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Circulation Nov 2018The arterial switch operation (ASO) is the gold standard operative correction of neonates with transposition of the great arteries and intact ventricular septum, with... (Comparative Study)
Comparative Study
BACKGROUND
The arterial switch operation (ASO) is the gold standard operative correction of neonates with transposition of the great arteries and intact ventricular septum, with excellent operative survival. The associations between patient and surgeon characteristics and outcomes are well understood, but the associations between variation in preoperative care and outcomes are less well studied.
METHODS
A multicenter retrospective cohort study of infants undergoing neonatal ASO between January 2010 and September 2015 at hospitals contributing data to the Pediatric Health Information Systems database was performed. The association between preoperative care (timing of ASO, preoperative use of balloon atrial septostomy, prostaglandin infusion, mechanical ventilation, and vasoactive agents) and operative outcomes (mortality, length of stay, and cost) was studied with multivariable mixed-effects models.
RESULTS
Over the study period, 2159 neonates at 40 hospitals were evaluated. Perioperative mortality was 2.8%. Between hospitals, the use of adjuvant therapies and timing of ASO varied broadly. At the subject level, older age at ASO was associated with higher mortality risk (age >6 days: odds ratio, 1.90; 95% CI, 1.11-3.26; P=0.02), cost, and length of stay. Receipt of a balloon atrial septostomy was associated with lower mortality risk (odds ratio, 0.32; 95% CI, 0.17-0.59; P<0.001), cost, and length of stay. Later hospital median age at ASO was associated with higher odds of mortality (odds ratio, 1.15 per day; 95% CI, 1.02-1.29; P=0.03), longer length of stay ( P<0.004), and higher cost ( P<0.001). Other hospital factors were not independently associated with the outcomes of interest.
CONCLUSIONS
There was significant variation in preoperative care between hospitals. Some potentially modifiable aspects of perioperative care (timing of ASO and septostomy) were significantly associated with mortality, length of stay, and cost. Further research on the perioperative care of neonates is necessary to determine whether modifying practice on the basis of the observed associations translates into improved outcomes.
Topics: Arterial Switch Operation; Cardiac Catheterization; Cardiovascular Agents; Databases, Factual; Female; Healthcare Disparities; Hospital Costs; Hospital Mortality; Humans; Infant, Newborn; Length of Stay; Male; Practice Patterns, Physicians'; Preoperative Care; Prostaglandins; Respiration, Artificial; Retrospective Studies; Risk Factors; Time Factors; Time-to-Treatment; Transposition of Great Vessels; Treatment Outcome
PubMed: 30474422
DOI: 10.1161/CIRCULATIONAHA.118.036145 -
Seizure Apr 2020The epilepsy surgery patient management conference is a fundamental part of the presurgical evaluation. This article reviews the literature and describes a single... (Review)
Review
The epilepsy surgery patient management conference is a fundamental part of the presurgical evaluation. This article reviews the literature and describes a single center's approach. Case examples highlight how patient management conferences may influence clinical care.
Topics: Adult; Child; Child, Preschool; Clinical Decision-Making; Epilepsy; Humans; Male; Neurosurgical Procedures; Patient Care Team; Preoperative Care
PubMed: 30660489
DOI: 10.1016/j.seizure.2019.01.006 -
Ugeskrift For Laeger Sep 2014Identification of patients with high risk for post-operative complications is instrumental in all surgical specialities. Proper identification can in some cases lead to... (Review)
Review
Identification of patients with high risk for post-operative complications is instrumental in all surgical specialities. Proper identification can in some cases lead to preoperative or intraoperative optimization resulting in reduced morbidity and morbidity. Several scoring systems exist for assessing overall mortality risk. Preoperative functional tests and biochemical risk markers have shown to be effective in predicting post-operative medical complications and mortality. Optimization can be done by medical interventions, improved anaesthesiological care and optimization directed towards improved communication in the surgical team.
Topics: Humans; Postoperative Complications; Preoperative Care; Risk Assessment; Risk Factors; Surgical Procedures, Operative
PubMed: 25293864
DOI: No ID Found -
TheScientificWorldJournal 2020Bowel preparation traditionally refers to the removal of bowel contents via mechanical cleansing measures. Although it has been a common practice for more than 70 years,... (Meta-Analysis)
Meta-Analysis Review
Bowel preparation traditionally refers to the removal of bowel contents via mechanical cleansing measures. Although it has been a common practice for more than 70 years, its use is based mostly on expert opinion rather than solid evidence. Mechanical bowel preparation in minimally invasive and vaginal gynecologic surgery is strongly debated, since many studies have not confirmed its effectiveness, neither in reducing postoperative infectious morbidity nor in improving surgeons' performance. A comprehensive search of Medline/PubMed and the Cochrane Library Database was conducted, for related articles up to June 2019, including terms such as "mechanical bowel preparation," "vaginal surgery," "minimally invasive," and "gynecology." We aimed to determine the best practice regarding bowel preparation before these surgical approaches. In previous studies, bowel preparation was evaluated only via mechanical measures. The identified randomized trials in laparoscopic approach and in vaginal surgery were 8 and 4, respectively. Most of them compare different types of preparation, with patients being separated into groups of oral laxatives, rectal measures (enema), low residue diet, and fasting. The outcomes of interest are the quality of the surgical field, postoperative infectious complications, length of hospital stay, and patients' comfort during the whole procedure. The results are almost identical regardless of the procedure's type. Routine administration of bowel preparation seems to offer no advantage to any of the objectives mentioned above. Taking into consideration the fact that in most gynecologic cases there is minimal probability of bowel intraluminal entry and, thus, low surgical site infection rates, most scientific societies have issued guidelines against the use of any bowel preparation regimen before laparoscopic or vaginal surgery. Nonetheless, surgeons still do not use a specific pattern and continue ordering them. However, according to recent evidence, preoperative bowel preparation of any type should be omitted prior to minimally invasive and vaginal gynecologic surgeries.
Topics: Female; Gynecologic Surgical Procedures; Humans; Minimally Invasive Surgical Procedures; Patient Outcome Assessment; Preoperative Care; Vagina
PubMed: 32110164
DOI: 10.1155/2020/8546037 -
Medicina (Kaunas, Lithuania) Jan 2019The use of websites to provide patient education is becoming more common. The benefits of a properly executed and effective preoperative patient educational intervention...
The use of websites to provide patient education is becoming more common. The benefits of a properly executed and effective preoperative patient educational intervention have been shown to result in improved psychological and physical well-being for patients undergoing surgery. The purpose of this pilot study was to determine the usability, utility, and feasibility of a website we created to increase engagement and improve the quality of the preoperative education patients receive in preparation for hip and knee arthroplasty. Eighty patients who met the inclusion criteria were recruited, aged between 40 to 65, among those 52.5% were female, 71.25% were placed for knee replacement, 28.75% for hip replacement. Forty patients were randomly assigned to paper education cohort, 40 to the paper and website education cohort. However, only 19 from each cohort participated in the survey questionnaire. The outcome of interest included qualitative data for patient knowledge, satisfaction, utilities, and usability, which were assessed based on the Perceived Health Website Usability Questionnaire online survey. The paper-based survey contains ten questions using a 7-point Likert scale while the web-based survey contains fourteen questions using the same 7-point Likert scale. Descriptive statistics and independent samples -tests were used for comparative analysis of usual paper education and website education cohorts; whereby Microsoft Excel data analytics tool was used to compute the results. The Alpha level was set to 0.05 for the statistical results. The result of the study showed no statistically significant differences in both cohorts at the 0.05 level. We hypothesized that both information delivery methods were effective in increasing knowledge and engaging patients to their preoperative educations. According to the survey result for the nursing staff, they believed that the use of the website improved nursing workflow, efficiency, and patient education.
Topics: Adult; Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cohort Studies; Feasibility Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Internet; Male; Middle Aged; Nursing Staff, Hospital; Patient Education as Topic; Patient Satisfaction; Pilot Projects; Preoperative Care; Surveys and Questionnaires
PubMed: 30704149
DOI: 10.3390/medicina55020032 -
World Journal of Surgery Apr 2023Patient education is recommended as an essential component of Enhanced Recovery after Surgery (ERAS) protocols. However, there are many uncertainties regarding content... (Review)
Review
BACKGROUND
Patient education is recommended as an essential component of Enhanced Recovery after Surgery (ERAS) protocols. However, there are many uncertainties regarding content and methodological criteria, which may have a significant impact on the effectiveness of the intervention. The aim of this review is to assess the effect of preoperative patient education on postoperative recovery in abdominal surgery and to examine different patient education strategies for their effectiveness.
METHODS
We performed a systematic review according to the PRISMA guidelines. PubMed, CINAHL, and Cochrane were searched from 2011 to 2022. All studies investigating the effect of preoperative patient education on postoperative recovery in abdominal surgery were included. A critical quality assessment of all included studies was performed.
RESULTS
We identified 826 potentially suitable articles via a database search and included 12 studies in this review. The majority of the included studies reported a reduction in the length of hospital stay (LOS) and even a reduction in postoperative complications and adverse events. Patients with preoperative education seemed to have lower psychological stress and experience less anxiety. However, the contents, delivery, and general conditions were implemented differently, making comparison difficult. Moreover, the majority of the included studies were weak in quality.
CONCLUSION
With this review, we report potential effects, current implementations, and frameworks of patient education. However, the results must be interpreted with caution and are not directly transferable to clinical practice. Further studies in this field are necessary to make concrete recommendations for clinical practice.
Topics: Humans; Patient Education as Topic; Postoperative Complications; Length of Stay; Preoperative Care; Anxiety
PubMed: 36641521
DOI: 10.1007/s00268-022-06884-4 -
Trials Feb 2020Patients' pre-operative health and physical function is known to influence their post-operative outcomes. In patients with knee osteoarthritis, pharmacological and...
Osteoarthritis Preoperative Package for care of Orthotics, Rehabilitation, Topical and oral agent Usage and Nutrition to Improve ouTcomes at a Year (OPPORTUNITY); a feasibility study protocol for a randomised controlled trial.
BACKGROUND
Patients' pre-operative health and physical function is known to influence their post-operative outcomes. In patients with knee osteoarthritis, pharmacological and non-pharmacological options are often not optimised prior to joint replacement. This results in some patients undergoing surgery when they are not as fit as they could be. The aim of this study is to assess the feasibility and acceptability of a pre-operative package of non-operative care versus standard care prior to joint replacement.
METHODS/DESIGN
This is a multicentre, randomised controlled feasibility trial of patients undergoing primary total knee replacement for osteoarthritis. Sixty patients will be recruited and randomised (2:1) to intervention or standard care arms. Data will be collected at baseline (before the start of the intervention), around the end of the intervention period and a minimum of 90 days after the planned date of surgery. Adherence will be reviewed each week during the intervention period (by telephone or in person). Participants will be randomised to a pre-operative package of non-operative care or standard care. The non-operative care will consist of (1) a weight-loss programme, (2) a set of exercises, (3) provision of advice on analgesia use and (4) provision of insoles. The intervention will be started as soon as possible after patients have been added to the waiting list for joint replacement surgery to take advantage of the incentive for behavioural change that this will create. The primary outcomes of this study are feasibility outcomes which will indicate whether the intervention and study protocol is feasible and acceptable and whether a full-scale effectiveness trial is warranted. The following will be measured and used to inform study feasibility: rate of recruitment, rate of retention at 90-day follow-up review after planned surgery date, and adherence to the intervention estimated through review questionnaires and weight change (for those receiving the weight-loss aspect of intervention). In addition the following information will be assessed qualitatively: analysis of qualitative interviews exploring acceptability, feasibility, adherence and possible barriers to implementing the intervention, and acceptability of the different outcome measures.
DISCUSSION
The aims of the study specifically relate to testing the feasibility and acceptability of the proposed effectiveness trial intervention and the feasibility of the trial methods. This study forms the important first step in developing and assessing whether the intervention has the potential to be assessed in a future fully powered effectiveness trial. The findings will also be used to refine the design of the effectiveness trial.
TRIAL REGISTRATION
ISRCTN registry, ID: ISRCTN96684272. Registered on 18 April 2018.
Topics: Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Exercise Therapy; Feasibility Studies; Humans; Multicenter Studies as Topic; Nutritional Status; Osteoarthritis, Knee; Postoperative Complications; Preoperative Care; Randomized Controlled Trials as Topic; Recovery of Function; Time Factors; Treatment Outcome; Weight Reduction Programs
PubMed: 32075663
DOI: 10.1186/s13063-019-3709-5 -
Anaesthesia Dec 2014
Topics: Female; Humans; Male; Nerve Block; Pain, Postoperative; Preoperative Care; Stellate Ganglion
PubMed: 25394700
DOI: 10.1111/anae.12882 -
The British Journal of Surgery Jan 2018The pathogenesis of colorectal cancer recurrence after a curative resection remains poorly understood. A yet-to-be accounted for variable is the composition and function... (Review)
Review
BACKGROUND
The pathogenesis of colorectal cancer recurrence after a curative resection remains poorly understood. A yet-to-be accounted for variable is the composition and function of the microbiome adjacent to the tumour and its influence on the margins of resection following surgery.
METHODS
PubMed was searched for historical as well as current manuscripts dated between 1970 and 2017 using the following keywords: 'colorectal cancer recurrence', 'microbiome', 'anastomotic leak', 'anastomotic failure' and 'mechanical bowel preparation'.
RESULTS
There is a substantial and growing body of literature to demonstrate the various mechanisms by which environmental factors act on the microbiome to alter its composition and function with the net result of adversely affecting oncological outcomes following surgery. Some of these environmental factors include diet, antibiotic use, the methods used to prepare the colon for surgery and the physiological stress of the operation itself.
CONCLUSION
Interrogating the intestinal microbiome using next-generation sequencing technology has the potential to influence cancer outcomes following colonic resection.
Topics: Anastomosis, Surgical; Anastomotic Leak; Colorectal Neoplasms; Gastrointestinal Microbiome; Humans; Neoplasm Recurrence, Local; Preoperative Care
PubMed: 29341151
DOI: 10.1002/bjs.10760 -
Anesthesiology Dec 2021Among chronic opioid users, the association between decreasing or increasing preoperative opioid utilization and postoperative outcomes is unknown. The authors...
BACKGROUND
Among chronic opioid users, the association between decreasing or increasing preoperative opioid utilization and postoperative outcomes is unknown. The authors hypothesized that decreasing utilization would be associated with improved outcomes and increasing utilization with worsened outcomes.
METHODS
Using commercial insurance claims, the authors identified 57,019 chronic opioid users (10 or more prescriptions or 120 or more days supplied during the preoperative year), age 18 to 89 yr, undergoing one of 10 surgeries between 2004 and 2018. Patients with a 20% or greater decrease or increase in opioid utilization between preoperative days 7 to 90 and 91 to 365 were compared to patients with less than 20% change (stable utilization). The primary outcome was opioid utilization during postoperative days 91 to 365. Secondary outcomes included alternative measures of postoperative opioid utilization (filling a minimum number of prescriptions during this period), postoperative adverse events, and healthcare utilization.
RESULTS
The average age was 63 ± 13 yr, with 38,045 (66.7%) female patients. Preoperative opioid utilization was decreasing for 12,347 (21.7%) patients, increasing for 21,330 (37.4%) patients, and stable for 23,342 (40.9%) patients. Patients with decreasing utilization were slightly less likely to fill an opioid prescription during postoperative days 91 to 365 compared to stable patients (89.2% vs. 96.4%; odds ratio, 0.323; 95% CI, 0.296 to 0.352; P < 0.001), though the average daily doses were similar among patients who continued to utilize opioids during this timeframe (46.7 vs. 46.5 morphine milligram equivalents; difference, 0.2; 95% CI, -0.8 to 1.2; P = 0.684). Of patients with increasing utilization, 93.6% filled opioid prescriptions during this period (odds ratio, 0.57; 95% CI, 0.52 to 0.62; P < 0.001), with slightly lower average daily doses (44.3 morphine milligram equivalents; difference, -2.2; 95% CI, -3.1 to -1.3; P < 0.001). Except for alternative measures of persistent postoperative opioid utilization, there were no clinically significant differences for the secondary outcomes.
CONCLUSIONS
Changes in preoperative opioid utilization were not associated with clinically significant differences for several postoperative outcomes including postoperative opioid utilization.
Topics: Aged; Analgesics, Opioid; Cohort Studies; Female; Humans; Male; Middle Aged; Opioid-Related Disorders; Pain, Postoperative; Preoperative Care; Retrospective Studies
PubMed: 34731242
DOI: 10.1097/ALN.0000000000004026