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Journal of Global Antimicrobial... Dec 2023Surgical site infection (SSI) is a serious complication of intestinal surgery. In this meta-analysis, we aimed to explore the efficacy and safety of different... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Surgical site infection (SSI) is a serious complication of intestinal surgery. In this meta-analysis, we aimed to explore the efficacy and safety of different preoperative oral antibiotic preparation (OABP) compared with intravenous antibiotic preparation (IVAP) and/or mechanical bowel preparation (MBP).
METHODS
A meta-analysis consisting of adult patients adopting oral antibiotics versus other regimens during the preoperative preparation of elective intestinal surgery was performed. The outcome included overall SSI, organ space SSI, superficial SSI, deep SSI, and mortality rate.
RESULTS
A total of 35 randomized controlled trials (RCTs) consisting of 8445 adult patients were included in our present analysis. OABP regimens were combined with IVAP in 29 RCTs. In general, the incidence of overall SSI in the OABP group was less compared with the IVAP alone or IVAP+MBP group (RR 0.56, 95% CI 0.46-0.69, P < .00001, I = 47%). Metronidazoles plus quinolones or aminoglycosides showed the best effect on reducing the overall SSI. OABP in combination with preoperative and postoperative IVAP was both significantly associated with reduced SSI. IVAP before and within 24 h after surgery showed the best advantage. No difference was found between the OABP without IVAP group and the control group in reducing SSI. OABP regimens also demonstrated a lower incidence rate of organ space SSI, superficial SSI, deep SSI, and mortality.
CONCLUSION
OABP in combination with preoperative IVAP and within 24 h post-operation significantly reduced the incidence of SSI in intestinal surgery. Metronidazoles accompanied with quinolones or aminoglycosides might be the appropriate combinations for OABP regimens.
Topics: Humans; Anti-Bacterial Agents; Surgical Wound Infection; Antibiotic Prophylaxis; Preoperative Care; Aminoglycosides; Quinolones; Randomized Controlled Trials as Topic
PubMed: 37797809
DOI: 10.1016/j.jgar.2023.09.017 -
Journal of Clinical Monitoring and... Oct 2023This study aimed to investigate the effect of preoperative education using virtual reality (VR) on preoperative anxiety and information desire. The participants were... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aimed to investigate the effect of preoperative education using virtual reality (VR) on preoperative anxiety and information desire. The participants were randomly assigned to the VR group and control group. The VR group received preoperative education using VR content describing preoperative and postoperative processes and their management, and the control group received preoperative education with traditional verbal education. Preoperative anxiety and information desire were measured using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Additionally, patient satisfaction was investigated. Preoperative anxiety (APAIS-A) and information desire (APAIS-I) scores were statistically significantly different between the VR group and the control group (p < 0.001). Patient satisfaction was not statistically significant (p = 0.147). Preoperative education using VR effectively reduced preoperative anxiety and information desire.Trial registration CRIS, KCT0007489. Registered 30 June 2022. http://cris.nih.go.kr/cris/ .
Topics: Humans; Anxiety; Virtual Reality; Preoperative Care; Patient Satisfaction
PubMed: 36933168
DOI: 10.1007/s10877-023-00988-5 -
The Surgical Clinics of North America Aug 2023Patients with vascular disease represent a particularly high-risk surgical population. Many of the comorbidities that contribute to their vascular presentation impact a... (Review)
Review
Patients with vascular disease represent a particularly high-risk surgical population. Many of the comorbidities that contribute to their vascular presentation impact a number of vascular beds or other organ systems. As a result, these patients have the highest rates of cardiac and pulmonary complications among patients with noncardiac surgery. The vascular surgeon is in a unique position to help evaluate and treat many of these conditions to not only reduce the perioperative risk but also to improve the patient's overall health. This article presents a comprehensive review of the common preoperative evaluations that have a high impact on patients with vascular disease.
Topics: Humans; Risk Assessment; Postoperative Complications; Preoperative Care; Comorbidity; Risk Factors; Vascular Diseases
PubMed: 37455026
DOI: 10.1016/j.suc.2023.05.005 -
Paediatric Anaesthesia Dec 2023Fasting for surgery is a routine step in the preoperative preparation for surgery. There have however been increasing concerns with regard to the high incidence of... (Review)
Review
Fasting for surgery is a routine step in the preoperative preparation for surgery. There have however been increasing concerns with regard to the high incidence of prolonged fasting in children, and the subsequent psycho-social distress and physiological consequences that this poses. Additionally, the past few years have yielded new research that has shown significant inter-individual variation in gastric emptying regardless of the length of the fast, with some patients still having residual gastric contents even after prolonged fasts. Additionally, multiple large-scale studies have shown no long-term sequalae from clear fluid aspiration, although two deaths from aspiration have been reported within the large Wake Up Safe cohort. This has led to a change in the recommended clear fluid fasting times in multiple international pediatric societies; similarly, many societies continue to recommend traditional fasting times. Multiple fasting strategies exist in the literature, though these have mostly been studied and implemented in the adult population. This review hopes to summarize the recent updates in fasting guidelines, discuss the issues surrounding prolonged fasting, and explore potential tolerance strategies for children.
Topics: Adult; Child; Humans; Pneumonia, Aspiration; Fasting; Incidence; Gastric Emptying; Gastrointestinal Contents; Preoperative Care
PubMed: 37533337
DOI: 10.1111/pan.14738 -
Otolaryngologic Clinics of North America Feb 2024The treatment of hyperparathyroidism through parathyroidectomy requires careful and complete preoperative evaluation. There are multiple imaging modalities and methods... (Review)
Review
The treatment of hyperparathyroidism through parathyroidectomy requires careful and complete preoperative evaluation. There are multiple imaging modalities and methods available to clinicians today to aid in identifying a pathological lesion; however, each has limitations that the clinician must understand. A systematic approach to patient evaluation, imaging, and surgical exploration is necessary to ensure accurate diagnosis and maximize the chances of minimally invasive and successful surgical removal.
Topics: Humans; Parathyroidectomy; Minimally Invasive Surgical Procedures; Hyperparathyroidism; Preoperative Care
PubMed: 37634984
DOI: 10.1016/j.otc.2023.07.004 -
World Journal of Surgery Oct 2023Surgery is often a complex process that requires detailed 3-dimensional anatomical knowledge and rigorous interplay between team members to attain ideal operational... (Review)
Review
BACKGROUND
Surgery is often a complex process that requires detailed 3-dimensional anatomical knowledge and rigorous interplay between team members to attain ideal operational efficiency or "flow." Virtual Reality (VR) represents a technology by which to rehearse complex plans and communicate precise steps to a surgical team prior to entering the operating room. The objective of this study was to evaluate the use of VR for preoperative surgical team planning and interdisciplinary communication across all surgical specialties.
METHODS
A systematic review of the literature was performed examining existing research on VR use for preoperative surgical team planning and interdisciplinary communication across all surgical fields in order to optimize surgical efficiency. MEDLINE, SCOPUS, CINAHL databases were searched from inception to July 31, 2022 using standardized search clauses. A qualitative data synthesis was performed with particular attention to preoperative planning, surgical efficiency optimization, and interdisciplinary collaboration/communication techniques determined a priori. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. All included studies were appraised for their quality using the Medical Education Research Study Quality Instrument (MERSQI) tool.
RESULTS
One thousand and ninety-three non-duplicated articles with abstract and full text availability were identified. Thirteen articles that examined preoperative VR-based planning techniques for optimization of surgical efficiency and/or interdisciplinary communication fulfilled inclusion and exclusion criteria. These studies had a low-to-medium methodological quality with a MERSQI mean score of 10.04 out of 18 (standard deviation 3.61).
CONCLUSIONS
This review demonstrates that time spent rehearsing and visualizing patient-specific anatomical relationships in VR may improve operative efficiency and communication across multiple surgical specialties.
Topics: Humans; Virtual Reality; Specialties, Surgical; Operating Rooms; Preoperative Care
PubMed: 37204439
DOI: 10.1007/s00268-023-07064-8 -
Patient Education and Counseling Jul 2023To investigate patient and clinician preferences regarding a preoperative educational program for patients undergoing shoulder replacement surgery.
OBJECTIVE
To investigate patient and clinician preferences regarding a preoperative educational program for patients undergoing shoulder replacement surgery.
METHODS
This study used a cross-sectional survey of patients awaiting shoulder replacement surgery and clinicians. The survey was comprised of 41 questions for patients and clinicians, regarding preferences for receiving information, content preferences and device preferences. Descriptive statistics were reported for survey questions.
RESULTS
180 patients and 175 clinicians completed the survey. Patients and clinicians' top choices for ways to receive information were: in-person, website and booklets, with use of CD/DVD being extremely unlikely. Patients and clinicians had different preferences regarding content choices. Patients rated the following content topics as important to include in a program: including other patient's previous experiences with this surgery (83 % patients; 40 % clinicians), information for caregivers (84 % patients; 65 % clinicians), expectations for hospital stay (89 % patients; 57 % clinicians), process of anesthesia (87 % patients; 51 % clinicians), and how the surgery is performed (94 % patients; 60 % clinicians).
CONCLUSIONS
Clinicians and patients have differing priorities and perspectives on the content and delivery of preoperative education programs, however, therapeutic goals and accessibility should be considered when designing programs.
PRACTICE IMPLICATIONS
Creating education programs should include the lens of both clinicians and patients.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Cross-Sectional Studies; Preoperative Care; Surveys and Questionnaires
PubMed: 37075651
DOI: 10.1016/j.pec.2023.107759 -
Ophthalmology May 2024Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare...
PURPOSE
Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events.
DESIGN
Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania.
PARTICIPANTS
Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims.
METHODS
Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10 Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling.
MAIN OUTCOME MEASURES
Total costs, prevalence, and strength of association as indicated by odds ratios.
RESULTS
Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107-$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two.
CONCLUSIONS
Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topics: Humans; United States; Prevalence; Retrospective Studies; Cataract Extraction; Cataract; Preoperative Care
PubMed: 38092081
DOI: 10.1016/j.ophtha.2023.12.001 -
Journal of Cancer Research and Clinical... Nov 2023In order to develop a feasible prehabilitation program before surgery of NSCLC, this study aimed to gain insight into beliefs, facilitators, and barriers of (1)...
BACKGROUND
In order to develop a feasible prehabilitation program before surgery of NSCLC, this study aimed to gain insight into beliefs, facilitators, and barriers of (1) healthcare professionals to refer patients to a prehabilitation program, (2) patients to participate in and adhere to a prehabilitation program, and (3) informal caregivers to support their loved ones.
METHODS
Semi-structured interviews were conducted with healthcare professionals, patients who underwent surgery for NSCLC, and their informal caregivers. The capability, opportunity, and motivation for behavior-model (COM-B) guided the development of the interview questions. Results were analyzed thematically.
RESULTS
The interviews were conducted with twelve healthcare professionals, seventeen patients, and sixteen informal caregivers. Four main themes were identified: (1) content of prehabilitation and referral, (2) organizational factors, (3) personal factors for participation, and (4) environmental factors. Healthcare professionals mentioned that multiple professionals should facilitate the referral of patients to prehabilitation within primary and secondary healthcare involved in prehabilitation, considering the short preoperative period. Patients did not know that a better preoperative physical fitness and nutritional status would make a difference in the risk of postoperative complications. Patients indicated that they want to receive information about the aim and possibilities of prehabilitation. Most patients preferred a group-based physical exercise training program organized in their living context in primary care. Informal caregivers could support their loved one when prehabilitation takes place by doing exercises together.
CONCLUSION
A prehabilitation program should be started as soon as possible after the diagnosis of lung cancer. Receiving information about the purpose and effects of prehabilitation in a consult with a physician seems crucial to patients and informal caregivers to be involved in prehabilitation. Support of loved ones in the patient's own living context is essential for adherence to a prehabilitation program.
Topics: Humans; Lung Neoplasms; Preoperative Exercise; Preoperative Care; Exercise; Carcinoma, Non-Small-Cell Lung
PubMed: 37668792
DOI: 10.1007/s00432-023-05298-6 -
Surgery For Obesity and Related... Aug 2023
Topics: Humans; Body Mass Index; Anti-Obesity Agents; Bariatric Surgery; Preoperative Care; Obesity, Morbid
PubMed: 37120356
DOI: 10.1016/j.soard.2023.03.011