Early Extubation Without Increased Adverse Events in High-Risk Cardiac Surgical Patients

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and hot spots quality management-audits proved to be valuable instruments.

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Closure of median sternotomy by the Sternal Talon®-system in high-risk cardiac surgical patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1246714 ◽

2010 ◽

Vol 58 (S 01) ◽

Author(s):

M Müller ◽

C Heilmann ◽

S Sorg ◽

S Kueri ◽

M Thoma ◽

...

Keyword(s):

High Risk ◽

Median Sternotomy ◽

Surgical Patients

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Adverse Events in Colorectal Surgical Patients Remaining in Hospital whilst Awaiting Medical Review, Rehabilitation or Long-Term Placement

Endoscopy ◽

10.1055/s-2006-956901 ◽

2006 ◽

Vol 38 (11) ◽

Author(s):

T Kallachil ◽

K Sevar ◽

C Benzoni ◽

T Daniel

Keyword(s):

Adverse Events ◽

Surgical Patients ◽

Medical Review

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Faculty of 1000 evaluation for Our study 20 years on: a randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718128643.793485799 ◽

2013 ◽

Author(s):

Andreas Hoeft

Keyword(s):

Clinical Trial ◽

High Risk ◽

Randomized Clinical Trial ◽

Oxygen Delivery ◽

Surgical Patients

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Faculty Opinions recommendation of Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725496542.793506815 ◽

2015 ◽

Author(s):

John Augoustides

Keyword(s):

High Risk ◽

Adverse Events ◽

Single Ventricle ◽

Noncardiac Surgery ◽

Single Ventricle Physiology

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Faculty Opinions recommendation of Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events: A Randomized Controlled Trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732786749.793554105 ◽

2018 ◽

Author(s):

Yoshinori Nakata

Keyword(s):

Randomized Controlled Trial ◽

High Risk ◽

Adverse Events ◽

Controlled Trial ◽

Randomized Controlled

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A Randomized Controlled Trial of Isoniazid to Prevent Mycobacterium tuberculosis Infection in Kenyan Human Immunodeficiency Virus–Exposed Uninfected Infants

Clinical Infectious Diseases ◽

10.1093/cid/ciaa827 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sylvia M LaCourse ◽

Barbra A Richardson ◽

John Kinuthia ◽

A J Warr ◽

Elizabeth Maleche-Obimbo ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Mycobacterium Tuberculosis ◽

High Risk ◽

Adverse Events ◽

Controlled Trial ◽

Preventive Therapy ◽

Infection Prevalence ◽

Mycobacterium Tuberculosis Infection ◽

Immunodeficiency Virus ◽

Exposed Uninfected

Abstract Background Human immunodeficiency virus (HIV)–exposed uninfected (HEU) infants in endemic settings are at high risk of tuberculosis (TB). For infants, progression from primary Mycobacterium tuberculosis (Mtb) infection to TB disease can be rapid. We assessed whether isoniazid (INH) prevents primary Mtb infection. Methods We conducted a randomized nonblinded controlled trial enrolling HEU infants 6 weeks of age without known TB exposure in Kenya. Participants were randomized (1:1) to 12 months of daily INH (10 mg/kg) vs no INH. Primary endpoint was Mtb infection at end of 12 months, assessed by interferon-γ release assay (QuantiFERON-TB Gold Plus) and/or tuberculin skin test (TST, added 6 months after first participant exit). Results Between 15 August 2016 and 6 June 2018, 416 infants were screened, with 300 (72%) randomized to INH or no INH (150 per arm); 2 were excluded due to HIV infection. Among 298 randomized HEU infants, 12-month retention was 96.3% (287/298), and 88.9% (265/298) had primary outcome data. Mtb infection prevalence at 12-month follow-up was 10.6% (28/265); 7.6% (10/132) in the INH arm and 13.5% (18/133) in the no INH arm (7.0 vs 13.4 per 100 person-years; hazard ratio, 0.53 [95% confidence interval {CI}, .24–1.14]; P = .11]), and driven primarily by TST positivity (8.6% [8/93] in INH and 18.1% [17/94] in no INH; relative risk, 0.48 [95% CI, .22–1.05]; P = .07). Frequency of severe adverse events was similar between arms (INH, 14.0% [21/150] vs no INH, 10.7% [16/150]; P = .38), with no INH-related adverse events. Conclusions Further studies evaluating TB preventive therapy to prevent or delay primary Mtb infection in HEU and other high-risk infants are warranted. Clinical Trials Registration NCT02613169.

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Modified STOP-Bang for predicting perioperative adverse events in the Thai population

BMC Anesthesiology ◽

10.1186/s12871-021-01347-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lisa Sangkum ◽

Chama Wathanavaha ◽

Visasiri Tantrakul ◽

Munthana Pothong ◽

Cherdkiat Karnjanarachata

Keyword(s):

High Risk ◽

Adverse Events ◽

Oxygen Therapy ◽

Elective Surgery ◽

Low Risk ◽

Perioperative Outcomes ◽

P Value ◽

Icu Admission ◽

Obstructive Sleep ◽

Postanesthetic Care Unit

Abstract Background Undiagnosed obstructive sleep apnea (OSA) is associated with adverse perioperative outcomes. The STOP-Bang questionnaire is a validated screening tool for OSA. However, its precision may vary among different populations. This study determined the association between high-risk OSA based on the modified STOP-Bang questionnaire and perioperative adverse events. Methods This cross-sectional study included patients undergoing elective surgery from December 2018 to February 2019. The modified STOP-Bang questionnaire includes a history of Snoring, daytime Tiredness, Observed apnea, high blood Pressure, Body mass index > 30 kg/m2, Age > 50, Neck circumference > 40 cm, and male Gender. High risk for OSA was considered as a score ≥ 3. Results Overall, 400 patients were included, and 18.3% of patients experienced perioperative adverse events. On the basis of modified STOP-Bang, the incidence of perioperative adverse events was 23.2 and 13.8% in patients with high risk and low risk (P-value 0.016) (Original STOP-Bang: high risk 22.5% vs. low risk 14.7%, P-value 0.043). Neither modified nor original STOP-Bang was associated with perioperative adverse events (adjusted OR 1.91 (95% CI 0.99–3.66), P-value 0.055) vs. 1.69 (95%CI, 0.89–3.21), P-value 0.106). Modified STOP-Bang ≥3 could predict the incidence of difficult ventilation, laryngoscopic view ≥3, need for oxygen therapy during discharge from postanesthetic care unit and ICU admission. Conclusions Neither modified nor original STOP-Bang was significantly associated with perioperative adverse events. However, a modified STOP-Bang ≥3 can help identify patients at risk of difficult airway, need for oxygen therapy, and ICU admission. Trial registrations This study was registered on Thai Clinical Trials Registry, identifier TCTR20181129001, registered 23 November 2018 (Prospectively registered).

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Validation of the Berlin Questionnaire and American Society of Anesthesiologists Checklist as Screening Tools for Obstructive Sleep Apnea in Surgical Patients

Anesthesiology ◽

10.1097/aln.0b013e31816d91b5 ◽

2008 ◽

Vol 108 (5) ◽

pp. 822-830 ◽

Cited By ~ 302

Author(s):

Frances Chung ◽

Balaji Yegneswaran ◽

Pu Liao ◽

Sharon A. Chung ◽

Santhira Vairavanathan ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

High Risk ◽

Screening Tools ◽

Surgical Patients ◽

Apnea Hypopnea Index ◽

Berlin Questionnaire ◽

Obstructive Sleep ◽

American Society ◽

American Society Of Anesthesiologists ◽

Stop Questionnaire

Background Because of the high prevalence of obstructive sleep apnea (OSA) and its adverse impact on perioperative outcome, a practical screening tool for surgical patients is required. This study was conducted to validate the Berlin questionnaire and the American Society of Anesthesiologists (ASA) checklist in surgical patients and to compare them with the STOP questionnaire. Methods After hospital ethics approval, preoperative patients aged 18 yr or older and without previously diagnosed OSA were recruited. The scores from the Berlin questionnaire, ASA checklist, and STOP questionnaire were evaluated versus the apnea-hypopnea index from in-laboratory polysomnography. The perioperative data were collected through chart review. Results Of 2,467 screened patients, 33, 27, and 28% were respectively classified as being at high risk of OSA by the Berlin questionnaire, ASA checklist, and STOP questionnaire. The performance of the screening tools was evaluated in 177 patients who underwent polysomnography. The sensitivities of the Berlin questionnaire, ASA checklist, and STOP questionnaire were 68.9-87.2, 72.1-87.2, and 65.6-79.5% at different apnea-hypopnea index cutoffs. There was no significant difference between the three screening tools in the predictive parameters. The patients with an apnea-hypopnea index greater than 5 and the patients identified as being at high risk of OSA by the STOP questionnaire or ASA checklist had a significantly increased incidence of postoperative complications. Conclusions Similar to the STOP questionnaire, the Berlin questionnaire and ASA checklist demonstrated a moderately high level of sensitivity for OSA screening. The STOP questionnaire and the ASA checklist were able to identify the patients who were likely to develop postoperative complications.

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