scholarly journals TP10.1.13A model for safe elective liver resection during the SARS-CoV-2 (COVID-19) pandemic – lessons for enhanced recovery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Maki Jitsumura ◽  
Pulkit Sethi ◽  
Fenella KS Welsh ◽  
Kandiah Chandrakumaran ◽  
Myrddin Rees
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Enhanced Recovery ◽  
Day Surgery ◽  
Operative Care ◽  
Cancer Services ◽  
Improved Outcomes ◽  
Recovery Protocols ◽  
Free Environment ◽  
The Uk

Abstract Background The COVID-19 outbreak in January 2020 rapidly became a pandemic, adversely impacting elective cancer services in the UK. This study describes the pandemic-driven changes to existing admission and enhanced recovery protocols, which allowed the Unit to maintain a liver resection service, and evaluates their impact on patient safety. Methods During the pandemic, all patients undergoing liver resection in this Unit isolated for 14 days prior to their admission, with COVID-19 testing 48 hours pre-admission. Patients were admitted on the day of surgery to the day surgery unit, a designated COVID-free environment. They underwent liver surgery, recovery and post-operative care, all within the day surgery unit. Using a prospectively collected database, short-term outcomes of consecutive patients undergoing elective hepatectomy during the COVID-19 pandemic (April - June 2020) were retrospectively compared to patients during the same period in 2019. Results During the pandemic, 24 patients underwent hepatectomy compared to 34 patients in 2019. There was no statistical difference in demographics, indications for surgery, intra-operative parameters or complications between these periods. The median post-operative length of stay (LOS) was significantly shorter during the pandemic [3 (IQR: 3-4) days vs. 4 (IQR; 4-7) days, p = 0.015], as was the overall LOS [4 (IQR: 4-6) days vs. 6 (IQR; 5-9) days, p = 0.006]. No patient contracted COVID-19 per-operatively. Conclusions Patient pathway changes during a pandemic enabled safe liver surgery to be undertaken with improved outcomes – a model that is transferrable to other Units.

Paediatric Anaesthesia

2019 ◽  
Keyword(s):  
Preoperative Assessment ◽  
Anaesthetic Management ◽  
Day Surgery ◽  
Paediatric Anaesthesia ◽  
Referral Centre ◽  
Tertiary Referral Centre ◽  
Accessible Information ◽  
Operative Care ◽  
Medical Emergencies ◽  
The Uk

Paediatric Anaesthesia is a comprehensive yet concise text covering everything from day surgery to complicated tertiary referral centre procedures. It provides concise and readily accessible information to trainee and expert alike. The book begins with the basic sciences and founding principles of anaesthetic management; containing simple tips on how to approach the perioperative care of children. Thereafter, each specialty is covered in a logical manner from preoperative assessment to post-operative care. Finally, the book covers paediatric medical emergencies, resuscitation and transfer of the child. This second edition has been uniformly updated and written by leading authorities from across the UK.

Spinal versus general anesthesia for outpatient joint arthroplasty: can the evidence keep up with the patients?

2020 ◽  
Vol 45 (11) ◽  
pp. 934-936
Author(s):  
Eric S Schwenk ◽  
Rebecca L Johnson
Keyword(s):  
General Anesthesia ◽  
Enhanced Recovery ◽  
Hospital Costs ◽  
Early Discharge ◽  
Multimodal Analgesia ◽  
Joint Arthroplasty ◽  
Institutional Pressures ◽  
Local Infiltration Analgesia ◽  
Improved Outcomes ◽  
Recovery Protocols

Total joint arthroplasty (TJA) is transitioning to be an outpatient rather than an inpatient procedure under national and institutional pressures to increase volumes while reducing hospital costs and length of stay. Innovative surgical and anesthesia techniques have allowed for earlier ambulation and physical therapy participation, maximizing the chance that an appropriately selected patient may be discharged within a day of surgery. The choice of anesthesia type is a modifiable factor that has a major impact on both surgical outcomes and discharge readiness. Recent large database studies have provided evidence for improved outcomes, including decreased mortality, with the use of spinal anesthesia. However, few randomized, controlled trials exist and database studies have limitations. Modern general anesthesia techniques, including total intravenous anesthesia and infusions targeted to anesthetic depth, may make some of these differences insignificant, especially when newer regional anesthesia and local infiltration analgesia techniques are incorporated into TJA enhanced recovery protocols. Multimodal analgesia for all TJA patients may also help minimize differences in pain. Perhaps even more important than anesthesia technique is the proper selection of patients likely to meet the necessary milestones for early discharge. In this article, we provide two contrasting viewpoints on the optimal primary anesthetic for outpatient TJA.

Elderly Patients Benefit From Enhanced Recovery Protocols After Colorectal Surgery

2021 ◽  
Vol 266 ◽  
pp. 54-61
Author(s):  
Jessica Y Liu ◽  
Sebastian D Perez ◽  
Glen G Balch ◽  
Patrick S Sullivan ◽  
Jahnavi K Srinivasan ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Enhanced Recovery ◽  
Recovery Protocols

Approaches to common conditions of the gastrointestinal tract in pet hamsters

2021 ◽  
Vol 26 (3) ◽  
pp. 20-26
Author(s):  
Vicki Baldrey
Keyword(s):  
Nutritional Support ◽  
Gastrointestinal Disease ◽  
Parasitic Infection ◽  
Positive Contrast ◽  
Abdominal Ultrasound ◽  
Gastrointestinal Diseases ◽  
Indications For Surgery ◽  
Pet Trade ◽  
Free Environment ◽  
The Uk

Hamsters are popular pets in the UK. The Syrian or Golden hamster (Mesocricetus auratus) is the best known species in the pet trade, with a variety of dwarf species also encountered. Gastrointestinal disease occurs frequently, and diarrhoea is a common presenting complaint. This is most often associated with bacterial or parasitic infection, but can also be related to neoplasia or the use of certain antibiotics. Initial stabilisation of the hamster with diarrhoea should include provision of a warm stress-free environment, fluid therapy, nutritional support with an appropriate critical care diet and analgesia. Following a full history and clinical examination, further diagnostic steps include faecal parasitology and microbiology, routine biochemistry and haematology, radiography with or without positive contrast, and abdominal ultrasound. Indications for surgery include evidence of intestinal obstruction or prolapsed intussusception. This article gives an overview of the most common gastrointestinal diseases encountered in hamster species and provides a guide of how to logically approach the investigation and treatment of these cases, achievable in general practice.

scholarly journals Biological impact of an enhanced recovery after surgery programme in liver surgery

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
S Gonvers ◽  
J Jurt ◽  
G -R Joliat ◽  
N Halkic ◽  
E Melloul ◽  
...  
Keyword(s):  
Liver Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Multivariable Analysis ◽  
Albumin Concentration ◽  
Biological Impact ◽  
Reactive Protein ◽  
Before And After ◽  
Major Resection

Abstract Background The clinical and economic impacts of enhanced recovery after surgery (ERAS) programmes have been demonstrated extensively. Whether ERAS protocols also have a biological effect remains unclear. This study aimed to investigate the biological impact of an ERAS programme in patients undergoing liver surgery. Methods A retrospective analysis of patients undergoing liver surgery (2010–2018) was undertaken. Patients operated before and after ERAS implementation in 2013 were compared. Surrogate markers of surgical stress were monitored: white blood cell count (WBC), C-reactive protein (CRP) level, albumin concentration, and haematocrit. Their perioperative fluctuations were defined as Δvalues, calculated on postoperative day (POD) 0 for Δalbumin and Δhaematocrit and POD 2 for ΔWBC and ΔCRP. Results A total of 541 patients were included, with 223 and 318 patients in non-ERAS and ERAS groups respectively. Groups were comparable, except for higher rates of laparoscopy (24.8 versus 11.2 per cent; P < 0.001) and major resection (47.5 versus 38.1 per cent; P = 0.035) in the ERAS group. Patients in the ERAS group showed attenuated ΔWBC (2.00 versus 2.75 g/l; P = 0.013), ΔCRP (60 versus 101 mg/l; P <0.001) and Δalbumin (12 versus 16 g/l; P < 0.001) compared with those in the no-ERAS group. Subgroup analysis of open resection showed similar results. Multivariable analysis identified ERAS as the only independent factor associated with high ΔWBC (odds ratio (OR) 0.65, 95 per cent c.i. 0.43 to 0.98; P = 0.038), ΔCRP (OR 0.41, 0.23 to 0.73; P = 0.003) and Δalbumin (OR 0.40, 95 per cent c.i. 0.22 to 0.72; P = 0.002). Conclusion Compared with conventional management, implementation of ERAS was associated with an attenuated stress response in patients undergoing liver surgery.

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

Sign in / Sign up

Export Citation Format

Share Document