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Der Unfallchirurg Oct 2021The success of a surgical procedure is significantly influenced by several critical factors. The safety of the patient is the primary goal. To this end, the term...
The success of a surgical procedure is significantly influenced by several critical factors. The safety of the patient is the primary goal. To this end, the term surgical preparation covers a number of procedures aiming to ensure the safety for the patient and a successful surgical intervention: verifying the indications, planning the intervention, identification of potential harmful factors, risks and countermeasures, patient education and documentation. Trauma surgery poses a particular challenge to preoperative preparation, especially due to urgent surgical interventions. Here, a standardized and evidence-based preoperative evaluation ensures a successful treatment of the patient.
Topics: Documentation; Humans; Preoperative Care
PubMed: 34292350
DOI: 10.1007/s00113-021-01037-z -
Studies in Health Technology and... Oct 2023The pilot project of pre-anesthetic evaluation through telemedicine at the Pedro Ernesto University Hospital (HUPE) of the State University of Rio de Janeiro (UERJ) is a...
The pilot project of pre-anesthetic evaluation through telemedicine at the Pedro Ernesto University Hospital (HUPE) of the State University of Rio de Janeiro (UERJ) is a commendable initiative that aims to address the challenges faced by patients in accessing preoperative care. The objective of this study was to reduce the waiting time between the surgical recommendation and its clinical clearance for the procedure. A service flow was established to enable patients to undergo a comprehensive evaluation, including examination and complementary tests, during a single visit with a general practitioner. Based on the type of surgery and the patient's comorbidities, the Teleconsultants Center assessed the case and provided the necessary guidance. A total of 20 patients were attended to in face-to-face sessions during morning shifts, with the participation of Internal Medicine and Anesthesiology. Subsequently, these patients' evaluations were scheduled for teleconsultation to assess their surgical risk. There has been a significant reduction in the time between the surgical recommendation and the clearance for the procedure with a notable improvement compared to the previous protocol. These initial outcomes demonstrate the project's potential to enhance the efficiency and effectiveness of the preoperative evaluation process through teleassistance.
Topics: Humans; Outpatients; Pilot Projects; Preoperative Care; Remote Consultation; Telemedicine
PubMed: 37869867
DOI: 10.3233/SHTI230806 -
European Urology Focus Jan 2024Surgeons must adopt multidisciplinary, evidence-based approaches to preoperative care for radical cystectomy to optimize outcomes. Implementation of early recovery after...
Surgeons must adopt multidisciplinary, evidence-based approaches to preoperative care for radical cystectomy to optimize outcomes. Implementation of early recovery after surgery protocols and individualized prehabilitation plans is crucial for reducing perioperative risks and enhancing postoperative quality of life.
Topics: Humans; Quality of Life; Preoperative Exercise; Preoperative Care; Cystectomy; Postoperative Period
PubMed: 37872082
DOI: 10.1016/j.euf.2023.10.013 -
International Anesthesiology Clinics Jan 2022
Topics: Brain; Cognition; Humans; Preoperative Care
PubMed: 34897220
DOI: 10.1097/AIA.0000000000000347 -
Current Opinion in Anaesthesiology Feb 2023Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of... (Review)
Review
PURPOSE OF REVIEW
Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of comorbidities that may complicate thoracic procedures, and references recent best practices for their management.
RECENT FINDINGS
Patients requiring thoracic surgeries present some of the most challenging cases for both intraoperative and postoperative management. The recent SARS-CoV-2 pandemic has only exacerbated these concerns. Effective preoperative optimization, however, provides for identification of patient comorbidities, allowing for mitigation of surgical risks. This kind of planning is multidisciplinary by nature. We believe patients benefit from early engagement of a dedicated preoperative clinic experienced for caring for complex surgical patients.
SUMMARY
Optimizing patients for thoracic surgery can be challenging for small and large health systems alike. Implementation of evidence-based guidelines can improve care and mitigate risk. As surgical techniques evolve, future research is needed to ensure that perioperative care continues to progress.
Topics: Humans; Thoracic Surgery; COVID-19; SARS-CoV-2; Thoracic Surgical Procedures; Perioperative Care; Preoperative Care
PubMed: 36550607
DOI: 10.1097/ACO.0000000000001215 -
International Journal of Colorectal... Dec 2022Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized.
METHODS
MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects.
RESULTS
The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: - 0.48 days, 95% CI: - 0.84 to - 0.12, p = 0.008) and stool (SMD: - 0.50 days, 95% CI: - 0.86 to - 0.14, p = 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: - 0.51 days, 95% CI: - 0.88 to - 0.14, p = 0.007). There was no difference in postoperative morbidity and patient well-being between both groups.
CONCLUSIONS
Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols.
Topics: Female; Humans; Middle Aged; Male; Diet, Carbohydrate Loading; Colorectal Surgery; Preoperative Care; Randomized Controlled Trials as Topic; Insulin; Length of Stay; Postoperative Complications
PubMed: 36472671
DOI: 10.1007/s00384-022-04288-3 -
Nature Reviews. Neurology Oct 2019Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological... (Review)
Review
Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.
Topics: Brain; Electroencephalography; Epilepsy; Humans; Magnetic Resonance Imaging; Preoperative Care
PubMed: 31341275
DOI: 10.1038/s41582-019-0224-y -
Canadian Journal of Ophthalmology.... Aug 2019To evaluate preoperative preparedness and patient satisfaction after implementation of the Cataract Screening Preprocedural Questionnaire (CSPQ) at Hamilton Regional Eye...
OBJECTIVE
To evaluate preoperative preparedness and patient satisfaction after implementation of the Cataract Screening Preprocedural Questionnaire (CSPQ) at Hamilton Regional Eye Institute.
DESIGN
Single-centred, prospective, cross-sectional study.
PARTICIPANTS/METHODS
One-hundred fifty-one adult patients undergoing elective cataract surgery completed the CSPQ questionnaire. Based on the responses, patients were triaged to the preoperative anaesthesia clinic or booked directly for surgery. Outcome measures included anxiety level, delays or cancellations in surgery, preoperative blood pressure, glucose levels, and satisfaction with the quality of preoperative instructions provided. Results were compared between patients who attended and those who bypassed the preoperative anaesthesia clinic.
RESULTS
Of the study population, 87 patients were female (57.6%) and the mean age was 72.0 ± 10.5 years. Only 11 patients (7.43%) were referred for preoperative consultation. Patients reported receiving preoperative instructions via handouts (94%) and verbally in combination with handouts (59.33%). Patients felt that adequate information was provided regarding preoperative medications (96.69%), eye drops (99.34%), fasting guidelines (98.68%), arrival time (99.34%), and instructions for accompaniment/drivers postoperatively (100%). All patients were compliant with the fasting guidelines. Patient satisfaction with the information received regarding cataract surgery and anaesthesia were 4.39 ± 0.88 and 3.80 ± 0.95, respectively. There was no difference in the anxiety level between patients who attended and those who bypassed the preoperative clinic (4.09 ± 2.92 and 5.18 ± 2.57, p = 0.14). There were no cancellations, delays, or immediate postoperative systemic complications.
CONCLUSIONS
The CSPQ model can be effectively used to streamline the preoperative preparation of patients for cataract surgery while maintaining a high degree of patient satisfaction with the perioperative experience.
Topics: Aged; Ambulatory Care Facilities; Cataract Extraction; Cross-Sectional Studies; Elective Surgical Procedures; Female; Humans; Male; Patient Satisfaction; Postoperative Period; Preoperative Care; Prospective Studies; Surveys and Questionnaires
PubMed: 31358144
DOI: 10.1016/j.jcjo.2018.11.008 -
Systematic Reviews Nov 2023International guidelines promote preoperative education for patients undergoing orthopedic surgery. However, the evidence sustaining these recommendations comes mainly... (Review)
Review
BACKGROUND
International guidelines promote preoperative education for patients undergoing orthopedic surgery. However, the evidence sustaining these recommendations comes mainly from studies for hip and knee replacement surgery. Little is known about patients undergoing foot and ankle surgery. We aimed to map and characterize all the available evidence on preoperative education for patients undergoing foot and ankle surgery.
METHODS
This study complies with the PRISMA-ScR guidelines. We searched eight databases, including MEDLINE, Embase, and CENTRAL. We performed cross-citations and revised the references of included studies. We included studies addressing preoperative education in patients undergoing foot and ankle surgery. We did not exclude studies because of the way of delivering education, the agent that provided it, or the content of the preoperative education addressed in the study. Two independent authors screened the articles and extracted the data. The aggregated data are presented in descriptive tables.
RESULTS
Of 1596 retrieved records, only 15 fulfilled the inclusion criteria. Four addressed preoperative education on patients undergoing foot and ankle surgery and the remaining 11 addressed a broader population, including patients undergoing foot and ankle surgery but did not provide separate data of them. Two studies reported that preoperative education decreases the length of stay of these patients, another reported that education increased the knowledge of the participants, and the other leaflets were well received by patients.
CONCLUSION
This scoping review demonstrates that evidence on preoperative education in foot and ankle surgery is scarce. The available evidence supports the implementation of preoperative education in patients undergoing foot and ankle surgery for now. The best method of education and the real impact of this education remain to be determined.
Topics: Humans; Ankle; Preoperative Care; Orthopedics; Orthopedic Procedures; Arthroplasty, Replacement, Knee
PubMed: 37957710
DOI: 10.1186/s13643-023-02375-2 -
Joint Commission Journal on Quality and... May 2024Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician...
BACKGROUND
Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician dissatisfaction.
METHODS
Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center.
RESULTS
In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information.
CONCLUSION
Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.
Topics: Humans; Cross-Sectional Studies; Aged; Female; Male; Middle Aged; Preoperative Care; Communication; New England; Aged, 80 and over
PubMed: 38360446
DOI: 10.1016/j.jcjq.2024.01.006