Nutritional management of gastrointestinal surgical patients in Victoria's public hospitals

2014 ◽  
Vol 72 (3) ◽  
pp. 240-246
Author(s):  
Lisa A. Barker ◽  
Timothy C. Crowe
Keyword(s):  
Public Hospitals ◽  
Surgical Patients ◽  
Nutritional Management

Nutrition

2019 ◽  
pp. 188-196
Author(s):  
George W. Williams
Keyword(s):  
Infectious Disease ◽  
Wound Healing ◽  
Critical Care ◽  
Nutritional Status ◽  
Respiratory Function ◽  
Surgical Patients ◽  
Nutritional Management ◽  
Equal Degree ◽  
Perioperative Nutrition

Nutrition is the second of two principal concepts (the first being infectious disease) in critical care not heavily emphasized in core anesthesiology training for reasons that are obvious. Optimal nutritional management is imperative to achieve positive outcomes in surgical patients. Wound healing, mobilization, and respiratory function are all particularly affected by nutritional status, and the optimal application assessment of nutrition directly affects surgical patients in the long term. Clinically, many physicians may take nutrition for granted and potentially conclude that it is not acutely important. Following consuming this content, the reader will be better equipped to educate their colleagues on the optimal assessment and application of perioperative nutrition. This chapter provides clinically useful and examination-oriented substrate to an equal degree, while being optimally digestible by the reader (no pun intended).

Rates of Surgical-Site Infection: An International Comparison

2005 ◽  
Vol 26 (5) ◽  
pp. 442-448 ◽  
Author(s):  
Maria Luisa Moro ◽  
Filomena Morsillo ◽  
Marilena Tangenti ◽  
Maria Mongardi ◽  
Maria Cristina Pirazzini ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Prospective Study ◽  
Surgical Site Infections ◽  
Public Hospitals ◽  
Operative Procedures ◽  
Surgical Patients ◽  
Site Infection ◽  
Italian Region ◽  
Convenience Sample ◽  
Study Population

AbstractObjectives:To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison.Design:Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation.Results:Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9–3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ–space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population.Conclusions:The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.

Surveillance of Healthcare-Acquired Infections in Queensland, Australia: Data and Lessons From the First 5 Years

2008 ◽  
Vol 29 (8) ◽  
pp. 695-701 ◽  
Author(s):  
Anthony P. Morton ◽  
Archie C. A. Clements ◽  
Shane R. Doidge ◽  
Jenny Stackelroth ◽  
Merrilyn Curtis ◽  
...  
Keyword(s):  
General Hospital ◽  
Risk Adjustment ◽  
Public Hospitals ◽  
Surgical Patients ◽  
Computer Assisted ◽  
Hospital Level ◽  
Tertiary Referral Center ◽  
Observational Prospective Cohort Study ◽  
Bayesian Shrinkage ◽  
Level 1

Objective.To present healthcare-acquired infection surveillance data for 2001-2005 in Queensland, Australia.Design.Observational prospective cohort study.Setting.Twenty-three public hospitals in Queensland.Methods.We used computer-assisted surveillance to identify episodes of surgical site infection (SSI) in surgical patients. The risk-adjusted incidence of SSI was calculated by means of a risk-adjustment score modified from that of the US National Nosocomial Infections Surveillance System, and the incidence of inpatient bloodstream infection (BSI) was adjusted for risk on the basis of hospital level (level 1, tertiary referral center; level 2, large general hospital; level 3, small general hospital). Funnel and Bayesian shrinkage plots were used for between-hospital comparisons.Patients.A total of 49,804 surgical patients and 4,663 patients who experienced healthcare-associated BSI.Results.The overall cumulative incidence of in-hospital SSI ranged from 0.28% (95% confidence interval [CI], 0%–1.54%) for radical mastectomies to 6.15% (95% CI, 3.22%–10.50%) for femoropopliteal bypass procedures. The incidence of inpatient BSI was 0.80,0.28, and 0.22 episodes per 1,000 occupied bed-days in level 1, 2, and 3 hospitals, respectively.Staphylococcus aureuswas the most commonly isolated microorganism for SSI and BSI. Funnel and shrinkage plots showed at least 1 hospital with a signal indicating a possible higher-than-expected rate of S. aureus-associated BSI.Conclusions.Comparisons between hospitals should be viewed with caution because of imperfect risk adjustment. It is our view that the data should be used to improve healthcare-acquired infection control practices using evidence-based systems rather than to judge institutions.

scholarly journals Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e005502 ◽  
Author(s):  
Hassan Assareh ◽  
Jack Chen ◽  
Lixin Ou ◽  
Stephanie J Hollis ◽  
Kenneth Hillman ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Peer Groups ◽  
Care Facility ◽  
Public Hospitals ◽  
Surgical Patients ◽  
Targeted Interventions ◽  
Hospital Variation

ObjectivesDespite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals.SettingA large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002–2009 in New South Wales, Australia.ParticipantsPatients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included.Outcome measuresVTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR).Results2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE.ConclusionsVTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities.

scholarly journals Geriatrician perspectives on perioperative care: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Janani Thillainadesan ◽  
Jesse Jansen ◽  
Jacqui Close ◽  
Sarah Hilmer ◽  
Vasi Naganathan
Keyword(s):  
Healthcare Professional ◽  
Qualitative Study ◽  
Perioperative Care ◽  
Geriatric Medicine ◽  
Public Hospitals ◽  
Perioperative Medicine ◽  
System Level ◽  
Surgical Patients ◽  
Patient Needs ◽  
Patient Reported

Abstract Background Perioperative medicine services for older surgical patients are being developed across several countries. This qualitative study aims to explore geriatricians’ perspectives on challenges and opportunities for developing and delivering integrated geriatrics perioperative medicine services. Methods A qualitative phenomenological semi-structured interview design. All geriatric medicine departments in acute public hospitals across Australia and New Zealand (n = 81) were approached. Interviews were conducted with 38 geriatricians. Data were analysed thematically using a framework approach. Results Geriatricians identified several system level barriers to developing geriatrics perioperative medicine services. These included lack of funding for staffing, encroaching on existing consultative services, and competing clinical priorities. The key barrier at the healthcare professional level was the current lack of clarity of roles within the perioperative care team. Key facilitators were perceived unmet patient needs, existing support for geriatrician involvement from surgical and anaesthetic colleagues, and the unique skills geriatricians can bring to perioperative care. Despite reporting barriers, geriatricians are contemplating and implementing integrated proactive perioperative medicine services. Geriatricians identified a need to support other specialties gain clinical experience in geriatric medicine and called for pragmatic research to inform service development. Conclusions Geriatricians perceive several challenges at the system and healthcare professional levels that are impacting current development of geriatrics perioperative medicine services. Yet their strong belief that patient needs can be met with their specialty skills and their high regard for team-based care, has created opportunities to implement innovative multidisciplinary models of care for older surgical patients. The barriers and evidence gaps highlighted in this study may be addressed by qualitative and implementation science research. Future work in this area may include application of patient-reported measures and qualitative research with patients to inform patient-centred perioperative care.

scholarly journals Nutritional Management of Bariatric Surgical Patients in the Peri-Operative Setting

2018 ◽  
pp. 18-20
Author(s):  
Jonathan Sivakumar
Keyword(s):  
Bariatric Surgery ◽  
Surgical Patients ◽  
Recent History ◽  
Nutritional Management ◽  
Evidenced Based ◽  
Surgical Treatments

Bariatric surgical treatments have increased in recent history, largely due to the growing rates of obesity. In light of this, correct nutritional management of these patients peri-operatively is as crucial as ever. This articles describes the evidenced-based approach to the nutritional management of patients in the setting of bariatric surgery in order to achieve the best possible outcome post-operatively

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