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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 -
Deutsches Arzteblatt International Jan 2015
Topics: Cardiovascular Diseases; Humans; Medical History Taking; Physical Examination; Postoperative Complications; Preoperative Care
PubMed: 25686387
DOI: 10.3238/arztebl.2015.0070b -
Anesthesiology Jan 2015
Topics: Anesthesiology; Female; Humans; Internship and Residency; Male; Practice Guidelines as Topic; Preoperative Care
PubMed: 25611666
DOI: 10.1097/ALN.0000000000000494 -
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 -
Anesthesiology Jun 2015
Topics: Colorectal Neoplasms; Female; Humans; Male; Postoperative Care; Preoperative Care
PubMed: 25988413
DOI: 10.1097/ALN.0000000000000661 -
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 -
Postgraduate Medical Journal Oct 1986Clinical data from two hundred consecutive patients undergoing surgical procedures at the Salt Lake City VA Hospital form the basis of this study. Results of nine...
Clinical data from two hundred consecutive patients undergoing surgical procedures at the Salt Lake City VA Hospital form the basis of this study. Results of nine commonly ordered preoperative tests (blood count, differential, electrolytes, chemistry panel, urinalysis, prothrombin time, partial thromboplastin time, electrocardiogram, and chest X-ray) were matched with the preoperative history and physical examination and the outcome of surgery in each patient. Each test was examined by the frequency with which it was ordered, the frequency with which it was abnormal, and the frequency with which the abnormal result affected preoperative care. A prevalence of medical illness was found in this population, with 47.5% having a major cardiovascular diagnosis, 35.5% a metabolic or endocrine disease, and 28% a major pulmonary diagnosis. A total of 1271 tests were performed, with 477 (35.5%) showing some abnormality. However, only 76 (5.9%) changed the patient's management before surgery. All but five of these abnormalities were predictable from the clinical evaluation and these five were minor. The overall postoperative complication rate was 9%. No complication was attributed to the omission of a preoperative test. No surgical cases were cancelled during the study period based solely on a preoperative test. We conclude that many preoperative tests can be safely eliminated by ordering only those based on a specific abnormality in the history or physical examination, resulting in more cost-effective surgical care.
Topics: Humans; Postoperative Complications; Preoperative Care
PubMed: 3774723
DOI: 10.1136/pgmj.62.732.925 -
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