Perioperative care standards in cardiac surgical patients aiming at enhancing recovery: A nationwide survey in the Netherlands and Belgium

Abstract Approximately 80 million inpatient and outpatient surgeries are performed annually in the United States. Widely variable and fragmented perioperative care exposes these surgical patients to lapses in expected standard of care, increases the chance for operational mistakes and accidents, results in unnecessary and potentially detrimental care, needlessly drives up costs, and adversely affects the patient healthcare experience. The American Society of Anesthesiologists and other stakeholders have proposed a more comprehensive model of perioperative care, the Perioperative Surgical Home (PSH), to improve current care of surgical patients and to meet the future demands of increased volume, quality standards, and patient-centered care. To justify implementation of this new healthcare delivery model to surgical colleagues, administrators, and patients and maintain the integrity of evidenced-based practice, the nascent PSH model must be rigorously evaluated. This special article proposes comparative effectiveness research aims or objectives and an optimal study design for the novel PSH model.

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A nationwide survey concerning practices in pessary use for pelvic organ prolapse in The Netherlands: identifying needs for further research

International Urogynecology Journal ◽

10.1007/s00192-015-2697-6 ◽

2015 ◽

Vol 26 (10) ◽

pp. 1453-1458 ◽

Cited By ~ 8

Author(s):

Joost Velzel ◽

Jan Paul Roovers ◽

C H Van der Vaart ◽

Bart Broekman ◽

Astrid Vollebregt ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

The Netherlands ◽

Nationwide Survey ◽

Pelvic Organ

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Abstract TP429: Association Between Perioperative Management and Outcome in Aged SAH Patients

Stroke ◽

10.1161/str.48.suppl_1.tp429 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Keisuke Ido ◽

Akiko Kada ◽

Kunihiro Nishimura ◽

Satoru Kamitani ◽

Kuniaki Ogasawara ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Perioperative Care ◽

Nationwide Survey ◽

Study Data ◽

Aged Patients ◽

Diagnosis Procedure Combination ◽

Aged Group ◽

Poor Outcome ◽

Improved Outcomes ◽

The Relationship

Background and purpose: The outcomes of subarachnoid hemorrhage (SAH) in aged patients are more severe than those in non-aged patients. There are few reports about the relationship between the age and the effect of perioperative care for SAH patients. We performed a nationwide survey in Japan to determine the relationship between perioperative care and SAH outcomes in aged and non-aged patients. Methods: We analyzed 17,343 subarachnoid hemorrhage (SAH) patients treated with clipping or coiling in 579 hospitals who participated in the J-ASPECT study. Data between 2010 and 2013 were obtained from the Japanese Diagnosis Procedure Combination Database. We stratified patients into two groups according to their age (aged group >75 y.o., n=3885; non-aged group < 75 y.o., n=13,458) and analyzed the association between perioperative care and poor outcome (modified Rankin Scale score 3-6 at the time of discharge). With respect to perioperative care, we evaluated time from onset to surgery (days), treatment (clipping or coiling), and drugs delivered after surgery (fasudil hydrochloride, ozagrel sodium, cilostazol, statin, EPA, edaravone). Results: In the non-aged group, coiling (OR=0.84; P<0.01) and treatment with fasudil hydrochloride (OR=0.59; P<0.01), statin (OR=0.83; P<0.01), and EPA (OR=0.83; P<0.01) significantly improved the outcomes and cilostazol treatment tended to improve the outcomes (OR=0.91; P=0.07). In both groups, edaravone treatment was associated with poor outcome (aged group: OR=2.34, P<0.01; non-aged group: OR=2.33, P<0.01). Although no factor that could improve outcome in the aged group was identified, JCS scores less than 30, coiling (OR=0.80; P=0.03), and EPA treatment (OR=0.74; P=0.02) were statistically significant prognosis improvement factors. Conclusion: Coiling and treatment with fasudil hydrochloride, statins, and EPA improved outcomes of non-aged patients. Although perioperative care did not improve the outcome of aged SAH patients, in cases of relatively mild SAH, perioperative care had the potential to improve the outcome.

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