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International Urogynecology Journal Apr 2024Routine preoperative type and screen (T&S) is often ordered prior to urogynecological surgery but is rarely used. We aimed to assess the cost effectiveness of routine...
INTRODUCTION AND HYPOTHESIS
Routine preoperative type and screen (T&S) is often ordered prior to urogynecological surgery but is rarely used. We aimed to assess the cost effectiveness of routine preoperative T&S and determine transfusion and transfusion reaction rates that make universal preoperative T&S cost effective.
METHODS
A decision tree model from the health care sector perspective compared costs (2020 US dollars) and effectiveness (quality-adjusted life-years, QALYs) of universal preoperative T&S (cross-matched blood) vs no T&S (O negative blood). Our primary outcome was the incremental cost-effectiveness ratio (ICER). Input parameters included transfusion rates, transfusion reaction incidence, transfusion reaction severity rates, and costs of management. The base case included a transfusion probability of 1.26%; a transfusion reaction probability of 0.0013% with or 0.4% without T&S; and with a transfusion reaction, a 50% probability of inpatient management and 0.0042 annual disutility. Costs were estimated from Medicare national reimbursement schedules. The time horizon was surgery/admission. We assumed a willingness-to-pay threshold of $150,000/QALY. One- and two-way sensitivity analyses were performed.
RESULTS
The base case and one-way sensitivity analyses demonstrated that routine preoperative T&S is not cost effective, with an ICER of $63,721,632/QALY. The optimal strategy did not change when base case cost, transfusion probability, or transfusion reaction disutility were varied. Threshold analysis revealed that if transfusion reaction probability without T&S is >12%, routine T&S becomes cost effective. Scenarios identified as cost effective in the threshold and sensitivity analyses fell outside reported rates for urogynecological surgery.
CONCLUSIONS
Within broad ranges, preoperative T&S is not cost effective, which supports re-evaluating routine T&S prior to urogynecological surgery.
Topics: Female; Humans; Blood Transfusion; Cost-Benefit Analysis; Cost-Effectiveness Analysis; Decision Trees; Gynecologic Surgical Procedures; Preoperative Care; Quality-Adjusted Life Years
PubMed: 38240801
DOI: 10.1007/s00192-023-05696-x -
Nutrients Oct 2023The aim of this study was to determine the influence of our own model of immunonutrition on phase angle and postoperative complications. Our goal was to establish modern...
BACKGROUND
The aim of this study was to determine the influence of our own model of immunonutrition on phase angle and postoperative complications. Our goal was to establish modern prehabilitation procedures for patients operated on for pancreatic cancer.
METHODS
Patients with pancreatic cancer who qualified for surgical treatment were divided into two groups. Group I (20 patients; 12 with pancreatic head cancer, 8 with pancreatic tail/body cancer) was given immunonutrition (Impact Oral 3× a day, 237 mL, for 5 days before surgery, and after surgery for an average of 3.5 days). Group II (20 patients; 12 with pancreatic head cancer, 8 with pancreatic tail/body cancer) did not receive immunonutrition. Body weight, body mass index and phase angle were assessed on admission to the hospital, after preoperative immunonutrition, on the third and eighth postoperative days. C-reactive protein and Interleukin-1 α were measured on admission to the hospital, after preoperative immunonutrition, on the eighth postoperative day. Postsurgical complications were assessed via Clavien-Dindo classification.
RESULTS
On admission to the hospital, the phase angle was 5.0° (4.70-5.85) in Group I and 5.1° (5.00-6.25) in Group II. After 5 days of using preoperative immunonutrition, it increased statistically significantly ( < 0.02) to 5.35°. In Group I, on the third day after surgery, it decreased statistically significantly ( < 0.001) to 4.65°, and then, increased to 4.85° on the eighth day. In Group II, statistically significant decreases in the phase angle were observed on the third (4.5°; < 0.002) and eighth (4.55°; < 0.008) days after surgery. A statistically significant increase in CRP (86.6 mg/dL; < 0.02) and IL-1α (18.5 pg/mL; < 0.03) levels was observed on the eighth day after surgery in this group. In Group I, a statistically significant negative correlation (R -0.501106; < 0.002) of the phase angle after 5 days of preoperative immunonutrition with postoperative complications was observed.
CONCLUSIONS
This study used our own model of immunonutrition in patients undergoing surgery for pancreatic cancer. The applied model of perioperative IN improved the postoperative course of patients operated on due to pancreatic cancer. Fewer complications were observed in patients in the group receiving IN. Also, the PA value increased after the 5-day preoperative IN, and the use of perioperative IN improved the PA value on the eighth postoperative day compared to the group that did not receive IN. On this day, an increase in inflammatory parameters was also observed in the group that did not receive IN. In addition, PA correlated negatively with complications. The PA can be a useful tool to assess the effectiveness of the applied IN, and thus, to predict the occurrence of postoperative complications. Therefore, there is a further need for studies on larger groups of patients.
Topics: Humans; Immunonutrition Diet; Preoperative Care; Postoperative Complications; Pancreatic Neoplasms
PubMed: 37892404
DOI: 10.3390/nu15204328 -
American Journal of Otolaryngology 2024To determine the utility of laryngoscopy in the evaluation of liver transplant patients.
PURPOSE
To determine the utility of laryngoscopy in the evaluation of liver transplant patients.
METHODS
This study is a single center retrospective cohort review of patients with a diagnosis of liver failure who underwent laryngoscopy or stroboscopy exam as part of a pre-transplant evaluation from 1/1/2010 to 12/31/2022. Patients were identified using ICD 9 and 10 codes for liver failure and CPT codes for flexible laryngoscopy and stroboscopy. Only patients who underwent preoperative liver transplant evaluation were included. Demographic data was collected. Cohort analysis between patients who did or did not undergo further diagnostic intervention was undertaken.
RESULTS
1824 patients were identified. 243 of these patients underwent pre-transplant laryngoscopy or stroboscopy. 26 of the 243 (10.7 %) patients had further diagnostic work up for findings during laryngoscopy, stroboscopy, or head and neck examination. There was one patient who was found to have head and neck cancer and was excluded from the transplant list until this was treated.
CONCLUSIONS
Otolaryngologic evaluation of liver transplant patients may be beneficial to identify head and neck pathology.
Topics: Humans; Laryngoscopy; Retrospective Studies; Preoperative Care; Stroboscopy; Liver Failure
PubMed: 38134853
DOI: 10.1016/j.amjoto.2023.104201 -
Interventional Neuroradiology : Journal... Oct 2023Meningiomas with transosseous extension provide opportunities for extensive preoperative embolization, through conventional trans-arterial approaches, and also through...
Meningiomas with transosseous extension provide opportunities for extensive preoperative embolization, through conventional trans-arterial approaches, and also through less commonly used percutaneous methods. This video demonstrates embolization of a 7.6 × 9.5 × 9.9 cm transosseous WHO grade II meningioma. Trans-arterial embolization was conducted via the left middle meningeal, occipital, and superficial temporal arteries. Only one superficial temporal artery was embolized to preserve vascular supply to the skin flap. To further devascularize the tumor, concomitant percutaneous embolization was performed. Transosseous extension of the tumor facilitated extensive percutaneous embolization of both the intracranial and extracranial components of the mass. Intraoperative bleeding from the scalp and extracranial component of the tumor was minimal. The intracranial tumor was soft and necrotic and was removed with suction and gentle dissection. Residual tumor was left behind within and adjacent to the superior sagittal sinus. The patient recovered without neurological deficit and was referred for radiation of the residual tumor.
Topics: Humans; Meningioma; Meningeal Neoplasms; Neoplasm, Residual; Embolization, Therapeutic; Preoperative Care
PubMed: 35506928
DOI: 10.1177/15910199221095982 -
Anaesthesia Dec 2023
Topics: Humans; Preoperative Exercise; Exercise Therapy; Preoperative Care; Cardiac Surgical Procedures; Postoperative Complications
PubMed: 37855196
DOI: 10.1111/anae.16146 -
British Journal of Anaesthesia Jul 2024Preoperative depression is an underappreciated comorbidity that has important implications for postoperative outcomes. Screening for symptoms of depression before... (Review)
Review
Preoperative depression is an underappreciated comorbidity that has important implications for postoperative outcomes. Screening for symptoms of depression before surgery can identify patients with or without a previous diagnosis of depression who could benefit from perioperative interventions to improve mood. Preoperative screening programmes are feasible to implement, although care must be taken to ensure that patients who are most likely to benefit are included.
Topics: Humans; Preoperative Care; Depression; Mass Screening; Postoperative Complications; Depressive Disorder
PubMed: 38879267
DOI: 10.1016/j.bja.2024.04.012 -
Current Opinion in Clinical Nutrition... Nov 2023Nutrition remains a key focus in the preoptimization of patients undergoing cancer surgery. Given the catabolic nature of cancer, coupled with the physiological insult... (Review)
Review
PURPOSE OF REVIEW
Nutrition remains a key focus in the preoptimization of patients undergoing cancer surgery. Given the catabolic nature of cancer, coupled with the physiological insult of surgery, malnutrition (when assessed) is prevalent in a significant proportion of patients. Therefore, robust research on interventions to attenuate the detrimental impact of this is crucial.
RECENT FINDINGS
As a unimodal prehabilitation intervention, assessment for malnutrition is the first step, as universal supplementation has not been shown to have a significant impact on outcomes. However, targeted nutritional therapy, whether that is enteral or parenteral, has been shown to improve the nutritional state of patients' presurgery, potentially reducing the rate of postoperative complications such as nosocomial infections. As part of multimodal prehabilitation, the situation is more nuanced given the difficulty in attribution of effects to the differing components, and vast heterogeneity in intervention and patient profiles.
SUMMARY
Multimodal prehabilitation is proven to improve length of hospital stay and postoperative outcomes, with nutrition forming a significant part of the therapy given. Further work is required to look at not only the interplay between the optimization of nutritional status and other prehabilitation interventions, but also how to best select which patients will achieve significant benefit.
Topics: Humans; Neoplasms; Malnutrition; Preoperative Care; Postoperative Complications; Nutritional Status; Nutrition Assessment; Length of Stay; Nutrition Therapy; Nutritional Support; Preoperative Exercise
PubMed: 37610824
DOI: 10.1097/MCO.0000000000000974 -
Paediatric Anaesthesia Feb 2024The perioperative period can be stressful for children and families. Minimizing child distress and investigating the quality of anesthetic care is important. There is a...
BACKGROUND
The perioperative period can be stressful for children and families. Minimizing child distress and investigating the quality of anesthetic care is important. There is a paucity of assessment tools available to assess perioperative anxiety in children.
AIM
To determine the validity and reliability of the modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale in a perioperative setting for children.
METHODS
Children (n = 189, 3-12 years old) scheduled for ear, nose, and throat surgery had their anxiety rated at induction by a registered nurse anesthetist. Two observers individually evaluated video recordings of the perioperative period. The Verbal-Numeric-Anxiety-Fear-Rating-Scale was used to assess the children's preoperative anxiety and fear, and the modified-Distraction-Short-Scale was used to evaluate coping behavior. The modified-Yale-Preoperative-Anxiety-Scale was used to measure preoperative anxiety and behavioral compliance during anesthesia induction.
RESULTS
Interrater reliability showed excellent agreement between observers on modified-Distraction-Short-Scale scores (weighted kappa (K ) = 0.91) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (K = 0.84). The agreements between the registered nurse anesthetist and observers were moderately good for modified-Distraction-Short-Scale (K = 0.65-0.80) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (K = 0.65-0.75). The intraclass correlation coefficient (ICC) for the registered nurse anesthetist and two observers was excellent for modified-Distraction-Short-Scale scores (ICC = 0.96) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (ICC = 0.90). Regarding concurrent validity, modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores were strongly correlated among all three observers (Spearman's correlation coefficient [r ] = 0.75-0.82). The modified-Yale-Preoperative-Anxiety-Scale scores were moderately correlated with modified-Distraction-Short-Scale (r = 0.57-0.66) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (r = 0.54-0.67). Construct validity was tested by using age as a discriminating variable, and Verbal-Numeric-Anxiety-Fear-Rating-Scale, modified-Distraction-Short-Scale, and modified-Yale-Preoperative-Anxiety-Scale scores were lower for the older age group; however, only modified-Distraction-Short-Scale (Observer 1: p = .035, Observer 2: p = .022), and modified-Yale-Preoperative-Anxiety-Scale scores were significantly lower (p < .001).
CONCLUSION
The modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale are simple and valid tools for assessing children's perioperative anxiety or fear and evaluating coping behavior. These results suggest that both scales are useful tools for routine clinical practice and research.
Topics: Child; Humans; Aged; Child, Preschool; Reproducibility of Results; Anxiety; Preoperative Care; Fear; Anesthesia, General
PubMed: 37728169
DOI: 10.1111/pan.14765 -
World Journal of Surgery Nov 2023Preoperative stoma site marking reduces the incidence of complications from elective surgery. However, the impact of stoma site marking in emergency patients with...
BACKGROUND
Preoperative stoma site marking reduces the incidence of complications from elective surgery. However, the impact of stoma site marking in emergency patients with colorectal perforation remains unclear. This study aimed to assess the impact of stoma site marking on morbidity and mortality in patients with colorectal perforation who underwent emergency surgery.
METHODS
This retrospective cohort study used the Japanese Diagnosis Procedure Combination inpatient database from April 1, 2012, to March 31, 2020. We identified patients who underwent emergency surgery for colorectal perforation. We compared outcomes between those with and without stoma site marking using propensity score matching to adjust for confounding factors. The primary outcome was the overall complication rate, and the secondary outcomes were stoma-related, surgical, and medical complications and 30-day mortality.
RESULTS
We identified 21,153 patients (682 with stoma site marking and 20,471 without stoma site marking) and grouped them into 682 pairs using propensity score matching. The overall complication rates were 23.5% and 21.4% in the groups with and without stoma site marking, respectively (p = 0.40). Stoma site marking was not associated with a decrease in stoma-related, surgical, or medical complications. The 30-day mortality did not differ significantly between the groups with and without stoma site marking (7.9% vs. 8.4%, p = 0.843).
CONCLUSIONS
Preoperative stoma site marking was not associated with a reduction in morbidity and mortality in patients with colorectal perforation who underwent emergency surgery.
Topics: Humans; Retrospective Studies; Preoperative Care; Surgical Stomas; Incidence; Colorectal Neoplasms; Postoperative Complications
PubMed: 37301796
DOI: 10.1007/s00268-023-07090-6 -
International Journal of Pediatric... Dec 2023This study investigates the effect of pre-operative cluster care nursing on patient compliance during preoperative isolation of pediatric patients from their family...
OBJECTIVE
This study investigates the effect of pre-operative cluster care nursing on patient compliance during preoperative isolation of pediatric patients from their family members before cochlear implant surgery.
STUDY METHODS
A total of 350 pediatric patients who underwent cochlear implant surgery at Sichuan Rehabilitation Hospital from January 2021 to December 2022 were enrolled. The children were divided into two groups:Experimental group (group E) consisted of 182 children who received pre-operative cluster care nursing, and control group (group C) consisted of 168 children who received pre-operative routine nursing. The compliance scores of the two groups of patients when separated from their families before entering the operating room and the number of patients requiring intravenous injection of midazolam were recorded.
RESULTS
The compliance scores of group E were significantly lower than those of group C (t = 4.141, P < 0.001). The percentage of patients requiring intravenous injection of midazolam was recorded: it was 21.98% (40/182) in group E and 42.26% (71/168) in group C. Notably, the injection rate of midazolam in group E was significantly lower than that in group C (χ = 16.597, P < 0.001).
CONCLUSION
Pre-operative cluster care nursing can improve patient compliance and reduce the use of sedative drugs during preoperative isolation of pediatric patients from their family members for cochlear implant surgery.
Topics: Child; Humans; Cochlear Implants; Midazolam; Cochlear Implantation; Preoperative Care; Patient Compliance
PubMed: 37852048
DOI: 10.1016/j.ijporl.2023.111752