scholarly journals Surgical Apgar score is strongly associated with postoperative ICU admission

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying-Chun Lin ◽  
Yi-Chun Chen ◽  
Chen-Hsien Yang ◽  
Nuan-Yen Su
Keyword(s):  
High Risk ◽  
Apgar Score ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Icu Admission ◽  
Postoperative Intensive Care ◽  
Icu Transfer ◽  
American Society ◽  
Postoperative Intensive Care Unit ◽  
Surgical Apgar Score

AbstractImmediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0–10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7–10 and 0–4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0–2, 3–4, and 5–6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.

scholarly journals Continuing Our Work: Transplant Surgery And Surgical Oncology In A Tertiary Referral COVID-19 Center

2020 ◽  
Author(s):  
Giammauro Berardi ◽  
Marco Colasanti ◽  
Giovanni Battista Levi Sandri ◽  
Celeste Del Basso ◽  
Stefano Ferretti ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Index ◽  
Surgical Oncology ◽  
Cardiac Risk ◽  
Tertiary Referral ◽  
Icu Admission ◽  
Asa Score ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit ◽  
Major Hepatectomies

Abstract Background. COVID-19 is rapidly spreading worldwide. Healthcare systems are struggling to properly allocate resources while ensuring cure for diseases outside of the infection. The aim of this study was to demonstrate how surgical activity was affected by the virus outbreak and show the changes in practice in a tertiary referral COVID-19 center.Methods. The official bulletins of the Italian National Institute for the Infectious Diseases “L. Spallanzani” were reviewed to retrieve the number of daily COVID-19 patients. Records of consecutive oncological and transplant procedures performed during the outbreak were reviewed. Patients with a high probability of postoperative intensive care unit (ICU) admission were considered as high-risk and defined by an ASA score ≥ III and/or a Charlson Comorbidity Index (CCI) ≥ 6 and/or a Revised Cardiac Risk Index for Preoperative Risk (RCRI) ≥ 3.Results. 72 patients were operated including 12 (16.6%) liver (n=6) and kidney (n=6) transplantations. Patients had few comorbidities (26.3%), low ASA score (1.9±0.5), CCI (3.7±1.3) and RCRI (1.2±0.6) and had low risk of postoperative ICU admission. Few patients had liver cirrhosis (12.5%) or received preoperative systemic therapy (16.6%). 36 (50%) high risk surgical procedures were performed including major hepatectomies, pancreaticoduodenectomies, total gastrectomies, multivisceral resections and transplantations. Despite this, only 15 patients (20.8%) were admitted to the ICU.Conclusions. Only oncologic cases and transplantations were performed during the COVID-19 outbreak. Careful selection of patients allowed to perform major cancer surgeries and transplantations without further stressing hospital resources, meanwhile minimizing collateral damage to patients.

scholarly journals A user guide to the American Society of Hematology clinical practice guidelines

2020 ◽  
Vol 4 (9) ◽  
pp. 2095-2110
Author(s):  
Ariel Izcovich ◽  
Adam Cuker ◽  
Robert Kunkle ◽  
Ignacio Neumann ◽  
Julie Panepinto ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Immune Thrombocytopenia ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cell Disease ◽  
Presentation Formats ◽  
American Society ◽  
The Many

Abstract Since November 2018, Blood Advances has published American Society of Hematology (ASH) clinical practice guidelines on venous thromboembolism, immune thrombocytopenia, and sickle cell disease. More ASH guidelines on these and other topics are forthcoming. These guidelines have been developed using consistent processes, methods, terminology, and presentation formats. In this article, we describe how patients, clinicians, policymakers, researchers, and others may use ASH guidelines and the many related derivates by describing how to interpret information and how to apply it to clinical decision-making. Also, by exploring how these documents are developed, we aim to clarify their limitations and possible inappropriate usage.

scholarly journals How to make good-enough risk decisions

2009 ◽  
Vol 15 (3) ◽  
pp. 192-198 ◽  
Author(s):  
Andrew Carroll
Keyword(s):  
Social Psychology ◽  
Decision Making ◽  
High Risk ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Managing Risk

SummaryMaking decisions in the context of risk is an integral part of psychiatric work. Despite this, decision-making skills are rarely systematically taught and the processes behind decisions are rarely made explicit. This article attempts to apply contemporary evidence from cognitive and social psychology to common dilemmas faced by psychiatrists when assessing and managing risk. It argues that clinical decision-making should acknowledge both the value and limitations of intuitive approaches in dealing with complex dilemmas. After discussing the various ways in which clinical decision-making is commonly derailed, the article outlines a framework that accommodates both rational and intuitive modes of thinking, with the aim of optimising decision-making in high-risk situations.

scholarly journals Comparing Machine Learning Algorithms for Predicting ICU Admission and Mortality in COVID-19

2020 ◽  
Author(s):  
Sonu Subudhi ◽  
Ashish Verma ◽  
Ankit B. Patel ◽  
C. Corey Hardin ◽  
Melin J. Khandekar ◽  
...  
Keyword(s):  
Machine Learning ◽  
Clinical Decision Making ◽  
Learning Algorithms ◽  
Disease Outbreaks ◽  
Clinical Decision ◽  
Machine Learning Algorithms ◽  
Healthcare Database ◽  
Icu Admission ◽  
Infectious Disease Outbreaks ◽  
Better Than

AbstractAs predicting the trajectory of COVID-19 disease is challenging, machine learning models could assist physicians determine high-risk individuals. This study compares the performance of 18 machine learning algorithms for predicting ICU admission and mortality among COVID-19 patients. Using COVID-19 patient data from the Mass General Brigham (MGB) healthcare database, we developed and internally validated models using patients presenting to Emergency Department (ED) between March-April 2020 (n = 1144) and externally validated them using those individuals who encountered ED between May-August 2020 (n = 334). We show that ensemble-based models perform better than other model types at predicting both 5-day ICU admission and 28-day mortality from COVID-19. CRP, LDH, and procalcitonin levels were important for ICU admission models whereas eGFR <60 ml/min/1.73m2, ventilator use, and potassium levels were the most important variables for predicting mortality. Implementing such models would help in clinical decision-making for future COVID-19 and other infectious disease outbreaks.

scholarly journals CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITION, METABOLIC, AND NONSURGICAL SUPPORT OF PATIENTS UNDERGOING BARIATRIC PROCEDURES – 2019 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY, THE OBESITY SOCIETY, AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY, OBESITY MEDICINE ASSOCIATION, AND AMERICAN SOCIETY OF ANESTHESIOLOGISTS

2019 ◽  
Vol 25 (Supplement 2) ◽  
pp. 1-75 ◽  
Author(s):  
Jeffrey I. Mechanick ◽  
Caroline Apovian ◽  
Stacy Brethauer ◽  
W. Timothy Garvey ◽  
Aaron M. Joffe ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Clinical Practice ◽  
Chronic Disease ◽  
Clinical Decision Making ◽  
American Association ◽  
Enhanced Recovery ◽  
Clinical Decision ◽  
American Society ◽  
American Society Of Anesthesiologists

Objective: The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results: New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusion: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues. Abbreviations: A1C = hemoglobin A1c; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; ACE = American College of Endocrinology; ADA = American Diabetes Association; AHI = Apnea-Hypopnea Index; ASA = American Society of Anesthesiologists; ASMBS = American Society of Metabolic and Bariatric Surgery; BMI = body mass index; BPD = biliopancreatic diversion; BPD/DS = biliopancreatic diversion with duodenal switch; CI = confidence interval; CPAP = continuous positive airway pressure; CPG = clinical practice guideline; CRP = C-reactive protein; CT = computed tomography; CVD = cardiovascular disease; DBCD = dysglycemia-based chronic disease; DS = duodenal switch; DVT = deep venous thrombosis; DXA = dual-energy X-ray absorptiometry; EFA = essential fatty acid; EL = evidence level; EN = enteral nutrition; ERABS = enhanced recovery after bariatric surgery; FDA = U.S. Food and Drug Administration; G4GAC = Guidelines for Guidelines, Algorithms, and Checklists GERD = gastroesophageal reflux disease; GI = gastrointestinal; HCP = health-care professional(s); HTN = hypertension; ICU = intensive care unit; IGB = intragastric balloon(s); IV = intravenous; LAGB = laparoscopic adjustable gastric band; LAGBP = laparoscopic adjustable gastric banded plication; LGP = laparoscopic greater curvature (gastric) plication; LRYGB = laparoscopic Roux-en-Y gastric bypass; LSG = laparoscopic sleeve gastrectomy; MetS = metabolic syndrome; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis; OAGB = one-anastomosis gastric bypass; OMA = Obesity Medicine Association; OR = odds ratio; ORC = obesity-related complication(s); OSA = obstructive sleep apnea; PE = pulmonary embolism; PN = parenteral nutrition; PRM = pulmonary recruitment maneuver; RCT = randomized controlled trial; RD = registered dietician; RDA = recommended daily allowance; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; SIBO = small intestinal bacterial overgrowth; TOS = The Obesity Society; TSH = thyroid-stimulating hormone; T1D = type 1 diabetes; T2D = type 2 diabetes; VTE = venous thromboembolism; WE = Wernicke encephalopathy; WHO = World Health Organization

Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

2011 ◽  
Vol 115 (6) ◽  
pp. 1236-1241 ◽  
Author(s):  
John Q. H. Bui ◽  
Rajith L. Mendis ◽  
James M. van Gelder ◽  
Mark M. P. Sheridan ◽  
Kylie M. Wright ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Loss ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Safe Alternative ◽  
Emergency Team ◽  
Icu Admission ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit

Object Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative. Methods Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed. Indications for craniotomy included tumor (257 patients) and transsphenoidal (63 patients), vascular (31 patients), ventriculostomy (22 patients), developmental (13 patients), and base of skull conditions (8 patients). Recorded data included age, operation, reason for ICU admission, medical emergency team (MET) calls, in-hospital mortality, and postoperative duration of stay. Results Three hundred forty-three patients were admitted to the regular ward after elective craniotomy, whereas there were 43 planned and 8 unplanned ICU admissions. The most common reasons for planned ICU admissions were anticipated lengthy operations (42%) and anesthetic risks (40%); causes for unplanned ICU admissions were mainly unexpected slow neurological recovery and extensive intraoperative blood loss. Of the 343 regular ward admissions, 10 (3%) required a MET call; only 3 of these MET calls occurred within the first 48 postoperative hours and did not lead to an ICU admission. The overall mortality rate in the investigated cohort was 1%, with no fatalities in patients admitted to the normal ward postoperatively. Conclusions Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.

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