Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery

2021 ◽  
Vol 75 ◽  
pp. 110475
Author(s):  
Sanam Tabatabai ◽  
Quyen Do ◽  
Jie Min ◽  
Christopher J. Tang ◽  
Devon Pleasants ◽  
...  
Keyword(s):  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Arthroplasty Surgery

Safety of emergency, elective and day case operating during the winter period at East Suffolk and North Essex NHS Foundation Trust: lessons from the outcomes of 4,254 surgical patients from the first COVID-19 wave

2021 ◽  
Vol 103 (7) ◽  
pp. 478-480
Author(s):  
S Parikh ◽  
L Cooper ◽  
W Matthews ◽  
M Khan ◽  
S Syed ◽  
...  
Keyword(s):  
Evidence Base ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Winter Period ◽  
Limited Evidence ◽  
Day Case ◽  
Emergency Admissions ◽  
Day Case Surgery ◽  
Case Surgery ◽  
Regular Review

Background There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. Methods We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. Results There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. Conclusions There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.

A multidisciplinary perioperative medicine clinic to improve high-risk patient outcomes: A service evaluation audit

2021 ◽  
pp. 0310057X2110171
Author(s):  
Aidan I Fullbrook ◽  
Elizabeth P Redman ◽  
Kerry Michaels ◽  
Lisa R Woods ◽  
Aruntha Moorthy ◽  
...  
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Perioperative Medicine ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Surgical Patient ◽  
High Risk Patients ◽  
Medicine Clinic ◽  
Risk Patients ◽  
High Risk Surgical Patient

Various perioperative interventions have been demonstrated to improve outcomes for high-risk patients undergoing surgery. This audit assessed the impact of introducing a multidisciplinary perioperative medicine clinic on postoperative outcomes and resource usage amongst high-risk patients. Between January 2019 and March 2020, our institution piloted a Comprehensive High-Risk Surgical Patient Clinic. Surgical patients were eligible for referral when exhibiting criteria known to increase perioperative risk. The patient’s decision whether to proceed with surgery was recorded; for those proceeding with surgery, perioperative outcomes and bed occupancy were recorded and compared against a similar surgical population identified as high-risk at our institution in 2017. Of 23 Comprehensive High-Risk Surgical Patient Clinic referrals, 11 did not proceed with the original planned surgery. Comprehensive High-Risk Surgical patients undergoing original planned surgery, as compared to high-risk patients from 2017, experienced reduced unplanned intensive care unit admission (8% versus 19%, respectively), 30-day mortality (0% versus 13%) and 30-day re-admission to hospital (0% versus 20%); had shorter postoperative lengths of stay (median (range) 8 (7–14) days versus 10.5 (5–28)) and spent more days alive outside of hospital at 30 days (median (range) 18 (0–25) versus 21 (16–23)). Cumulatively, the Comprehensive High-Risk Surgical patient cohort compared to the 2017 cohort (both n=23) occupied fewer postoperative intensive care (total 13 versus 24) and hospital bed-days (total 106 versus 212). The results of our Comprehensive High-Risk Surgical Patient pilot project audit suggest improved individual outcomes for high-risk patients proceeding with surgery. In addition, the results support potential resource savings through more appropriate patient selection.

scholarly journals Anaesthesia provider volume and perioperative outcomes in total joint arthroplasty surgery

2019 ◽  
Vol 123 (5) ◽  
pp. 679-687
Author(s):  
Stavros G. Memtsoudis ◽  
Lauren A. Wilson ◽  
Janis Bekeris ◽  
Jiabin Liu ◽  
Lazaros Poultsides ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Perioperative Outcomes ◽  
Provider Volume ◽  
Anaesthesia Provider ◽  
Arthroplasty Surgery

scholarly journals Perioperative sleep apnea: a real problem or did we invent a new disease?

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 48 ◽  
Author(s):  
Sebastian Zaremba ◽  
James E. Mojica ◽  
Matthias Eikermann
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Perioperative Complications ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Real Problem ◽  
New Disease ◽  
Clinical Algorithm ◽  
Obstructive Sleep

Depending on the subpopulation, obstructive sleep apnea (OSA) can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA  and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery.

Misclassification of diabetic vascular surgical patients when analyzing their perioperative outcomes

2009 ◽  
Vol 21 (3) ◽  
pp. 233-234
Author(s):  
Devi Mahendran ◽  
Balachundhar Subramaniam ◽  
Allen Hamdan
Keyword(s):  
Surgical Patients ◽  
Perioperative Outcomes

scholarly journals Smoking and Perioperative Outcomes

2011 ◽  
Vol 114 (4) ◽  
pp. 837-846 ◽  
Author(s):  
Alparslan Turan ◽  
Edward J. Mascha ◽  
Dmitry Roberman ◽  
Patricia L. Turner ◽  
Jing You ◽  
...  
Keyword(s):  
Perioperative Risk ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Inclusion Criteria ◽  
Improvement Program ◽  
Surgical Quality ◽  
Individual Outcomes ◽  
American College Of Surgeons ◽  
Never Smokers ◽  
Never Smoker

Background Patients are often concerned about the effects of smoking on perioperative risk. However, effective advice may be limited by the paucity of information about smoking and perioperative risk. Thus, our goal was to determine the effect of smoking on 30-day postoperative outcomes in noncardiac surgical patients. Methods We evaluated 635,265 patients from the American College of Surgeons National Surgical Quality Improvement Program database; 520,242 patients met our inclusion criteria. Of these patients, 103,795 were current smokers; 82,304 of the current smokers were propensity matched with 82,304 never-smoker controls. Matched current smokers and never-smokers were compared on major and minor composite morbidity outcomes and respective individual outcomes. Results Current smokers were 1.38 (95% CI, 1.11-1.72) times more likely to die than never smokers. Current smokers also had significantly greater odds of pneumonia (odds ratio [OR], 2.09; 95% CI, 1.80-2.43), unplanned intubation (OR, 1.87; 95% CI, 1.58-2.21), and mechanical ventilation (OR, 1.53; 95% CI, 1.31-1.79). Current smokers were significantly more likely to experience a cardiac arrest (OR, 1.57; 95% CI, 1.10-2.25), myocardial infarction (OR, 1.80; 95% CI, 1.11-2.92), and stroke (OR, 1.73; 95% CI, 1.18-2.53). Current smokers also had significantly higher odds of having superficial (OR, 1.30; 95% CI, 1.20-1.42) and deep (OR, 1.42; 95% CI, 1.21-1.68) incisional infections, sepsis (OR, 1.30; 95% CI, 1.15-1.46), organ space infections (OR, 1.38; 95% CI, 1.20-1.60), and septic shock (OR, 1.55; 95% CI, 1.29-1.87). Conclusion Our analysis indicates that smoking is associated with a higher likelihood of 30-day mortality and serious postoperative complications. Quantification of increased likelihood of 30-day mortality and a broad range of serious smoking-related complications may enhance the clinician's ability to motivate smoking cessation in surgical patients.

scholarly journals Implications of congenital heart disease on growth and development of paediatric cardiac surgical patients

2021 ◽  
Author(s):  
Mohammad Abdallah Khasawneh ◽  
Ashraf Fadel Mohammad ◽  
Safwan G. Al-Fawares ◽  
Odai Almomani ◽  
Fadi Al-Husban
Keyword(s):  
Cardiac Surgery ◽  
Nutritional Status ◽  
World Health ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Average Weight ◽  
Z Score ◽  
Patients Âgés ◽  
Icu Stay ◽  
Paediatric Patients

Background: To identify the prevalence, predictors and implications of malnutrition and failure to thrive (FTT) in paediatric cardiac surgical patients.Methods: Observational retrospective analysis of data of paediatric patients presenting for cardiac surgery at Queen Alia heart institute/Amman/Jordan between April 2020 and October 2020. Patients' ages, anthropometric measurements, diagnoses, type of surgical intervention, ICU stay and perioperative outcomes were recorded on a special form designed for the purpose of this study. Prevalence of malnutrition based on world health organization (WHO) and centers for disease control (CDC) growth charts was determined using height-for-age z-score (HAZ) and percentile, weight-for-age z-score (WAZ) and percentile, weight-for-height z-score (WHZ) and percentile. BMI was used for patients above 2 years of age in 109 paediatric cardiac surgical patients. Prevalence of malnutrition and FTT was examined according to age category and cardiac pathology). Patients were divided according to heart pathology into cyanotic and acyanotic CHD.Results: One hundred and nine pediatric cardiac surgical patients were presented for cardiac surgery (59 males and 50 females). Patients' age ranged from 2 days to 17 years (mean 3.7 years, SD±4.5 years). Patients' body weight ranged from 2.7 to 70 kg (mean 14.98 kg, SD±14.2 kg). Average weight percentile was 19.26 (SD±20.01) and ranged between 0.1 and 88.5 and the average Z-score for weight was -1.274±1.037 (mean±SD). The overall height percentile for the all patients with CHD averaged 18.53±17.1 (mean±SD) and the average Z-score for height was -1.1029±0.743 (mean±SD). Prevalence of isolated malnutrition and FTT was 33.2% and 20.2%. Normal nutritional status was found in 46.78%. Cyanotic type CHD was more commonly associated with FTT (p=0.001), longer cardiopulmonary bypass (p=0.001), higher intraoperative lactate (p=0.012) and aortic cross clamp times (p=0.001). Patients with malnutrition and FTT had average ICU stay of 4.32±2.219 days and averaged 4.772±2.065 days (mean±SD) respectively, which was almost double of the ICU stay of patients who had normal nutritional status 2.32±2.261 days (mean±SD).Conclusions: Prevalence of malnutrition and FTT is high in paediatric patients with CHD at time of presentation for surgery. Predicting factors for malnutrition and FTT are cyanotic type of CHD and smaller age. Malnutrition was associated with longer ICU stay.

scholarly journals Analysis of worldwide surgical outcomes in COVID-19-infected patients: a gynecological oncology perspective

2020 ◽  
Vol 6 (10) ◽  
pp. FS0629
Author(s):  
David L Phelps ◽  
Srdjan Saso ◽  
Sadaf Ghaem-Maghami
Keyword(s):  
Evidence Base ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Surgical Specialty ◽  
Surgical Decision ◽  
Gynecological Oncology ◽  
Urgent Surgery ◽  
The United Kingdom ◽  
Individualized Approach ◽  
Surgical Decision Making

Coronavirus Disease 2019 (COVID-19) guidance limits all but the most urgent surgery in the United Kingdom. We review the literature and our experience in gynecology to assess perioperative outcomes. PubMed was searched with (surg*[Title])AND(COVID[Title]), (surg*[Title])AND(2019-nCoV[Title]), and (surg*[Title])AND(SARS-CoV-2[Title]), and 67 COVID-19-positive surgical patients across ten hospitals in four countries are included. Median mortality was 33%. Cardiac and pulmonary co-morbidities associated with higher risk of COVID-19-positive postoperative death. Mortality was high in neurosurgery (80%) and the lowest in gynecological oncology surgery (none). This analysis provides an evidence base on which to consider surgical risk assessment for different specialties. Risk of perioperative death needs to be assessed in the context of patients’ co-morbidities and surgical specialty. An individualized approach toward surgical decision making is imperative.

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