-
Anesthesiology Jan 2015
Topics: Anesthesiology; Female; Humans; Internship and Residency; Male; Practice Guidelines as Topic; Preoperative Care
PubMed: 25611665
DOI: 10.1097/ALN.0000000000000493 -
Anesthesiology Jun 2015
Topics: Colorectal Neoplasms; Female; Humans; Male; Postoperative Care; Preoperative Care
PubMed: 25988414
DOI: 10.1097/ALN.0000000000000662 -
CMAJ : Canadian Medical Association... Aug 2015There is concern about increasing utilization of low-value health care services, including preoperative testing for low-risk surgical procedures. We investigated... (Comparative Study)
Comparative Study
BACKGROUND
There is concern about increasing utilization of low-value health care services, including preoperative testing for low-risk surgical procedures. We investigated temporal trends, explanatory factors, and institutional and regional variation in the utilization of testing before low-risk procedures.
METHODS
For this retrospective cohort study, we accessed linked population-based administrative databases from Ontario, Canada. A cohort of 1 546 223 patients 18 years or older underwent a total of 2 224 070 low-risk procedures, including endoscopy and ophthalmologic surgery, from Apr. 1, 2008, to Mar. 31, 2013, at 137 institutions in 14 health regions. We used hierarchical logistic regression models to assess patient- and institution-level factors associated with electrocardiography (ECG), transthoracic echocardiography, cardiac stress test or chest radiography within 60 days before the procedure.
RESULTS
Endoscopy, ophthalmologic surgery and other low-risk procedures accounted for 40.1%, 34.2% and 25.7% of procedures, respectively. ECG and chest radiography were conducted before 31.0% (95% confidence interval [CI] 30.9%-31.1%) and 10.8% (95% CI 10.8%-10.8%) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%-2.9%) and 2.1% (95% CI 2.1%-2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66-75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6-19.0; for radiography, adjusted OR 2.9, 95% CI 2.8-3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5-8.8; for radiography, adjusted OR 2.2, 95% CI 2.1-2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7-6.9; for radiography, adjusted OR 3.6, 95% CI 3.5-3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively.
INTERPRETATION
Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient- and institution-level factors.
Topics: Adult; Aged; Cohort Studies; Databases, Factual; Electrocardiography; Endoscopy; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Ontario; Ophthalmologic Surgical Procedures; Outcome Assessment, Health Care; Preoperative Care; Quality Control; Radiography, Thoracic; Retrospective Studies; Risk Assessment; Safety Management
PubMed: 26032314
DOI: 10.1503/cmaj.150174 -
Missouri Medicine 2016Primary care physicians and specialists are frequently involved in the care of surgical patients. Changes in reimbursement have prompted re-examination of preoperative...
Primary care physicians and specialists are frequently involved in the care of surgical patients. Changes in reimbursement have prompted re-examination of preoperative testing and health care expenditures. Physicians have additional incentives to improve health care delivery and reduce costs. The perioperative surgical home concept involves coordinating all aspects of patient care, including behavioral modifications, during the perioperative period. Evidence-based guidelines on preoperative evaluation are available to assist practitioners in managing cardiovascular disease, and communicating surgical risks. Shared decision making in the preoperative period can improve surgical outcomes and patient satisfaction.
Topics: Algorithms; Clinical Decision-Making; Humans; Patient Satisfaction; Patient-Centered Care; Physicians, Primary Care; Preoperative Care; Risk; Surgical Procedures, Operative
PubMed: 27443045
DOI: No ID Found -
Anaesthesia Jan 2019The pre-operative optimisation of comorbidities is increasingly recognised as an important element of the pre-operative pathway. These efforts have primarily focused on... (Review)
Review
The pre-operative optimisation of comorbidities is increasingly recognised as an important element of the pre-operative pathway. These efforts have primarily focused on physical comorbidities such as anaemia and the optimisation of exercise and nutrition. However, there is a growing recognition of the importance of psychological morbidity. Increasingly, evidence suggests that psychological factors have an impact on surgical outcomes in both the short and long term. Pre-operative anxiety, depression and low self-efficacy are consistently associated with worse physiological surgical outcomes and postoperative quality of life. This has led to the emergence of psychological prehabilitation and the trimodal approach to prehabilitation, incorporating psychological intervention as well as exercise and nutritional optimisation. However, there is currently insufficient evidence to be sure that pre-operative psychological interventions are of benefit, or which interventions are most effective, because their impact has been mixed. There is an urgent need for high quality, contemporaneous prospective trials with baseline psychological evaluation, well-described interventions and agreement on the most appropriate psychological, quality of life and physiological outcomes measures.
Topics: Anxiety Disorders; Depressive Disorder; Humans; Patient Outcome Assessment; Postoperative Complications; Preoperative Care; Quality of Life; Self Efficacy; Surgical Procedures, Operative
PubMed: 30604423
DOI: 10.1111/anae.14507 -
Journal of Clinical Nursing Jul 2017To explore the issues and challenges of care transitions in the preoperative environment.
AIMS AND OBJECTIVES
To explore the issues and challenges of care transitions in the preoperative environment.
BACKGROUND
Ineffective transitions play a role in a majority of serious medical errors. There is a paucity of research related to the preoperative arena and the multiple inherent transitions in care that occur there.
DESIGN
Qualitative descriptive design was used.
METHODS
Semistructured interviews were conducted in a 975-bed academic medical centre.
RESULTS
A total of 30 providers and 10 preoperative patients participated. Themes that arose were as follows: (1) need for clarity of purpose of preoperative care, (2) care coordination, (3) interprofessional boundaries of care and (4) inadequate time and resources.
CONCLUSION
Effective transitions in the preoperative environment require that providers bridge scope of practice barriers to promote good teamwork. Preoperative care that is a product of well-informed providers and patients can improve the entire perioperative care process and potentially influence postoperative patient outcomes.
RELEVANCE TO CLINICAL PRACTICE
Nurses are well positioned to bridge the gaps within transitions of care and accordingly affect health outcomes.
Topics: Academic Medical Centers; Adult; Female; Humans; Patient Care Team; Perioperative Care; Preoperative Care; Qualitative Research; Quality of Health Care; Time Factors; Transitional Care
PubMed: 27706872
DOI: 10.1111/jocn.13610 -
Anesthesiology Jun 2015
Topics: Colorectal Neoplasms; Female; Humans; Male; Postoperative Care; Preoperative Care
PubMed: 25988413
DOI: 10.1097/ALN.0000000000000661 -
Medical Ultrasonography Feb 2019Airway management is one of the most important skills in everyday practice of anesthesia. Improper airway management might contribute to significant morbidity and... (Review)
Review
Airway management is one of the most important skills in everyday practice of anesthesia. Improper airway management might contribute to significant morbidity and mortality. In some patients, clinical parameters do not anticipate all difficulties related to airway management. Ultrasonography (US) might confer a potential screening tool for difficult airway. Suprahyoid and infrahyoid US measurements have been investigated for difficult airway prediction in anesthesiology. The most extensively investigated parameter was the anterior neck soft tissue thickness measured at different levels: anterior to the hyoid bone, epiglottis and vocal cords commissure. Hyomental distances measured with the head placed in neutral, sniffing or maximal hyperextended position and the derived hyomental distance ratios have also been evaluated for difficult airway prediction. For the evaluation of the tongue, measurements such as thickness, cross-sectional area, width, volume and tongue-to-oral cavityratio can be used. Thus, anesthesiologists have many available potential US measurements, which could provide information regarding airway anatomy during the preoperative airway assessment and could serve as potential screening parameters for difficult airway. Still, we do not yet know which of these provides optimal predictive accuracy and larger sample size studiesare required to validate their use in the preoperative evaluation of the airway.
Topics: Airway Management; Anesthesiology; Humans; Hyoid Bone; Larynx; Neck; Neck Muscles; Preoperative Care; Tongue; Ultrasonography
PubMed: 30779836
DOI: 10.11152/mu-1764 -
Gaceta Medica de Mexico 2019Preoperative assessment in non-cardiac surgery is essential to reducing the rate of in-hospital complications. Its purpose is to identify patients with higher levels of... (Review)
Review
Preoperative assessment in non-cardiac surgery is essential to reducing the rate of in-hospital complications. Its purpose is to identify patients with higher levels of risk. Preoperative assessment should not be restricted to cardiovascular aspects, but it should focus on all organs and systems and include medication reconciliation. The purpose of this article is to approach the performance of a preoperative assessment in non-cardiac surgery from the perspective of the internist, with the purpose to help prevent adverse events and improve the overall outcome.
Topics: Cardiovascular Diseases; Humans; Postoperative Complications; Preoperative Care; Surgical Procedures, Operative
PubMed: 31219462
DOI: 10.24875/GMM.18004492 -
BMC Health Services Research Nov 2019Requesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by... (Review)
Review
BACKGROUND
Requesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by anticipating the patient will be transfused to provide a safety margin in an event of unexpected haemorrhage. Over requesting with minimal utilization results in significant wastage of blood, reagents and human resource. This study was conducted to assess blood utilization practice of the largest tertiary hospital in Ethiopia.
METHODS
A cross-sectional prospective study method was used. Data was collected using a Proforma questionnaire by perusal of each individual patient's records from December 1, 2017 to February 28, 2018.patient age, sex, department requesting the blood, level of operating surgeon, hemodynamic status, number of unit requested, number of unit crossed matched and number of unit transfused were collected. Efficiency of blood utilization was calculated with three indices: Crossmatch to transfusion ratio, transfusion probability, and transfusion index indices.
RESULTS
Blood was requested for 406 patients and a total of 898 units were crossmatched for this patients. Overall Crossmatch to transfusion ration, transfusion probability and transfusion index were 7.6, 15.3% and 0.29 respectively. Results showed insignificant blood usage. Among different departments and units, better blood utilization was seen in neurosurgical unit with C/T ratio, TP and TI of 4.9, 24.4 and 0.6% respectively, while worst indices were from obstetrics unit with C/T ratio, TP and TI of 31.0, 6.5% and 0.06.
CONCLUSION
Using all the three parameters for evaluation of efficiency of blood utilization, the practice in our hospital shows ineffective blood utilization in elective surgical procedure. Blood requesting physician should order the minimum blood anticipated to be used as much as possible.
Topics: Blood Grouping and Crossmatching; Blood Transfusion; Cost-Benefit Analysis; Cross-Sectional Studies; Elective Surgical Procedures; Humans; Practice Guidelines as Topic; Preoperative Care; Prospective Studies
PubMed: 31694644
DOI: 10.1186/s12913-019-4584-1