Impact of caregiver overnight stay on postoperative outcomes

Purpose The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. Design/methodology/approach This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates. Findings Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified. Originality/value This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.

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Appointment standardization evaluation in a primary care facility

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-01-2016-0004 ◽

2016 ◽

Vol 29 (6) ◽

pp. 675-686 ◽

Cited By ~ 4

Author(s):

Yu-Li Huang

Keyword(s):

Primary Care ◽

Access To Care ◽

Wait Time ◽

Idle Time ◽

Urgent Care ◽

Content Type ◽

Finish Time ◽

Number Of Patients ◽

Patient Wait Time ◽

The Impact

Purpose – The purpose of this paper is to evaluate the performance on standardizing appointment slot length in a primary care clinic to understand the impact of providers’ preferences and practice differences. Design/methodology/approach – The treatment time data were collected for each provider. There were six patient types: emergency/urgent care (ER/UC), follow-up patient (FU), new patient, office visit (OV), physical exam, and well-child care. Simulation model was developed to capture patient flow and measure patient wait time, provider idle time, cost, overtime, finish time, and the number of patients scheduled. Four scheduling scenarios were compared: scheduled all patients at 20 minutes; scheduled ER/UC, FU, OV at 20 minutes and others at 40 minutes; scheduled patient types on individual provider preference; and scheduled patient types on combined provider preference. Findings – Standardized scheduling among providers increase cost by 57 per cent, patient wait time by 83 per cent, provider idle time by five minutes per patient, overtime by 22 minutes, finish time by 30 minutes, and decrease patient access to care by approximately 11 per cent. An individualized scheduling approach could save as much as 14 per cent on cost and schedule 1.5 more patients. The combined preference method could save about 8 per cent while the number of patients scheduled remained the same. Research limitations/implications – The challenge is to actually disseminate the findings to medical providers and adjust scheduling systems accordingly. Originality/value – This paper concluded standardization of providers’ clinic preference and practice negatively impact clinic service quality and access to care.

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The Impact of Preoperative Warming of Ambulatory Surgery Patients on the Prevention of Postoperative Hyposthermia

10.28971/532010cm122 ◽

2010 ◽

Author(s):

Mary Croft

Keyword(s):

Ambulatory Surgery ◽

Intervention Group ◽

Surgical Patients ◽

Ambulatory Setting ◽

Control Group ◽

Anesthesia Induction ◽

Convenience Sample ◽

Forced Air Warming ◽

Number Of Patients ◽

The Impact

Postoperative hypothermia is a continuing problem in surgical patients. Preoperative warming has been shown to benefit patients undergoing major surgical procedures but studies are lacking in patients in the ambulatory setting. Objective: The purpose of this study was to explore the effect of warming ambulatory surgical patients preoperatively prior to anesthesia induction and surgery on maintenance of core body temperature, prevention of hypothermia in PACU, and patient comfort. Method: A convenience sample of96 adult patients undergoing ambulatory surgery was provided standard care (cotton bath blankets) (n=4 7) or pre-warming (Bair Paws®Flex warming gown) (n =49). All patients received forced air warming intraoperatively. Results: The mean pre-warming time was 58.6 minutes. The intervention group mean temperatures were significantly improved (intervention mean 97.304 pre vs. 98.044 post; p = 0.002 vs. control mean 97.54 pre vs. 97.87 post; p = 0.063) upon discharge from the preoperative holding area and prior to transport to the OR surgical suite. There was a 0.13 degree F increase in mean core temperature to PACU in the pre-warmed group as compared to control (intervention means 97.66 vs. control mean 97.53; 95% CI). The control group had a mean temperature decrease of 0.01 F from preop temperature to PACU while the intervention groups' mean temperatures increased by 0.19° F. Seven patients in the control group arrived to PACU complaining of cold and one shivering, compared to one patient in the intervention group. Conclusions: Preoperative warming utilizing the Bair Paws® flex warming gowns increased patients' core temperatures on arrival to PACU and lessened the number of patients arriving to PACU complaining of cold.

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Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence

Journal of Clinical Medicine ◽

10.3390/jcm10102121 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2121

Author(s):

Gerardo-Alfonso Márquez-Sánchez ◽

Bárbara-Yolanda Padilla-Fernández ◽

Miguel Perán-Teruel ◽

Pedro Navalón-Verdejo ◽

Sebastián Valverde-Martínez ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Surgical Techniques ◽

High Survival ◽

Complication Rates ◽

Exact Test ◽

Number Of Patients ◽

Male Stress Urinary Incontinence ◽

Group B

Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

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The Role of Visceral Obesity, Sarcopenia and Sarcopenic Obesity on Surgical Outcomes After Liver Resections for Colorectal Metastases

World Journal of Surgery ◽

10.1007/s00268-021-06073-9 ◽

2021 ◽

Author(s):

M. Runkel ◽

T. D. Diallo ◽

S. A. Lang ◽

F. Bamberg ◽

M. Benndorf ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Visceral Obesity ◽

The Body ◽

Postoperative Outcomes ◽

Sarcopenic Obesity ◽

Colorectal Metastases ◽

Complication Rates ◽

The Impact ◽

Body Compositions

Abstract Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

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Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

Anesthesiology Research and Practice ◽

10.1155/2018/5710641 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Sivesh K. Kamarajah ◽

Behrad Barmayehvar ◽

Mustafa Sowida ◽

Amirul Adlan ◽

Christina Reihill ◽

...

Keyword(s):

Risk Stratification ◽

Glomerular Filtration ◽

Elective Surgery ◽

Gastrointestinal Surgery ◽

Major Complication ◽

Postoperative Outcomes ◽

Queen Elizabeth Hospital ◽

Complication Rates ◽

Significant Difference ◽

The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

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BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

Journal of Clinical Medicine ◽

10.3390/jcm10235665 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5665

Author(s):

Helena Sophie Leitner ◽

Reinhard Pauzenberger ◽

Ines Ana Ederer ◽

Christine Radtke ◽

Stefan Hacker

Keyword(s):

Postoperative Complications ◽

Breast Reconstruction ◽

Positive Impact ◽

Surgical Techniques ◽

Study Cohort ◽

Complication Rates ◽

Impaired Wound Healing ◽

Reconstruction Methods ◽

Study Results ◽

The Impact

Background: Breast reconstruction has a positive impact on body image and quality of life for women after experiencing the physically and psychologically demanding process of mastectomy. Previous studies have presented body mass index (BMI) as a predictor for postoperative complications after breast reconstruction, however, study results vary. This retrospective study aimed to investigate the impact of patients’ BMI on postoperative complications following implant-based breast reconstruction. Methods: All implant-based breast reconstructions performed at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna from January 2001 to March 2018 were evaluated. A total of 196 reconstructed breasts among 134 patients met eligibility criteria. Demographic data, surgical techniques, as well as major and minor complications within a one-year follow-up period were analyzed. Results: Patients’ BMI did not show a significant impact on complication rates. The overall incidence of postoperative complications was 30.5% (40/131) of which 17.6% required reoperation. Impaired wound healing (18.3%), seroma (6.1%), hematoma (4.6%), capsular contraction (4.6%) and infection (3.8%) were the most common complications. Conclusion: In our study cohort, BMI was not associated with a significantly higher risk of complications. However, postoperative complications significantly increased with a longer operative time and resulted in an extended length of hospital stay.

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756. Impact of Infectious Diseases Pharmacists as Part of an Interdisciplinary OPAT Team Managing Vancomycin

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.824 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S337-S338

Author(s):

Meagan L Adamsick ◽

Ronak G Gandhi ◽

Samantha N Steiger ◽

Monique R Bidell ◽

Sandra B Nelson ◽

...

Keyword(s):

Infectious Diseases ◽

Adverse Drug Events ◽

Massachusetts General Hospital ◽

Intervention Group ◽

Ambulatory Setting ◽

Patient Specific ◽

Control Group ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Number Of Patients ◽

The Impact

Abstract Background Outpatient Parenteral Antimicrobial Therapy (OPAT) is a growing area of Infectious Diseases (ID) that allows for the treatment of severe infections in the ambulatory setting. Massachusetts General Hospital (MGH) incorporated inpatient ID pharmacists into the OPAT team in June 2017 to assist with vancomycin monitoring and dosing. Laboratory results were received and documented by the OPAT nurse and forwarded to the pharmacists for assessment via the electronic medical record (EMR). Pharmacists then sent clinical recommendations to the physician. This study aimed to determine the impact of pharmacists’ involvement in OPAT vancomycin management. Methods An EMR-generated report identified patients in the OPAT program from June 2016 through May 2017 as the control group and June 2017 through May 2018 as the intervention group. One hundred patients were randomly selected during each period. Patients were excluded from the intervention group if no pharmacist documentation was present. The primary outcome was to evaluate the proportion of vancomycin levels within the patient-specific goal range and secondary outcomes included the proportion of (1) pharmacists’ recommendations accepted by the ID physician and (2) patients who experienced adverse drug events. Results A total of 200 patients were evaluated. The most common indication for enrollment was osteomyelitis (46%). No differences in baseline characteristics were noted, and the median age was 67 years. The percentage of vancomycin levels within goal was significantly higher in the pharmacist-managed group compared with the control group (66.8% vs. 54.2%; P < 0.0001). The number of patients who experienced adverse drug events was similar between the two groups (39% vs. 43%; P = 0.66); however, fewer patients in the pharmacist group experienced acute kidney injury (5% vs. 13%; P = 0.08). Finally, 100% of pharmacist recommendations were accepted by ID physicians. Conclusion Leveraging inpatient ID pharmacists at MGH in the management of OPAT vancomycin provided improved percentage of vancomycin in therapeutic range and high acceptance rate of interventions. Further evaluation is necessary to assess the inpatient ID pharmacists’ workflow for implementation into other OPAT programs. Disclosures All authors: No reported disclosures.

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Influence of Obesity on Surgical Regional Anesthesia in the Ambulatory Setting: An Analysis of 9,038 Blocks

Anesthesiology ◽

10.1097/00000542-200501000-00027 ◽

2005 ◽

Vol 102 (1) ◽

pp. 181-187 ◽

Cited By ~ 104

Author(s):

Karen C. Nielsen ◽

Ulrich Guller ◽

Susan M. Steele ◽

Stephen M. Klein ◽

Roy A. Greengrass ◽

...

Keyword(s):

Postoperative Pain ◽

Regional Anesthesia ◽

The United States ◽

Ambulatory Setting ◽

Efficacy Rate ◽

Complication Rates ◽

Obese Patients ◽

Acute Complications ◽

Pain At Rest ◽

The Impact

Background Regional anesthesia is increasing in popularity for ambulatory surgical procedures. Concomitantly, the prevalence of obesity in the United States population is increasing. The objective of the present investigation was to assess the impact of body mass index (BMI) on patient outcomes after ambulatory regional anesthesia. Methods This study was based on prospectively collected data including 9,038 blocks performed on 6,920 patients in a single ambulatory surgery center. Patients were categorized into three groups according to their BMI (<25 kg/m2, 25-29 kg/m2, > or =30 kg/m2). Block efficacy, rate of acute complications, postoperative pain (at rest and with movement), postoperative nausea and vomiting, rate of unscheduled hospital admissions, and overall patient satisfaction were assessed. Linear and logistic multivariable analyses were used to obtain the risk-adjusted effect of BMI on these outcomes. Results Of all patients 34.8% had a BMI <25 kg/m2, 34.0% were overweight (BMI 25-29 kg/m2), and 31.3% were obese (BMI > or = 30 kg/m2). Patients with BMI > or =30 kg/m2 were 1.62 times more likely to have a failed block (P = 0.04). The unadjusted rate of acute complications was higher in obese patients (P = 0.001). However, when compared with patients with a normal BMI, postoperative pain at rest, unanticipated admissions, and overall satisfaction were similar in overweight and obese patients. Conclusions The present investigation shows that obesity is associated with higher block failure and complication rates in surgical regional anesthesia in the ambulatory setting. Nonetheless, the rate of successful blocks and overall satisfaction remained high in patients with increased BMI. Therefore, overweight and obese patients should not be excluded from regional anesthesia procedures in the ambulatory setting.

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Chemotherapy for malignant gliomas

Journal of Neurosurgery ◽

10.3171/jns.1988.68.1.0001 ◽

1988 ◽

Vol 68 (1) ◽

pp. 1-17 ◽

Cited By ~ 226

Author(s):

Paul L. Kornblith ◽

Michael Walker

Keyword(s):

Clinical Management ◽

Malignant Gliomas ◽

New Agents ◽

Specific Patient ◽

Content Type ◽

Number Of Patients ◽

New Findings ◽

The Impact ◽

The Brain ◽

Fine Print

✓ There continues to be an extensive effort to develop chemotherapeutic approaches to the treatment of malignant gliomas of the brain. In the past 5 years there have been literally hundreds of trials of new agents, combinations of old and new agents, and even new routes and approaches to the delivery of chemotherapy. In this review, the literature has been studied and the individual reports analyzed to evaluate the impact of the new findings on clinical management of the patient with malignant glioma of the brain. The major areas of progress include the addition of new drugs with varying modes of action, the use of combinations of drugs in a synergistic fashion, and the development of new routes of drug delivery. None of the advances has brought about the revolution in clinical care that is so eagerly sought, but clearly the amount of new knowledge gained by these studies helps in understanding how to use chemotherapy more effectively. Furthermore, the remarkable degree of interest and involvement in the use of chemotherapy promises that an even greater number of patients with malignant gliomas will be considered for vigorous and enthusiastic clinical management programs even if chemotherapy itself is not the key modality in the treatment of a specific patient.

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Standardized follow-up program may reduce emergency room and urgent care visits for patients undergoing radical prostatectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.1655 ◽

2014 ◽

Vol 8 (7-8) ◽

pp. 505 ◽

Cited By ~ 5

Author(s):

Ryan Kendrick Flannigan ◽

Geoffrey T. Gotto ◽

Bryan Donnelly ◽

Kevin V. Carlson

Keyword(s):

Radical Prostatectomy ◽

Urgent Care ◽

Additional Patient ◽

Readmission Rates ◽

Entire Cohort ◽

Number Of Patients ◽

Ed Visits ◽

Hospital Visits ◽

The Impact

Introduction: The objective of the current study was to determine the impact of a standardized follow-up program on the morbidity and rates of hospital visits following radical prostatectomy (RP) in a tertiary, non-teaching urologic centre.Methods: Patients who underwent a RP in 2008 were retrospectively evaluated in this study. Postoperative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine the reason for readmission.Results: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. Of the 321 patients, 77 (24.0%) visited an ED within 90 days, and 14 were readmitted to hospital, with an additional patient readmitted directly (with a total 15 readmissions, 4.7% overall). No patients died within the study period. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care by a dedicated nurse between May and November. We found that 90-day readmission rates among this cohort dropped to 5% and 2.6% for ED visits and hospital readmission, respectively.Conclusions: At our tertiary non-teaching centre, a significant number of patients presented back to hospital within 90 days following RP. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care EDs. This conclusion is supported by our early experience. Limitations include retrospective design, and variability in practice of surgeons in this study.

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