgical patients.
Topics: Aged; Aged, 80 and over; Geriatrics; Humans; Perioperative Care; Preoperative Care; Surgeons
PubMed: 26315633
DOI: 10.1016/j.anclin.2015.05.012 -
British Journal of Anaesthesia Jul 2021In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of evidence and strength of association between perioperative lymphopaenia across different surgical procedures and mortality/morbidity has not been examined by systematic review or meta-analysis.
METHODS
We searched MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane databases from their inception to June 29, 2020 for observational studies reporting lymphocyte count and in-hospital mortality rate in adults. We defined preoperative lymphopaenia as a lymphocyte count 1.0-1.5×10 L. Meta-analysis was performed using either fixed or random effects models. Quality was assessed using the Newcastle-Ottawa Scale. The I index was used to quantify heterogeneity. The primary outcome was in-hospital mortality rate and mortality rate at 30 days.
RESULTS
Eight studies met the inclusion criteria for meta-analysis, comprising 4811 patients (age range, 46-91 yr; female, 20-79%). These studies examined preoperative lymphocyte count exclusively. Studies were of moderate to high quality overall, ranking >7 using the Newcastle-Ottawa Scale. Preoperative lymphopaenia was associated with a threefold increase in mortality rate (risk ratio [RR]=3.22; 95% confidence interval [CI], 2.19-4.72; P<0.01, I=0%) and more frequent major postoperative complications (RR=1.33; 95% CI, 1.21-1.45; P<0.01, I=6%), including cardiovascular morbidity (RR=1.77; 95% CI, 1.45-2.15; P<0.01, I=0%), infections (RR=1.45; 95% CI, 1.19-1.76; P<0.01, I=0%), and acute renal dysfunction (RR=2.66; 95% CI, 1.49-4.77; P<0.01, I=1%).
CONCLUSION
Preoperative lymphopaenia is associated with death and complications more frequently, independent of the type of surgery.
PROSPERO REGISTRY NUMBER
CRD42020190702.
Topics: Elective Surgical Procedures; Hospital Mortality; Humans; Lymphopenia; Morbidity; Postoperative Complications; Preoperative Care; Prospective Studies
PubMed: 33795133
DOI: 10.1016/j.bja.2021.02.023 -
Journal of Gastroenterology Sep 2015Preoperative biliary drainage (PBD) has been thought to be preferable regardless of the site of biliary strictures, e.g., distal or proximal strictures because PBD by... (Review)
Review
Preoperative biliary drainage (PBD) has been thought to be preferable regardless of the site of biliary strictures, e.g., distal or proximal strictures because PBD by endoscopy or interventional radiology decreases postoperative mortality and morbidity rates. However, recently, several studies have revealed that PBD strategy showed an increased mortality rate or a high frequency of surgical site infection. Herein, we reviewed reports in the literature regarding the current status of PBD and investigated the effects of PBD on patients with distal and proximal biliary obstructions due to potentially resectable pancreatobiliary cancers. Our summary demonstrated that there is as yet no optimal PBD method regardless of the distal and proximal biliary strictures because of the small sample size and the lack of better control groups in previous studies. Thus, prospective randomized studies with a large sample size are needed to establish the optimal mode of PBD and to evaluate the potential benefits of PBD in patients with both distal and proximal biliary obstructions.
Topics: Cholestasis; Drainage; Humans; Pancreatic Neoplasms; Preoperative Care
PubMed: 26138070
DOI: 10.1007/s00535-015-1096-6 -
AORN Journal Jul 2019
Topics: Drug Misuse; Hemorrhage; Humans; Male; Middle Aged; Preoperative Care
PubMed: 31246306
DOI: 10.1002/aorn.12711 -
NeuroImage. Clinical 2018Functional magnetic resonance imaging (fMRI) is increasingly used for preoperative counseling and planning, and intraoperative guidance for tumor resection in the... (Review)
Review
Functional magnetic resonance imaging (fMRI) is increasingly used for preoperative counseling and planning, and intraoperative guidance for tumor resection in the eloquent cortex. Although there have been improvements in image resolution and artifact correction, there are still limitations of this modality. In this review, we discuss clinical fMRI's applications, limitations and potential solutions. These limitations depend on the following parameters: foundations of fMRI, physiologic effects of the disease, distinctions between clinical and research fMRI, and the design of the fMRI study. We also compare fMRI to other brain mapping modalities which should be considered as alternatives or adjuncts when appropriate, and discuss intraoperative use and validation of fMRI. These concepts direct the clinical application of fMRI in neurosurgical patients.
Topics: Brain; Brain Mapping; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Oxygen; Preoperative Care
PubMed: 29270359
DOI: 10.1016/j.nicl.2017.12.008