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Journal of Clinical Anesthesia Jun 2024
Topics: Humans; Emergence Delirium; Postoperative Period; Sevoflurane; Hearing Loss; Psychomotor Agitation; Anesthesia Recovery Period
PubMed: 38237441
DOI: 10.1016/j.jclinane.2024.111394 -
Journal of Clinical Anesthesia Dec 2023We estimated hospital costs associated with postoperative reintubation and tested the hypothesis that prolonged surveillance in the post-anesthesia care unit (PACU)... (Observational Study)
Observational Study
OBJECTIVE
We estimated hospital costs associated with postoperative reintubation and tested the hypothesis that prolonged surveillance in the post-anesthesia care unit (PACU) modifies the hospital costs of reintubation.
DESIGN
Retrospective observational research study.
SETTING
Two tertiary care academic healthcare networks in the Bronx, New York and Boston, Massachusetts, USA.
PATIENTS
68,125 adult non-cardiac surgical patients undergoing general anesthesia between 2016 and 2021.
INTERVENTIONS
The exposure variable was unplanned reintubation within 7 days of surgery.
MEASUREMENTS
The primary outcome was direct hospital costs associated with patient care related activities. We used a multivariable generalized linear model based on log-transformed costs data, adjusting for pre- and intraoperative confounders. We matched our data with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS). In the key secondary analysis, we examined if prolonged postoperative surveillance, defined as PACU utilization (≥4 h) modifies the association between reintubation and costs of care.
MAIN RESULTS
1759 (2.6%) of patients were re-intubated within 7 days after surgery. Reintubation was associated with higher direct hospital costs (adjusted model estimate 2.05; 95% CI: 2.00-2.10) relative to no reintubation. In the HCUP-NIS matched cohort, the adjusted absolute difference (AD) in costs amounted to US$ 18,837 (95% CI: 17,921-19,777). The association was modified by the duration of PACU surveillance (p-for-interaction <0.001). In patients with a shorter PACU length of stay, reintubation occurred later (median of 2 days; IQR 1, 5) versus 1 days (IQR 0, 2; p < .001), and was associated with magnified effects on hospital costs compared to patients who stayed in the PACU longer (AD of US$ 23,444, 95% CI: 21,217-25,799 versus AD of US$ 17,615, 95% CI: 16,350-18,926; p < .001).
CONCLUSION
Postoperative reintubation is associated with 2-fold higher hospital costs. Prolonged surveillance in the recovery room mitigated this effect. The cost-saving effect of longer PACU length of stay was likely driven by earlier reintubation in patients who needed this intervention.
Topics: Adult; Humans; Anesthesia, General; Hospital Costs; Length of Stay; Postoperative Period; Recovery Room; Retrospective Studies
PubMed: 37722150
DOI: 10.1016/j.jclinane.2023.111264 -
Arquivos Brasileiros de Cirurgia... 2023Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients'...
BACKGROUND
Weight regain in the postoperative period after bariatric surgery is directly related to the relapse of preoperative comorbidities and a negative impact on the patients' biochemical profile.
AIMS
To assess the metabolic impact of weight regain on preoperative comorbidities and on patients' biochemical profiles, in order to show the impact of the complications on the metabolic outcomes of bariatric surgery.
METHODS
A retrospective study was carried out with 75 women in the late postoperative period of bariatric surgery who presented pathological weight regain (≥20% of the maximum weight loss). Data of interest consisted of glycemic, lipid, and inflammatory profile measurements at three different moments of evaluation: preoperative period, at the weight nadir (minimum weight), and after weight regain. A multivariate analysis was performed.
RESULTS
The mean age was 46.39±12.09 years. Preoperative body mass index was 40.10±4.11 kg/m2. There was an overall increase of 3.36 points in the mean body mass index between the nadir and after regain: from 26.30±3.9 kg/m2 to 29.66±4.66 kg/m2. The mean time to reach the nadir was 18±7.6 months, with an average percentage of excess weight loss of 91.08±11.8%. The median time for pathological weight regain was 48 months, and the mean regain amongst the sample was 8.85±5.65 kg. There was a significant correlation between pathological weight regain and levels of insulin (r=0.351; p<0.011), C-peptide (r=0.303; p<0.011), C-reactive protein (r=0.402; p<0.001), and vitamin D (r=-0.435; p<0.001), the last two being the most influenced by the percentage of weight regained.
CONCLUSIONS
The pathological weight regain in the postoperative period of bariatric surgery results in losses in the patients' metabolic and inflammatory profiles. However, the biochemical benefits are sustained up to the preoperative levels of the parameters analyzed.
Topics: Humans; Female; Adult; Middle Aged; Weight Gain; Retrospective Studies; Bariatric Surgery; Weight Loss; Multivariate Analysis; Postoperative Period; Metabolome; Obesity, Morbid
PubMed: 37585909
DOI: 10.1590/0102-672020230037e1755 -
BMC Cancer Sep 2023The relationship between postoperative CA125 level changes and early recurrence after curative resection of resectable PDAC is still unclear.
BACKGROUND
The relationship between postoperative CA125 level changes and early recurrence after curative resection of resectable PDAC is still unclear.
METHODS
The electronic medical records and follow-up data of patients with resectable pancreatic cancer were evaluated. Dynamic CA125 detection was used to identify the rules for postoperative CA125 level change and its prognostic value in patients with resectable pancreatic cancer.
RESULTS
The study included a total of 118 patients with resectable pancreatic cancer who underwent curative resection. Early postoperative CA125 levels were significantly higher than those before surgery (P < 0.05). It decreased gradually in the group without early recurrence (P < 0.05) but not in the early recurrence group (P>0.05). There was no correlation between early postoperative CA125 levels and early recurrence (P > 0.05). CA125 levels three months after surgery were associated with an increased risk of early recurrence (P = 0.038, 95% CI (1.001-1.025)). The cutoff CA125 level at 3 months after surgery for predicting early recurrence was 22.035. Patients with CA125 levels < 22.035 three months postoperatively had similar DFS and OS, regardless of whether the value was exceeded in the early postoperative period, but these values were significantly better than those of patients with CA125 levels > 22.035 at 3 months postoperatively (p < 0.05).
CONCLUSIONS
Patients with different prognoses have different patterns of CA125 level changes. Elevations in CA125 levels > 3 months postoperatively, rather than early postoperative elevation, were associated with a poor prognosis.
Topics: Humans; Prognosis; CA-125 Antigen; Pancreatic Neoplasms; Postoperative Period
PubMed: 37670245
DOI: 10.1186/s12885-023-11346-8 -
AORN Journal Sep 2023Hospital-acquired pressure injuries create a tremendous cost to health care organizations and negatively affect quality and patient safety. Surgical patients are at an...
Hospital-acquired pressure injuries create a tremendous cost to health care organizations and negatively affect quality and patient safety. Surgical patients are at an increased risk for skin injury, particularly a pressure injury, because of a lack of sensation and immobility during a procedure. An interprofessional team at our facility identified factors that place surgical patients at risk for skin injury. We developed a risk assessment protocol in March 2021 using the Six Sigma DMAIC (define, measure, analyze, improve, and control) method. After data review and analysis, we identified age of 65 years or older, existence of a skin condition, and procedural duration greater than four hours as significant predictors for postoperative skin injury. Our findings reinforce the benefit of using an appropriate risk assessment protocol that alerts the perioperative team members to at-risk patients.
Topics: Humans; Aged; Patient Safety; Postoperative Period; Pressure Ulcer; Risk Assessment
PubMed: 37624055
DOI: 10.1002/aorn.13985 -
Orthopedics 2023Anterior cruciate ligament tears or ruptures are common orthopedic injuries. Anterior cruciate ligament reconstruction (ACLR) is an orthopedic procedure allowing for... (Review)
Review
Anterior cruciate ligament tears or ruptures are common orthopedic injuries. Anterior cruciate ligament reconstruction (ACLR) is an orthopedic procedure allowing for earlier return to sports, improved maintenance of lifestyle demands, and restored knee stability and kinematics. A perioperative rehabilitative adjunct recently gaining interest is blood flow restriction (BFR), a method in which temporary restriction of blood flow to a chosen extremity is introduced and can be used as early as a few days postoperative. There has been increasing investigation and recent literature regarding BFR. This review synthesizes current concepts of BFR use in the ACLR perioperative period. [. 2023;46(6):e333-e340.].
Topics: Humans; Anterior Cruciate Ligament; Knee Joint; Anterior Cruciate Ligament Injuries; Postoperative Period; Anterior Cruciate Ligament Reconstruction
PubMed: 37561100
DOI: 10.3928/01477447-20230804-02 -
Journal of Wound Care Jul 2023It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are...
OBJECTIVE
It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are preventable with effective postoperative education and closer follow-up. Providing patients with information enables them to detect when medical intervention may be required. The aim of this study was to describe the content of postoperative wound care education given to patients, and to identify demographic and clinical factors that predict receipt of surgical wound care education across two tertiary hospitals in Queensland, Australia.
METHOD
A prospective correlational design using structured observations, field notes and an electronic chart audit was used. A consecutive sample of surgical patients and a convenience sample of nurses were observed during episodes of postoperative wound care. Field notes were documented to gain a nuanced understanding of the wound care education delivered by nurses. Descriptive statistics were used to describe the samples. A multivariate logistic regression model was developed to describe associations between seven predictors: sex; age; case complexity; type of wound; dietetic consult; the number of postoperative days; and receipt of postoperative wound care education.
RESULTS
In total, 154 nurses delivering surgical wound care and 257 patients receiving wound care were observed. Across the combined number of patients across the two hospitals, 71/257 (27.6%) wound care episodes included postoperative wound education. The content of the wound care education mainly focused on keeping the wound dressing dry and intact, while the secondary focus was on showing patients how to remove and replace the dressing. In this study, three of the seven predictors were significant: sex (β=-0.776, p=0.013); hospital site (β=-0.702, p=0.025); and number of postoperative days (β=-0.043, p=0.039). Of these, sex was the strongest, with females twice as likely to receive some form of wound care education during the postoperative period. These predictors explained 7.6-10.3% of variance in the postoperative wound care education patients received.
CONCLUSION
Further research to develop strategies designed to improve the consistency and comprehensiveness of the postoperative wound care education delivered to patients is needed.
Topics: Female; Humans; Patient Education as Topic; Postoperative Complications; Postoperative Period; Prospective Studies; Surgical Wound; Male
PubMed: 37405945
DOI: 10.12968/jowc.2023.32.7.437 -
Tuberkuloz Ve Toraks Sep 2023Chronic obstructive pulmonary disease is a progressive airway disease that can progress to the terminal stage requiring oxygen supply. In this period, lung volume...
INTRODUCTION
Chronic obstructive pulmonary disease is a progressive airway disease that can progress to the terminal stage requiring oxygen supply. In this period, lung volume reduction therapies and/or lung transplantation may be considered. Morbidity and mortality risks due to transplant surgery and posttransplant immunosuppressive therapy show the importance of selecting the best candidates who will benefit from transplantation. In this context, BODE index criteria serve as important markers. This study aimed to analyze the outcomes of lung transplantation in patients with chronic obstructive pulmonary disease and to identify variables that may affect post-transplant clinical outcomes.
MATERIALS AND METHODS
Lung transplants diagnosed with chronic obstructive pulmonary disease performed in our center between March 2013 and January 2023 were included in the study. Demographic information and both pre-op and post-op clinical data of the transplant patients were collected. The effect of BODE index criteria and other pre-transplant clinical data on short- and long-term outcomes after transplantation were investigated.
RESULTS
During the study period, 34 lung transplants were performed for chronic obstructive pulmonary disease. One patient died during the operation, three patients received single transplants, and 30 received double transplants. Post-operative primary graft dysfunction was more common in single transplant recipients. The results were comparable between single and double transplants in terms of post-transplant pulmonary function and the development of chronic lung allograft dysfunction. BODE index criteria had no effect on early and late post-operative clinical data, however intra-operative use of extracorporeal membrane oxygenation, primary graft dysfunction, and prolonged extubation were significantly higher in recipients younger than 60 years.
CONCLUSION
Our study suggests that prelisting demographic and clinical data of chronic obstructive pulmonary disease patients had no significant effect on post-operative outcomes, however, intra-operative ECMO use, prolonged extubation, primary graft dysfunction (p< 0.05 for each) and chronic rejection (p> 0.05) were more common in patients who are <60 years of age. These data need to be confirmed by larger studies.
Topics: Humans; Primary Graft Dysfunction; Lung Transplantation; Pulmonary Disease, Chronic Obstructive; Pneumonectomy; Postoperative Period
PubMed: 37740625
DOI: 10.5578/tt.20239703 -
Nephrology Nursing Journal : Journal of... 2023Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major postoperative complication that results in significant morbidity and mortality. Causes are... (Review)
Review
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major postoperative complication that results in significant morbidity and mortality. Causes are heterogeneous, treatment strategies are largely supportive, and data on outcomes, such as potential for recovery, are lacking. This literature review explores the evidence on how furosemide may alter the course and outcome of postoperative fluid overload in patients with CSA-AKI. Nephrology nurse practitioners need to employ tailored preventive therapies at the preoperative, intraoperative, and postoperative points of care. This article discusses the unique methods for CSA-AKI mechanisms, hemodynamic monitoring strategies employed at the point of care recommended by clinical practice guidelines and recent evidence, and emerging biomarkers of AKI.
Topics: Humans; Adult; Cardiac Surgical Procedures; Acute Kidney Injury; Postoperative Period; Risk Factors
PubMed: 37695518
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Jul 2023: Multiple factors are associated with postoperative functional outcomes, such as acute kidney injury (AKI), following partial nephrectomy (PN). The pre-, peri-, and...
: Multiple factors are associated with postoperative functional outcomes, such as acute kidney injury (AKI), following partial nephrectomy (PN). The pre-, peri-, and postoperative factors are heavily intertwined and change dynamically, making it difficult to predict postoperative renal function. Therefore, we aimed to build an artificial intelligence (AI) model that utilizes perioperative factors to predict residual renal function and incidence of AKI following PN. : This retrospective study included 785 patients (training set 706, test set 79) from six tertiary referral centers who underwent open or robotic PN. Forty-four perioperative features were used as inputs to train the AI prediction model. XG-Boost and genetic algorithms were used for the final model selection and to determine feature importance. The primary outcome measure was immediate postoperative serum creatinine (Cr) level. The secondary outcome was the incidence of AKI (estimated glomerular filtration rate (eGFR) < 60 mL/h). The average difference between the true and predicted serum Cr levels was considered the mean absolute error (MAE) and was used as a model evaluation parameter. : An AI model for predicting immediate postoperative serum Cr levels was selected from 2000 candidates by providing the lowest MAE (0.03 mg/dL). The model-predicted immediate postoperative serum Cr levels correlated closely with the measured values (R = 0.9669). The sensitivity and specificity of the model for predicting AKI were 85.5% and 99.7% in the training set, and 100.0% and 100.0% in the test set, respectively. The limitations of this study included its retrospective design. : Our AI model successfully predicted accurate serum Cr levels and the likelihood of AKI. The accuracy of our model suggests that personalized guidelines to optimize multidisciplinary plans involving pre- and postoperative care need to be developed.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Acute Kidney Injury; Artificial Intelligence; Creatinine; Machine Learning; Models, Theoretical; Nephrectomy; Postoperative Period; Retrospective Studies
PubMed: 37629692
DOI: 10.3390/medicina59081402