scholarly journals Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

2014 ◽  
Vol 5 (3) ◽  
pp. 336 ◽  
Author(s):  
Mathias Opperer
Keyword(s):  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Evidence Based

Perioperative risk prediction

2021 ◽  
pp. 1-2
Author(s):  
Edward Davis
Keyword(s):  
Decision Making ◽  
Risk Prediction ◽  
Scoring Systems ◽  
Perioperative Risk ◽  
Surgical Patients ◽  
Evidence Based

Predicting outcomes for surgical patients accurately can be challenging preoperatively. Fortunately, there is an array of evidence-based scoring systems which can guide perioperative decision making and discussions of risk with patients.

The efficacy of Enhanced recovery after surgery (ERAS) for elderly patients with intertrochanteric fractures received surgery: study protocol for a randomized, blinded, controlled trial

2020 ◽  
Author(s):  
Mengchen Yin ◽  
Yinjie Yan ◽  
Zhaoxiang Fan ◽  
Niankang Fang ◽  
Hongbo Wan ◽  
...  
Keyword(s):  
Western Medicine ◽  
Intertrochanteric Fracture ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Controlled Trial ◽  
Intramedullary Fixation ◽  
Perioperative Outcomes ◽  
Evidence Based ◽  
Randomized Controlled

Abstract Background: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promote repair of injured tissues and eliminate traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with and western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation, and provide reliable evidence-based data for applying the program to clinical practice. Methods/design: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway, and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. Discussion: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine. But, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway Trial registration: Registered on 12 Oct 2019; Trial number is ChiCTR190t0026487 Keywords: intertrochanteric fracture; enhanced recovery after surgery; perioperative period; integrating TCM with and western medicine; randomized controlled trial

scholarly journals The Effect of a Multifaceted Postoperative Nausea and Vomiting Reduction Strategy on Prophylaxis Administration Amongst Higher-Risk Adult Surgical Patients

2018 ◽  
Vol 46 (2) ◽  
pp. 185-189 ◽  
Author(s):  
A. Pym ◽  
E. Ben-Menachem
Keyword(s):  
High Risk ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Outcome Data ◽  
Nausea And Vomiting ◽  
Surgical Patients ◽  
Evidence Based ◽  
Post Intervention ◽  
Reduction Strategy ◽  
Risk Patients

Postoperative nausea and vomiting (PONV) is a common and distressing problem for patients and increases the burden of care in post-anaesthesia care units (PACU). As such it has been a recent focus for quality improvement. Evidence-based guidelines have demonstrated the benefit of PONV risk stratification and prophylaxis, but may be underutilised in clinical practice. This prospective pre-/post-intervention study was conducted at an adult tertiary hospital in non-cardiac adult surgical patients at higher risk of PONV. The intervention included promotion of an evidence-based PONV guideline, and provision of individualised prescribing and patient outcome data to anaesthetists. Six hundred and twenty-eight patients with ≥2 risk factors for PONV following general anaesthesia for non-cardiac surgery were included (333 pre-intervention and 295 post-intervention). Prior to the intervention, 9.0% (30/333) of moderate- and high-risk patients received antiemetic prophylaxis consistent with our guideline. Post-intervention, the rate of guideline adherence was 19.3% (57/295). In the high-risk PONV group, the time in PACU was significantly reduced post-intervention, 66 minutes versus 83 minutes (P=0.032). This institution-specific PONV reduction strategy had a modest but significant effect on improving prophylaxis administration. However, our findings indicate that further efforts would be required to ensure fuller compliance with the current extensive evidence base for PONV management in higher-risk patients.

Article Commentary: Optimizing Surgical Care: A Contemporary Assessment of Temperature, Oxygen, and Glucose

2010 ◽  
Vol 76 (6) ◽  
pp. 571-577 ◽  
Author(s):  
Ashley Dickinson ◽  
Motaz Qadan ◽  
Hiram C. Polk
Keyword(s):  
Immune Response ◽  
Quality Of Care ◽  
Innate Immune Response ◽  
Surgical Care ◽  
Innate Immune ◽  
Surgical Patients ◽  
Evidence Based

Factors such as temperature, oxygen, and glucose have recently been implicated in the development of surgical sepsis by either promoting or attenuating protective components of the innate immune response. Reducing infective sequelae and the improvement of the quality of care of surgical patients is a top practice priority today. These factors and their associated effects are discussed through the examination of recent clinical and scientific studies to provide an up-to-date evidence-based review.

scholarly journals Infusion and transfusion therapy: main aspects

2021 ◽  
Vol 17 (3) ◽  
pp. 25-29
Author(s):  
V.V. Nikonov ◽  
K.I. Lyzohub ◽  
M.V. Lyzohub
Keyword(s):  
Perioperative Period ◽  
Surgical Patients ◽  
Infusion Therapy ◽  
Evidence Based ◽  
Consensus Guidelines ◽  
Successful Management ◽  
Transfusion Therapy ◽  
Vital Functions ◽  
Crystalloid Solutions ◽  
Based Medicine

The adequate choice of strategy for infusion therapy is an essential component of successful management of critically ill patients. Infusion therapy is one of the main methods of maintai-ning vital functions of patients in the perioperative period. In the practice of a doctor, there are reasonable doubts about the feasibility and safety of various solutions for infusion therapy. Both are fundamental principles of infusion therapy, and the changes that have taken place, of course, need to be understood from the standpoint of evidence-based medicine. Balanced crystalloid solutions were safe and clinically effective, their use is provided by the Bri-tish Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients.

Safety of emergency, elective and day case operating during the winter period at East Suffolk and North Essex NHS Foundation Trust: lessons from the outcomes of 4,254 surgical patients from the first COVID-19 wave

2021 ◽  
Vol 103 (7) ◽  
pp. 478-480
Author(s):  
S Parikh ◽  
L Cooper ◽  
W Matthews ◽  
M Khan ◽  
S Syed ◽  
...  
Keyword(s):  
Evidence Base ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Winter Period ◽  
Limited Evidence ◽  
Day Case ◽  
Emergency Admissions ◽  
Day Case Surgery ◽  
Case Surgery ◽  
Regular Review

Background There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. Methods We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. Results There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. Conclusions There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.

A multidisciplinary perioperative medicine clinic to improve high-risk patient outcomes: A service evaluation audit

2021 ◽  
pp. 0310057X2110171
Author(s):  
Aidan I Fullbrook ◽  
Elizabeth P Redman ◽  
Kerry Michaels ◽  
Lisa R Woods ◽  
Aruntha Moorthy ◽  
...  
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Perioperative Medicine ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Surgical Patient ◽  
High Risk Patients ◽  
Medicine Clinic ◽  
Risk Patients ◽  
High Risk Surgical Patient

Various perioperative interventions have been demonstrated to improve outcomes for high-risk patients undergoing surgery. This audit assessed the impact of introducing a multidisciplinary perioperative medicine clinic on postoperative outcomes and resource usage amongst high-risk patients. Between January 2019 and March 2020, our institution piloted a Comprehensive High-Risk Surgical Patient Clinic. Surgical patients were eligible for referral when exhibiting criteria known to increase perioperative risk. The patient’s decision whether to proceed with surgery was recorded; for those proceeding with surgery, perioperative outcomes and bed occupancy were recorded and compared against a similar surgical population identified as high-risk at our institution in 2017. Of 23 Comprehensive High-Risk Surgical Patient Clinic referrals, 11 did not proceed with the original planned surgery. Comprehensive High-Risk Surgical patients undergoing original planned surgery, as compared to high-risk patients from 2017, experienced reduced unplanned intensive care unit admission (8% versus 19%, respectively), 30-day mortality (0% versus 13%) and 30-day re-admission to hospital (0% versus 20%); had shorter postoperative lengths of stay (median (range) 8 (7–14) days versus 10.5 (5–28)) and spent more days alive outside of hospital at 30 days (median (range) 18 (0–25) versus 21 (16–23)). Cumulatively, the Comprehensive High-Risk Surgical patient cohort compared to the 2017 cohort (both n=23) occupied fewer postoperative intensive care (total 13 versus 24) and hospital bed-days (total 106 versus 212). The results of our Comprehensive High-Risk Surgical Patient pilot project audit suggest improved individual outcomes for high-risk patients proceeding with surgery. In addition, the results support potential resource savings through more appropriate patient selection.

scholarly journals Treatment of Surgical Patients is Evidence-based

2001 ◽  
Vol 167 (5) ◽  
pp. 324-330 ◽  
Author(s):  
Ross Kingston, Mary Barry, Sean Tierney,
Keyword(s):  
Surgical Patients ◽  
Evidence Based
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