scholarly journals Continuing Our Work: Transplant Surgery And Surgical Oncology In A Tertiary Referral COVID-19 Center

2020 ◽  
Author(s):  
Giammauro Berardi ◽  
Marco Colasanti ◽  
Giovanni Battista Levi Sandri ◽  
Celeste Del Basso ◽  
Stefano Ferretti ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Index ◽  
Surgical Oncology ◽  
Cardiac Risk ◽  
Tertiary Referral ◽  
Icu Admission ◽  
Asa Score ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit ◽  
Major Hepatectomies

Abstract Background. COVID-19 is rapidly spreading worldwide. Healthcare systems are struggling to properly allocate resources while ensuring cure for diseases outside of the infection. The aim of this study was to demonstrate how surgical activity was affected by the virus outbreak and show the changes in practice in a tertiary referral COVID-19 center.Methods. The official bulletins of the Italian National Institute for the Infectious Diseases “L. Spallanzani” were reviewed to retrieve the number of daily COVID-19 patients. Records of consecutive oncological and transplant procedures performed during the outbreak were reviewed. Patients with a high probability of postoperative intensive care unit (ICU) admission were considered as high-risk and defined by an ASA score ≥ III and/or a Charlson Comorbidity Index (CCI) ≥ 6 and/or a Revised Cardiac Risk Index for Preoperative Risk (RCRI) ≥ 3.Results. 72 patients were operated including 12 (16.6%) liver (n=6) and kidney (n=6) transplantations. Patients had few comorbidities (26.3%), low ASA score (1.9±0.5), CCI (3.7±1.3) and RCRI (1.2±0.6) and had low risk of postoperative ICU admission. Few patients had liver cirrhosis (12.5%) or received preoperative systemic therapy (16.6%). 36 (50%) high risk surgical procedures were performed including major hepatectomies, pancreaticoduodenectomies, total gastrectomies, multivisceral resections and transplantations. Despite this, only 15 patients (20.8%) were admitted to the ICU.Conclusions. Only oncologic cases and transplantations were performed during the COVID-19 outbreak. Careful selection of patients allowed to perform major cancer surgeries and transplantations without further stressing hospital resources, meanwhile minimizing collateral damage to patients.

scholarly journals Surgical Apgar score is strongly associated with postoperative ICU admission

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying-Chun Lin ◽  
Yi-Chun Chen ◽  
Chen-Hsien Yang ◽  
Nuan-Yen Su
Keyword(s):  
High Risk ◽  
Apgar Score ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Icu Admission ◽  
Postoperative Intensive Care ◽  
Icu Transfer ◽  
American Society ◽  
Postoperative Intensive Care Unit ◽  
Surgical Apgar Score

AbstractImmediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0–10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7–10 and 0–4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0–2, 3–4, and 5–6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.

scholarly journals The Use of Lee and Co-Workers’ Index to Assist a Risk Adjusted Audit of Perioperative Cardiac Outcome

2008 ◽  
Vol 36 (2) ◽  
pp. 167-173 ◽  
Author(s):  
P. J. Moran ◽  
T. Ghidella ◽  
G. Power ◽  
A. S. Jenkins ◽  
D. Whittle
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Positive Result ◽  
Cardiac Event ◽  
Risk Index ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Frequent Use ◽  
Cardiac Outcome ◽  
The Impact

Lee and co-workers’ revised cardiac risk index was used to study the perioperative cardiac outcome of 296 patients. The index uses a history of ischaemic heart disease, congestive cardiac failure, diabetes treated with insulin, a creatinine greater than 180 μmol/l, cerebrovascular disease and high risk surgery as the risk factors involved in predicting a perioperative cardiac event. It was derived on the basis of data from patients over the age of 50 years undergoing elective, noncardiac surgery with an expected inpatient stay of two or more days. The presence of one, two and three or more risk factors predicted a risk of a major cardiac event of 1.3% (95% confidence interval [CI] 0.7 to 2.1), 3.6% (95% CI 2.1 to 5.6) and 9% (95% CI 5.5 to 13.8) respectively in Lee's derivation group of 2,893 patients. In our audit of 296 patients we observed a cardiac event rate of 0.8% (95% CI 0 to 2.3%), 6.7% (95% CI 1.6 to 10%) and 2% (95% CI 0 to 5.9%), in patients with one, two and three or more risk factors respectively. The more frequent use of ECGs and troponin levels in the routine postoperative care of high risk patients undergoing major noncardiac surgery is recommended on the basis of the frequency of a positive result and the impact of a positive result on a patient's management.

Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

2011 ◽  
Vol 115 (6) ◽  
pp. 1236-1241 ◽  
Author(s):  
John Q. H. Bui ◽  
Rajith L. Mendis ◽  
James M. van Gelder ◽  
Mark M. P. Sheridan ◽  
Kylie M. Wright ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Loss ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Safe Alternative ◽  
Emergency Team ◽  
Icu Admission ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit

Object Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative. Methods Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed. Indications for craniotomy included tumor (257 patients) and transsphenoidal (63 patients), vascular (31 patients), ventriculostomy (22 patients), developmental (13 patients), and base of skull conditions (8 patients). Recorded data included age, operation, reason for ICU admission, medical emergency team (MET) calls, in-hospital mortality, and postoperative duration of stay. Results Three hundred forty-three patients were admitted to the regular ward after elective craniotomy, whereas there were 43 planned and 8 unplanned ICU admissions. The most common reasons for planned ICU admissions were anticipated lengthy operations (42%) and anesthetic risks (40%); causes for unplanned ICU admissions were mainly unexpected slow neurological recovery and extensive intraoperative blood loss. Of the 343 regular ward admissions, 10 (3%) required a MET call; only 3 of these MET calls occurred within the first 48 postoperative hours and did not lead to an ICU admission. The overall mortality rate in the investigated cohort was 1%, with no fatalities in patients admitted to the normal ward postoperatively. Conclusions Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.

Abstract 15582: Patterns of Statin Initiation in Patients Undergoing Intermediate to High Risk Non-Cardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Elisabetta Patorno ◽  
Shirley Wang ◽  
Sebastian Schneeweiss ◽  
Jun Liu ◽  
Brian Bateman
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Vascular Surgery ◽  
Elective Surgery ◽  
Risk Index ◽  
Cardiac Risk ◽  
Cardiac Events ◽  
Initiation Rate ◽  
Cardiac Risk Index ◽  
Recent Estimate

Background: Starting from early to mid 2000s a growing body of literature has been produced on the potential role of statins in reducing perioperative cardiac events in patients undergoing non-cardiac surgery. However, evidence remains inconsistent and little is known regarding the use of perioperative statins in clinical practice. Objectives: To examine pattern of statin initiation among patients undergoing non-cardiac elective surgery in the US. Methods: Using data from a large US healthcare insurer, we identified patients ≥18 years who underwent moderate- to high-risk non-cardiac elective surgery and initiated statins within 30-days before surgery. We assessed trends of statin initiation over time and predictors of initiation. To ensure statin initiation was precipitated by non-cardiac surgery vs. alternative indications, we also assessed the effect of temporal proximity to surgery on initiation in a matched analysis. Results: Of 460,154 patients undergoing surgery between 2003-2012, 5,628 (1.2%) initiated a statin before surgery. Initiation rate increased from 0.8% in 2003 to 1.5% in 2012 (p = .0004). The increase was more pronounced among patients with revised cardiac risk index (RCRI) score ≥2 and patients undergoing vascular surgery, with initiation rates equal to 7.2% and 14.9% respectively by the end of 2012. Proximity to surgery was predictive of statin initiation (p < .0001). Significant predictors of initiation were older age, male sex, revised cardiac risk index (RCRI) score ≥1, vascular or orthopedic surgery. At the most recent estimate, patients undergoing vascular surgery and with a RCRI score ≥2 had initiation rates equal to 19.9%. Conclusions: The rate of statin initiation progressively increased from 2003 to 2012, particularly among patients with higher RCRI score and undergoing major vascular surgery. Research is needed to further define the risks and benefits of initiation of statins prior to surgery.

scholarly journals Patient Selection for Routine Troponin Monitoring After Noncardiac Surgery

2021 ◽  
Author(s):  
Corien S. A. Weersink ◽  
Judith A. R. van Waes ◽  
Remco B. Grobben ◽  
Hendrik M. Nathoe ◽  
Wilton A. van Klei
Keyword(s):  
High Risk ◽  
Troponin I ◽  
Elective Surgery ◽  
Risk Index ◽  
Regression Tree ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Classification And Regression Tree ◽  
Regression Tree Analysis ◽  
Number Needed To Screen

Background Myocardial infarction is an important complication after noncardiac surgery. Therefore, perioperative troponin surveillance is recommended for patients at risk. The aim of this study was to identify patients at high risk of perioperative myocardial infarction (POMI), in order to aid appropriate selection and to omit redundant laboratory measurements in patients at low risk. Methods and Results This observational cohort study included patients ≥60 years of age who underwent intermediate to high risk noncardiac surgery. Routine postoperative troponin I monitoring was performed. The primary outcome was POMI. Classification and regression tree analysis was used to identify patient groups with varying risks of POMI. In each subgroup, the number needed to screen to identify 1 patient with POMI was calculated. POMI occurred in 216 (4%) patients and other myocardial injury in 842 (15%) of the 5590 included patients. Classification and regression tree analysis divided patients into 14 subgroups in which the risk of POMI ranged from 1.7% to 42%. Using a risk of POMI ≥2% to select patients for routine troponin I monitoring, this monitoring would be advocated in patients ≥60 years of age undergoing emergency surgery, or those undergoing elective surgery with a Revised Cardiac Risk Index class >2 (ie >1 risk factor). The number needed to screen to detect a patient with POMI would be 14 (95% CI 14–14) and 26% of patients with POMI would be missed. Conclusions To improve selection of high‐risk patients ≥60 years of age, routine postoperative troponin I monitoring could be considered in patients undergoing emergency surgery, or in patients undergoing elective surgery classified as having a revised cardiac risk index class >2.

scholarly journals Incidence of Postoperative Intensive Care Admissions in Elective Surgical Patients with High-risk Anaesthesia Consent Preoperatively

2021 ◽  
Author(s):  
Ramyavel Thangavelu ◽  
Sagiev Koshy George
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Blood Loss ◽  
Surgical Patients ◽  
Haemodynamic Instability ◽  
Icu Admission ◽  
Postoperative Intensive Care ◽  
Long Duration ◽  
Duration Of Surgery

Introduction: Surgical patients who require high-risk anaesthesia consent are often at risk of developing perioperative complications and morbidity often warranting postoperative Intensive Care Unit (ICU) admissions. Aim: To study the incidence of postoperative ICU admissions among surgical patients who require high-risk anaesthesia consent preoperatively. Materials and Methods: A retrospective study using chart analysis of 64 patients who required high-risk consent for elective surgery over a period of 18 months from January 2018 to July 2019 was done. The details on demographics, the American Society of Anaesthesiologists (ASA) class, the reason for obtaining high-risk consent, type of anaesthesia administered, intraoperative events, duration of surgery and reason for shifting to Intensive Care Unit (ICU) was collected and recorded. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Multiple logistic regressions were performed to determine the predictors of postoperative ICU admissions. Results: Out of 64 high-risk patients, 35.9% of patients were shifted to ICU postoperatively, with the most common reason for ICU admission being metabolic/haemodynamic instability intraoperatively (47.8%). Among the various preoperative factors (presence of cardiovascular, respiratory diseases with poor reserve or functional impairment, chronic kidney disease, morbid obesity) for obtaining high-risk consent, anticipated long duration surgery with blood loss was associated with a 3.9 {95% CIs of 1.25 and 12.22} times higher odds of being shifted to ICU postoperatively. Conclusion: About one-third of elective surgical patients who required high-risk anaesthesia consent preoperatively required ICU admission postoperatively. In addition, anticipated long duration surgery with blood loss was found to be an independent predictor of ICU requirement postoperatively.

scholarly journals Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting

2021 ◽  
Author(s):  
Jianying Zhang ◽  
Wei Jiang ◽  
Felipe Urdaneta
Keyword(s):  
Health Economic ◽  
Direct Laryngoscopy ◽  
Length Of Hospital Stay ◽  
Video Laryngoscopy ◽  
Inpatient Cost ◽  
Icu Admission ◽  
Postoperative Intensive Care ◽  
Clinical Benefits ◽  
Postoperative Intensive Care Unit ◽  
Surgical Setting

Aim: Compared with direct laryngoscopy (DL), video laryngoscopy (VL) offers clinical benefits in routine and difficult airways. The health economic benefit of VL versus DL for routine tracheal intubation remains unknown. Materials & methods: This analysis compared VL and DL health economic outcomes, including total inpatient costs, length of hospital stay (LOS), postoperative intensive care unit (ICU) admission and incidence of procedurally associated complications. Results: Patients with VL had decreased inpatient cost (US$1144–5891 across eight major diagnostic categories [MDC]); >1-day LOS reduction in five MDC; reduced odds for postoperative ICU admission (0.04–0.68) and reduced odds of respiratory complications in three MDC (0.43–0.90). Conclusion: Video laryngoscopy may lower total costs, reduce LOS and decrease the likelihood of postoperative ICU admission.

Sign in / Sign up

Export Citation Format

Share Document