scholarly journals The impact of preoperative education in satisfaction and postoperative outcomes of patients undergoing cardiac surgery

2019 ◽  
Vol 2 (1) ◽  
pp. 46
Author(s):  
Antonia Kalogianni ◽  
Georgios Georgiadis ◽  
Olga Katselou ◽  
Olga Kadda ◽  
Aikaterini Sotiropoulou ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intervention Group ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Patient Centered ◽  
Preoperative Education ◽  
Elective Cardiac Surgery ◽  
The Impact

Introduction: The effectiveness of preoperative education in postoperative course of cardiac surgery patients has been questioned. Aim: To estimate the impact of preoperative education in satisfaction and postoperative outcomes of patients undergoing cardiac surgery. Material and Method: A quasi-experimental trial was conducted. Sixty nine patients who admitted for elective cardiac surgery were divided randomly in intervention (34) and control group (35). Intervention group received written and verbal education based on patient centered communication by specially trained nurses. Patients’ satisfaction, postoperative complications and hospital length of stay (LOS) was measured. Results: Scores on all dimensions of satisfaction were greater for intervention group (p<0,001).No difference found for complications in intensive care unit (ICU) (p=0,150) in both groups. The total complications was lower (p=0,028) in intervention group with a lower proportion of arrhythmia (p=0,011). The median LOS in ICU was shorter for intervention group (p=0,035). No difference found in median hospital LOS in either group. Conclusions: Nurse-led preoperative education increases satisfaction of patients undergoing cardiac surgery and may have an effect on LOS shortening and complications control.

scholarly journals The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of Cardiac Surgery: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Andres Zorrilla-Vaca ◽  
Rafael A. Núñez-Patiño ◽  
Valentina Torres ◽  
Yudy Salazar-Gomez
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Meta Analysis ◽  
Unit Length ◽  
Volatile Anesthetic ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Randomized Controlled ◽  
The Impact

Objectives. To evaluate the impact of volatile anesthetic choice on clinically relevant outcomes of patients undergoing cardiac surgery. Methods. Major databases were systematically searched for randomized controlled trials (RCTs) comparing volatile anesthetics (isoflurane versus sevoflurane) in cardiac surgery. Study-level characteristics, intraoperative events, and postoperative outcomes were extracted from the articles. Results. Sixteen RCTs involving 961 patients were included in this meta-analysis. There were no significant differences between both anesthetics in terms of intensive care unit length of stay (SMD −0.07, 95% CI −0.38 to 0.24, P=0.66), hospital length of stay (SMD 0.06, 95% CI −0.33 to 0.45, P=0.76), time to extubation (SMD 0.29, 95% CI −0.08 to 0.65, P=0.12), S100β (at the end of surgery: SMD 0.08, 95% CI −0.33 to 0.49, P=0.71; 24 hours after surgery: SMD 0.21, 95% CI −0.23 to 0.65, P=0.34), or troponin (at the end of surgery: SMD −1.13, 95% CI −2.39 to 0.13, P=0.08; 24 hours after surgery: SMD 0.74, 95% CI −0.15 to 1.62, P=0.10). CK-MB was shown to be significantly increased when using isoflurane instead of sevoflurane (SMD 2.16, 95% CI 0.57 to 3.74, P=0.008). Conclusions. The volatile anesthetic choice has no significant impact on postoperative outcomes of patients undergoing cardiac surgery.

Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients

2011 ◽  
Vol 9 (4) ◽  
pp. 401-406 ◽  
Author(s):  
Dana Lustbader ◽  
Renee Pekmezaris ◽  
Michael Frankenthaler ◽  
Rajni Walia ◽  
Frederick Smith ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Palliative Medicine ◽  
Intervention Group ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Control Group ◽  
Do Not Resuscitate ◽  
Log Rank Test ◽  
The Impact ◽  
Reduced Time

AbstractObjective:The purpose of this study was to assess the impact of a palliative medicine consultation on medical intensive care unit (MICU) and hospital length of stay, Do Not Resuscitate (DNR) designation, and location of death for MICU patients who died during hospitalization.Method:A comparison of two retrospective cohorts in a 17-bed MICU in a tertiary care university-affiliated hospital was conducted. Patients admitted to the MICU between January 1, 2003 and June 30, 2004 (N = 515) were compared to MICU patients who had had a palliative medicine consultation between January 1, 2005 and June 1, 2009 (N = 693). To control for disease severity, only patients in both cohorts who died during their hospitalization were considered for this study.Results:Palliative medicine consultation reduced time until death during the entire hospitalization (log-rank test,p < 0.01). Time from MICU admission until death was also reduced (log-rank test,p < 0.01), further demonstrating the impact of the palliative care consultation on the duration of dying for hospitalized patients. The intervention group contained a significantly higher percentage of patients with a DNR designation at death than did the control group (86% vs. 68%, χ2test,p < 0.0001).Significance of results:Palliative medicine consultation is associated with an increased rate of DNR designation and reduced time until death. Patients in the intervention group were also more likely to die outside the MICU as compared to controls in the usual care group.

scholarly journals A Implementation of Antibiotic Prophylaxis Program for Cesarean Section at Thai Nguyen National Hospital

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Nguyen Thi Thu Thuy ◽  
Nguyem Thanh Hai ◽  
Nguyem Xuan Bach ◽  
Hoang Thi Thu Huong ◽  
Nguyem Chi Cuong ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Viet Nam ◽  
National Hospital ◽  
Ministry Of Health

This study aims to evaluate the effectiveness of the use of antibiotic prophylaxis in cesarean section at Thai Nguyen National Hospital as a first pilot activity of a surgical prophylaxis program. In the study, a randomized controlled trial was designed with two groups: intervention group and control group. Patients characteristics and effectiveness of prophylactic antibiotics for caesarean section were compared. The study results show that the patients’ ages ranged from 18 to 44 years; most of the patients had ASA score of 1; and mean hospital length of stay was statistically significant between the two groups (p<0.05). Regarding the indication of caesarean section, the reason of genital tract abnormalities accounted for the highest proportion. The percentage of the patients switching from prophylactic antibiotic regimens to therapeutic antibiotics in the intervention group was 2%. There was no patient with superficial and/or deep incisional surgical site infections in both groups. The difference in mean number of injections in the two groups was statistically significant (p<0.05). The average cost of antibiotics for each patient in the intervention group and control group were 267.720 VND and 543.871 VND, respectively. The study concludes that the effectiveness of antibiotics prophylaxis for caesarean section: 99% of the patients were without wound infection; hospital length of stay in the intervention group was shorter than the control group; and using prophylactic antibiotics was not only more economical but could also reduce the workload of medical staff, costs of antibiotics and medical supplies. Keywords  Antibiotics prophylaxis, caesarean section, Thai Nguyen National Hospital. References [1] Viet Nam Ministry of Health, National guideline on prevention of surgical site infection, issued with Decision No. 3671/QD-BYT, September 27, 2012 of Viet Nam Ministry of Health, Ha Noi, 2012 (in Vietnamese).[2] Viet Nam Ministry of Health, National guideline on antibiotics use, issued with Decision No.708/QD-BYT, March 2, 2015 of Viet Nam Ministry of Health, Ha Noi, 2015 (in Vietnamese).[3] D.W. Bratzler, K.M. Olsen, et al., Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery, American Journal of Health-System Pharmacy 70 (2013) 195 – 283. https://doi.org/10.2146/ajhp120568.[4] R.F. Lamont, J.D. Sobel, et al., Current debate on the use of antibiotic prophylaxis for caesarean section, BJOG: An International Journal of Obstetrics & Gynaecology 118 (2011) 193-201. https://doi.org/10.1111/j.14710528.2010.02729.x.[5] T.V. Khai, Infection rate of surgical incisions and associated factors on women after cesarean section at Dong Nai General Hospital, Scientific Research Project of Dong Nai Hospital, 2015 (in Vietnamese).[6] N.H. Tuan, Study on the use of cefazolin to prevent infection after cesarean section or uterine fibroids surgery at the Institute of maternal and neonatal protection, Master’s thesis, Hanoi University of Pharmacy, 2002 (in Vietnamese).[7] F.M. Smaill, R.M. Grivell, Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section, Cochrane Database Syst Rev 10 (2014) CD007482. https://doi.org/10.1002/14651858.cd007482.pub3.    

Daily Interruption of Sedation with Physical and Occupational Therapy in Mechanically Ventilated Patients

2018 ◽  
pp. 309-316
Author(s):  
Michael Wolfe ◽  
Daniel Saddawi-Konefka
Keyword(s):  
Occupational Therapy ◽  
Functional Status ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Schweickert et al. studied effects of early physical and occupational therapy in mechanically ventilated patients. 109 mechanically ventilated medical ICU patients (with independent functional status prior to hospitalization) were randomized to receive physical and occupational therapy initiated at time of enrollment (intervention group) vs. physical and occupational therapy ordered at the discretion of the primary team (control group), with both groups receiving daily interruptions of sedation. The primary outcome, independent functional status at time of discharge, was met in 59% of the intervention group vs. 35% of the control group (p = 0.02). Lower rates of ICU and hospital delirium were observed in the intervention group. Hospital length of stay and mortality were unaffected. This study demonstrated that physical and occupational therapy can be safely accomplished in critically ill, mechanically ventilated medical ICU patients, and that early implementation of therapy may improve return to independent functional status at hospital discharge.

scholarly journals Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Olga L. Cortés ◽  
Mauricio Herrera-Galindo ◽  
Claudia Becerra ◽  
Mónica Rincón-Roncancio ◽  
Camilo Povea-Combariza ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Waiting Time ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Rank Test ◽  
Early Ambulation ◽  
Log Rank Test ◽  
The Impact

Abstract Background Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. Methods A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan–Meier estimator (log-rank test). Results There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). Conclusion Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. Trial registration: PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.

scholarly journals Clinical Outcomes and Cost of Ventilator Weaning and Endotracheal Extubation Guided by An Established Ventilator Weaning Protocol in Patients Undergoing Elective Cardiac Surgery

2021 ◽  
Vol 73 (12) ◽  
pp. 815-822
Author(s):  
Supanan Innok ◽  
Witchuda Dokphueng ◽  
Kamol Udol ◽  
Worawong Slisatkorn ◽  
Prasert Sawasdiwipachai
Keyword(s):  
Cardiac Surgery ◽  
Primary Outcome ◽  
Intervention Group ◽  
Ventilator Weaning ◽  
Control Group ◽  
Early Extubation ◽  
Elective Cardiac Surgery ◽  
Postoperative Intensive Care ◽  
Cardiovascular Care ◽  
Relevant Cost

Objective: To compare successful early extubation rates, complications, and cost before and after the use of anestablished ventilator weaning protocol in patients undergoing elective cardiac surgery.Materials and Methods: Subjects were adult patients undergoing elective cardiac surgery who were clinically stablewithin 2 hours after surgery. The control group underwent conventional ventilator weaning at the discretion of theirattending staff. The intervention group underwent protocol-guided ventilator weaning. The primary outcome wasa successful early extubation (within 6 hours after surgery). Secondary outcomes were complications from weaningto 24 hours after surgery, and the relevant cost related to respiratory and cardiovascular care within 24 hours afteradmission to the postoperative intensive care unit.Results: The primary outcome occurred in 37 out of 65 patients (56.9%) in the intervention group and in 5 out of65 patients (7.7%) in the control group (adjusted odds ratio 20.6; 95% confidence interval 6.7–62.9, p<0.001). Thecomplication rates were not statistically different between the intervention and control groups (26.2% vs. 20.0%,p=0.41). The relevant cost, approximated by the service charges, related to respiratory and cardiovascular care wassignificantly less in the intervention group than in the control group (median 2,491 vs. 2,711 Thai baht, p<0.001).Conclusion: The use of the established ventilator weaning protocol after elective cardiac surgery was associated witha higher rate of successful early extubation and lower cost related to respiratory and cardiovascular care comparedto the conventional practices of ventilator weaning and extubation. The rates of overall complications were notsignificantly different.

scholarly journals Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vivien Berthoud ◽  
Maxime Nguyen ◽  
Anouck Appriou ◽  
Omar Ellouze ◽  
Mohamed Radhouani ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
Primary Outcome ◽  
Randomized Study ◽  
Intervention Group ◽  
Prospective Randomized Study ◽  
Control Group ◽  
Standard Group ◽  
Postoperative Course ◽  
The Impact

AbstractPupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

scholarly journals Prophylaxis for postoperative atrial fibrillation: A quality initiative study exploring adherence to NICE guidance in a UK tertiary cardiothoracic intensive care unit

2019 ◽  
Vol 21 (4) ◽  
pp. 290-295
Author(s):  
Vasileios Zochios ◽  
Joht Singh Chandan ◽  
Thomas Taverner ◽  
Aswin Babu ◽  
Harjot Singh
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Rate Control ◽  
Significant Proportion ◽  
Hospital Length ◽  
Postoperative Atrial Fibrillation ◽  
Hospital Length Of Stay ◽  
Nice Guidance ◽  
The Impact

Background Acute onset atrial fibrillation is a common dysrhythmia experienced by patients following cardiac surgery which can often cause morbidity and extended hospital length of stay. The primary aim of the study was to explore adherence to National Institute for Health and Care Excellence (NICE) guidance which suggests the need for prophylaxis for postoperative atrial fibrillation (POAF). Secondary aims were to explore factors contributing to the development POAF and the impact of POAF on patient-centred outcomes. Methods An analysis consisting of descriptive statistics and regression models was conducted using 138 patient’s records who underwent cardiac surgery between January and March 2017. Results We identified 83 (62%) patients on prophylactic rate control medications prior to surgery. During the study period, a total of 50 patients (36%) developed POAF, of which 28 were on prophylactic medication prior to surgery. Patients who developed POAF had significantly prolonged hospital length of stay compared to those who did not develop POAF. Conclusion Our study identified a significant proportion of patients not being offered prophylactic rate control prior to cardiac surgery. It is clear that poor patient outcomes are associated with the development of POAF and therefore there is an important need to ensure preventative measures are implemented in guidance relating to the management of these patients. Our results also suggest that tight management of clinical and physiological risk factors prior and during cardiac surgery may improve outcomes in this group of patients and could be considered in future enhanced recovery after cardiac surgery protocols.

scholarly journals Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Wouter W. Jansen Klomp ◽  
Carl G. M. Moons ◽  
Arno P. Nierich ◽  
George J. Brandon Bravo Bruinsma ◽  
Arnoud W. J. van’t Hof ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Transesophageal Echocardiography ◽  
Intervention Group ◽  
Postoperative Mortality ◽  
Control Group ◽  
Aortic Atherosclerosis ◽  
Stroke Incidence ◽  
Relative Risks ◽  
Large Cohort Study ◽  
The Impact

The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, p<0.001) and more often females (31.0% versus 28.0%, p<0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p<0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50–1.00, p=0.05) and 0.67 (95% CI: 0.45–0.98, p=0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73–1.45) and 1.01 (95% CI: 0.71–1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.

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