1
|
Douglas RN, Kattil P, Lachman N, Johnson RL, Niesen AD, Martin DP, Ritter MJ. Superficial versus deep parasternal intercostal plane blocks: cadaveric evaluation of injectate spread. Br J Anaesth 2024; 132:1153-1159. [PMID: 37741722 DOI: 10.1016/j.bja.2023.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Deep and superficial parasternal intercostal plane blocks provide anterior chest wall analgesia for both breast and cardiac surgery. Our primary objective of this cadaveric study was to describe the parasternal spread of deep and superficial parasternal intercostal plane blocks. Our secondary objectives were to describe needle proximity to the internal mammary artery when performing deep parasternal intercostal plane blocks, and compare lateral injectate spread and extension into the rectus sheath. METHODS We performed ultrasound-guided deep and superficial parasternal intercostal plane blocks 2 cm from the sternum at the T3-4 interspace in four fresh frozen cadavers as described in clinical studies. RESULTS Parasternal spread of injectate was greater with the deep parasternal intercostal plane injection than with the superficial parasternal intercostal plane injection. The internal mammary artery was ∼3 mm away from the needle trajectory in cadaver #1 and ∼5 mm from the internal mammary artery in cadaver #2. Lateral spread extended to the midclavicular line for all deep parasternal intercostal plane blocks and beyond the midclavicular line for all superficial parasternal intercostal plane blocks. Neither block extended to the rectus sheath. CONCLUSIONS A greater number of parasternal interspaces were covered with the deep parasternal intercostal plane block than with the superficial parasternal intercostal plane block when one injection was performed at the T3-4 interspace. However, considering proximity to the internal mammary artery, and potential devastating consequences of an arterial injury, we propose that the deep parasternal intercostal plane block be classified as an advanced block and that future studies focus on optimising superficial parasternal intercostal plane parasternal spread.
Collapse
Affiliation(s)
- Rachel N Douglas
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Punnose Kattil
- Department of Clinical Anatomy, Mayo Clinic, Rochester, MN, USA
| | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam D Niesen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - David P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Ritter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
2
|
Johnson RL. Enabling Registered Nurses, Licensed Practical and Vocational Nurses, and Assistive Personnel to Practice to Their Fullest Extent. Crit Care Nurse 2024; 44:64-67. [PMID: 38555959 DOI: 10.4037/ccn2024809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Rebecca L Johnson
- Rebecca L. Johnson is a nurse educator, medical intensive care unit, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York
| |
Collapse
|
3
|
Shanthanna H, D'Souza RS, Johnson RL, YaDeau JT. How Real Are the Effects of Virtual Reality in Decreasing Acute Pain? Anesth Analg 2024; 138:746-750. [PMID: 38489794 DOI: 10.1213/ane.0000000000006698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Affiliation(s)
- Harsha Shanthanna
- From the Departments of Anesthesia
- Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacques T YaDeau
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| |
Collapse
|
4
|
Johnson RL, Slattery TJ. Processing difficulty while reading words with neighbors is not due to increased foveal load: Evidence from eye movements. Atten Percept Psychophys 2024:10.3758/s13414-024-02880-z. [PMID: 38532237 DOI: 10.3758/s13414-024-02880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
Words with high orthographic relatedness are termed "word neighbors" (angle/angel; birch/birth). Activation-based models of word recognition assume that lateral inhibition occurs between words and their activated neighbors. However, studies of eye movements during reading have not found inhibitory effects in early measures assumed to reflect lexical access (e.g., gaze duration). Instead, inhibition in eye-movement studies has been found in later measures of processing (e.g., total time, regressions in). We conducted an eye-movement boundary change study (Rayner, Cognitive Psychology, 7(1), 65-81, 1975) that manipulated the parafoveal preview of the word following the neighbor word (word N+1). In this way, we explored whether the late inhibitory effects seen with transposed letter words and words with higher-frequency neighbors result from reduced parafoveal preview due to increased foveal load and/or interference during late stages of lexical processing (the L2 stage within the E-Z Reader framework). For word N+1, while there were clear preview effects, there was not an effect of the neighborhood status of word N, nor a significant interaction. This suggests that the late inhibitory effects of earlier eye-movement studies are driven by misidentification of neighbor words rather than being due to increased foveal load.
Collapse
Affiliation(s)
- Rebecca L Johnson
- Department of Psychology, Neuroscience Program, Skidmore College, Saratoga Springs, NY, 12866, USA.
| | - Timothy J Slattery
- Psychology Department, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
| |
Collapse
|
5
|
Lee BH, Sideris A, Ladha KS, Johnson RL, Wu CL. Cannabis and Cannabinoids in the Perioperative Period. Anesth Analg 2024; 138:16-30. [PMID: 35551150 DOI: 10.1213/ane.0000000000006070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cannabis use is increasingly common, and with a growing number of jurisdictions implementing legalization frameworks, it is likely that providers will encounter more patients who use cannabis. Therefore, it is important for providers to understand the implications of cannabis use and practical considerations for the perioperative period. Cannabis affects multiple organ systems and may influence intraoperative anesthesia, as well as postoperative pain management. The effects of cannabis and key anesthetic considerations are reviewed here.
Collapse
Affiliation(s)
- Bradley H Lee
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Alexandra Sideris
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Karim S Ladha
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher L Wu
- From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| |
Collapse
|
6
|
El-Boghdadly K, Albrecht E, Wolmarans M, Mariano ER, Kopp S, Perlas A, Thottungal A, Gadsden J, Tulgar S, Adhikary S, Aguirre J, Agur AMR, Altıparmak B, Barrington MJ, Bedforth N, Blanco R, Bloc S, Boretsky K, Bowness J, Breebaart M, Burckett-St Laurent D, Carvalho B, Chelly JE, Chin KJ, Chuan A, Coppens S, Costache I, Dam M, Desmet M, Dhir S, Egeler C, Elsharkawy H, Bendtsen TF, Fox B, Franco CD, Gautier PE, Grant SA, Grape S, Guheen C, Harbell MW, Hebbard P, Hernandez N, Hogg RMG, Holtz M, Ihnatsenka B, Ilfeld BM, Ip VHY, Johnson RL, Kalagara H, Kessler P, Kwofie MK, Le-Wendling L, Lirk P, Lobo C, Ludwin D, Macfarlane AJR, Makris A, McCartney C, McDonnell J, McLeod GA, Memtsoudis SG, Merjavy P, Moran EML, Nader A, Neal JM, Niazi AU, Njathi-Ori C, O'Donnell BD, Oldman M, Orebaugh SL, Parras T, Pawa A, Peng P, Porter S, Pulos BP, Sala-Blanch X, Saporito A, Sauter AR, Schwenk ES, Sebastian MP, Sidhu N, Sinha SK, Soffin EM, Stimpson J, Tang R, Tsui BCH, Turbitt L, Uppal V, van Geffen GJ, Vermeylen K, Vlassakov K, Volk T, Xu JL, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks. Reg Anesth Pain Med 2023:rapm-2023-104884. [PMID: 38050174 DOI: 10.1136/rapm-2023-104884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/13/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. METHODS We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research. CONCLUSIONS We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.
Collapse
Affiliation(s)
| | - Eric Albrecht
- Department of Anaesthesia, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Anahi Perlas
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | - Jose Aguirre
- Ambulatory Center Europaallee, City Hospital Zurich, Zurich, Switzerland
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nigel Bedforth
- Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rafael Blanco
- Anaesthesia and Intensive Care, Corniche Hospital, Abu Dhabi, UAE
| | - Sébastien Bloc
- Anesthesiology Department, Clinique Drouot Sport, Paris, France
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Boston's Children's Hospital, Boston, Massachusetts, USA
| | - James Bowness
- Department of Anesthesia, Oxford University, Oxford, UK
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Margaretha Breebaart
- Department of Health Sciences, University of Antwerp, Antwerpen, Belgium
- Anesthesia, University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Jacques E Chelly
- Anesthesiology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Ki Jinn Chin
- Duke University Medical Center, Durham, North Carolina, USA
| | - Alwin Chuan
- Liverpool Hospital, Liverpool, New South Wales, Australia
- University of New South Wales, South West Sydney, New South Wales, Australia
| | - Steve Coppens
- Anesthesiology, KU Leuven University Hospitals, Leuven, Belgium
| | - Ioana Costache
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mette Dam
- Department of Anesthesia and Intensive Care, University Hospital Hvidore, Copenhagen, Denmark
| | | | - Shalini Dhir
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | | | | | | | - Ben Fox
- Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Carlo D Franco
- Anesthesiology, John H. Stroger Jr. Hospital of Cook Country, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Stuart Alan Grant
- Anesthesiology, The University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sina Grape
- Anesthesia, Hôpital du Valais, Sion, Switzerland
| | - Carrie Guheen
- Anesthesia, Hospital for Special Surgery, New York, New York, USA
| | | | - Peter Hebbard
- Department of Anesthesia Northeast Health, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary M G Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Margaret Holtz
- Anesthesia, WellStar Health System, Marietta, Georgia, USA
| | - Barys Ihnatsenka
- Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Brian M Ilfeld
- Anesthesia, University of California, La Jolla, California, USA
- Anesthesia, University of California San Diego, La Jolla, California, USA
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - M Kwesi Kwofie
- Department of Anesthesia, Perioperative Medicine and Pain Managaement, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Le-Wendling
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Philipp Lirk
- Dept. of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Clara Lobo
- Cleveland Clinic, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | | | | | - Colin McCartney
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Graeme A McLeod
- Department of Anaesthesia, NHS Tayside, Dundee, UK
- Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - E M Louise Moran
- Anaesthesia and Critical Care, Letterkenny University Hospital, Letterkenny, Ireland
| | - Antoun Nader
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph M Neal
- Anesthesiology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Ahtsham U Niazi
- Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Catherine Njathi-Ori
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Matt Oldman
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Steven L Orebaugh
- Anesthesiology, University of Pittsburgh Medical Center-Southside, Pittsburgh, Pennsylvania, USA
| | - Teresa Parras
- Anesthesiology, Critical Care, and Pain Medicine, Hospital Quironsalud, Malaga, Spain
| | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK
- Faculty of Life Sciences and Medicine, King's college London, London, UK
| | - Philip Peng
- Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Bridget P Pulos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
- Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Axel R Sauter
- Department of Anaesthesiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Eric S Schwenk
- Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Navdeep Sidhu
- Anesthesia and Perioperative Medicine, North shore Hospital, Auckland, New Zealand
| | - Sanjay Kumar Sinha
- Anesthesiology, Woodland Anesthesiology Associates, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - James Stimpson
- Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Raymond Tang
- Anesthesia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Lloyd Turbitt
- Department of Anesthesia, Belfast Health and Social Care trust, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | | | - Kris Vermeylen
- Anesthesia and Intensive Care, Algemeen Ziekenhuis Turnhout Campus Sint Elisabeth, Turnhout, Belgium
| | - Kamen Vlassakov
- Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Jeff L Xu
- Anesthesiology, New York Medical College, Valhalla, New York, USA
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nabil M Elkassabany
- Anesthesiology & Critical Care, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
7
|
Sarcon AK, Zhang W, Degnim AC, Johnson RL, Harmsen WS, Glasgow AE, Jakub JW. The Benefits of Local Anesthesia Used in Mastectomy Without Reconstruction. Am Surg 2023; 89:4271-4280. [PMID: 35656869 DOI: 10.1177/00031348221091959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND The opioid epidemic has driven renewed interest in local anesthesia to reduce postoperative opioid use. Our objective was to determine if local anesthesia decreased hospital pain scores, oral morphine equivalents (OME), length of stay (LOS), and nausea/vomiting. METHODS Single institution retrospective study of females who underwent mastectomy without reconstruction. RESULTS Overall, 712 patients were included; 63 (8.8%) received bupivacaine (B), 512 (72%) liposomal bupivacaine (LB), and 137 (19%) no local. 95% were discharged on POD1. Liposomal bupivacaine use increased from 2014 to 2019. Additional factors associated with use of local regimen were surgeon and extent of axillary surgery. Fewer patients used postop opioids during their hospital stay if any local was used compared to none (76 vs 88%; 0.003). Compared to none, local had shorter mean PACU LOS (95 vs 87 min; P = .02), lower mean intraoperative-OME (96 vs 106; P < .001), and lower mean postoperative OME/hr (1.4 vs 1.8 P = .001). Multivariable analysis (MVA) showed lower OME/hr with LB compared to B and none (P = .002); this translates to 22 mg and 30 mg of oxycodone in a 24-hr period, respectively. MVA showed lower POD1 pain scores with LB relative to none (P = .049). Local did not impact nausea/emesis. CONCLUSION Local anesthesia was superior to no local in several measures. However, a consistent benefit of a specific local anesthetic agent was not demonstrated (LB vs B). A prospective study is warranted to determine the optimal local regimen for this cohort and further inform clinical relevance.
Collapse
Affiliation(s)
- Aida K Sarcon
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Wenxia Zhang
- Department of Breast Surgery, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
- Department of Breast Surgery, Southern Medical University, Guangzhou, China
| | - Amy C Degnim
- Division of Breast & Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L Johnson
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - William S Harmsen
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Amy E Glasgow
- Department of Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, Fl, USA
| |
Collapse
|
8
|
Restrepo-Holguin M, Kopp SL, Johnson RL. Motor-sparing peripheral nerve blocks for hip and knee surgery. Curr Opin Anaesthesiol 2023; 36:541-546. [PMID: 37552001 DOI: 10.1097/aco.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients. RECENT FINDINGS Distal peripheral nerve blocks may allow for preserved quadriceps motor strength and comparable analgesia to traditional techniques. However, few studies in hip and knee populations include strength or function as primary outcomes. For hip surgeries, studies have failed to show analgesic differences between regional blocks and periarticular infiltration. Similarly for knee arthroplasty in the absence of periarticular infiltration, recent evidence suggests adding combinations of blocks (ACB plus iPACK or genicular nerve blocks) may balance pain control and early ambulation. SUMMARY The use of motor-sparing peripheral nerve block techniques enables early ambulation, adequate pain control, and avoidance of opioid-related side effects facilitating outpatient/ambulatory lower extremity surgery. Further studies of these techniques for continuous peripheral nerve block catheters are needed to assess if extended blockade continues to provide motor-sparing and opioid-sparing benefits.
Collapse
|
9
|
Johnson RL, Wootten M, Spear AI, Smolensky A. The Relationship Between Personality Traits and the Processing of Emotion Words: Evidence from Eye-Movements in Sentence Reading. J Psycholinguist Res 2023; 52:1497-1523. [PMID: 37084147 DOI: 10.1007/s10936-023-09959-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
Previous research shows that processing times on emotion words (both negative and positive) are faster than on non-emotional neutral words. In the current study, we explored how personality traits (the Big Five and the trait emotional intelligence factors) may further influence the processing of emotion versus non-emotion words by conducting two experiments where participants silently read sentences while their eye movements were recorded. The results replicated the facilitative emotion effect and showed that those with higher agreeableness scores had stronger emotion effects on positive words and those with higher extraversion scores, higher openness scores, higher agreeableness scores, lower sociability scores, and higher emotionality scores had stronger emotion effects on negative words. Furthermore, some personality traits also led to different ways that readers approach text, for example, through more risky reading strategies.
Collapse
Affiliation(s)
- Rebecca L Johnson
- Department of Psychology, Skidmore College, Saratoga Springs, NY, 12866, USA.
| | - Megan Wootten
- Department of Psychology, Skidmore College, Saratoga Springs, NY, 12866, USA
| | - Abigail I Spear
- Department of Psychology, Skidmore College, Saratoga Springs, NY, 12866, USA
| | - Ashley Smolensky
- Department of Psychology, Skidmore College, Saratoga Springs, NY, 12866, USA
| |
Collapse
|
10
|
Johnson RL, Koch C, Wootten M. Keep clam and carry on: Misperceptions of transposed-letter neighbours. Q J Exp Psychol (Hove) 2023:17470218231196409. [PMID: 37594188 DOI: 10.1177/17470218231196409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Previous research has provided evidence that readers experience processing difficulty when reading words that have a transposed-letter (TL) neighbour (e.g., TRAIL has the TL neighbour TRIAL). Here, we provide direct evidence that this interference is driven by explicit misidentifications of the word for its TL neighbour. Experiment 1 utilised an eye-tracking task in which participants read sentences aloud and reading errors were coded. Sentences had a target word that either (1) had a TL neighbour or (2) was a matched control word with no TL neighbour. In Experiment 2, participants identified words within sentences that they consciously misread and reported the interloper. In both experiments, readers explicitly misidentified many more of the TL words than control words, and most often for their TL neighbour. These findings support the idea that TL interference effects are due primarily to initial misperceptions and post-lexical checking rather than co-activation at the lexical level.
Collapse
Affiliation(s)
- Rebecca L Johnson
- Neuroscience Program, Department of Psychology, Skidmore College, Saratoga Springs, NY, USA
| | - Cara Koch
- Neuroscience Program, Department of Psychology, Skidmore College, Saratoga Springs, NY, USA
| | - Megan Wootten
- Neuroscience Program, Department of Psychology, Skidmore College, Saratoga Springs, NY, USA
| |
Collapse
|
11
|
Owen AR, Amundson AW, Larson DR, Duncan CM, Smith HM, Johnson RL, Taunton MJ, Pagnano MW, Berry DJ, Abdel MP. Spinal Versus General Anesthesia in Contemporary Revision Total Knee Arthroplasties. J Arthroplasty 2023; 38:S271-S274.e1. [PMID: 36773661 PMCID: PMC10433444 DOI: 10.1016/j.arth.2023.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Interest in spinal anesthesia utilization in revision total knee arthroplasties (TKAs) is rising. This study investigated the pain control, length of stay (LOS), and complications associated with spinal versus general anesthesia in a single institution series of revision TKAs. METHODS We identified 3,711 revision TKAs (3,495 patients) from 2001 to 2016 using our institutional total joint registry. There were 66% who had general anesthesia and 34% who had spinal anesthesia. Mean age, sex, and BMI were similar between groups at 67 years, 53% women, and 32, respectively. Data were analyzed using inverse probability of treatment weighted models based on propensity scores that accounted for patient and operative factors. Mean follow-up was 6 years (range, 2 to 17). RESULTS Patients treated with spinal anesthesia required fewer postoperative oral morphine equivalents (OMEs) (P < .0001) and had lower numeric pain rating scale scores (P < .001). Spinal anesthesia was associated with shorter LOS (4.0 versus 4.6 days; P < .0001), less cases of altered mental status (AMS; Odds Ratio (OR) 2.0, P = .004), less intensive care unit (ICU) admissions (OR 1.6, P = .02), fewer re-revisions (OR 1.7, P < .001), and less reoperations (OR 1.4, P < .001). There was no difference in the incidence of VTE (P = .82), 30-day readmissions (P = .06), or 90-day readmissions (P = .18) between anesthetic techniques. CONCLUSION We found that spinal anesthesia for revision TKAs was associated with significantly lower pain scores, reduced OME requirements, and decreased LOS. Furthermore, spinal anesthesia was associated with fewer cases of AMS, ICU admissions, and re-revisions even after accounting for numerous patient and operative factors. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
Collapse
Affiliation(s)
- Aaron R. Owen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Adam W. Amundson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Dirk R. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Christopher M. Duncan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Hugh M. Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Rebecca L. Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Michael J. Taunton
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Mark W. Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| |
Collapse
|
12
|
Zhu Z, Johnson RL, Zhang Z, Herring LE, Jiang G, Damania B, James LI, Liu P. Development of VHL-recruiting STING PROTACs that suppress innate immunity. Cell Mol Life Sci 2023; 80:149. [PMID: 37183204 DOI: 10.1007/s00018-023-04796-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
STING acts as a cytosolic nucleotide sensor to trigger host defense upon viral or bacterial infection. While STING hyperactivation can exert anti-tumor effects by increasing T cell filtrates, in other contexts hyperactivation of STING can contribute to autoimmune and neuroinflammatory diseases. Several STING targeting agonists and a smaller subset of antagonists have been developed, yet STING targeted degraders, or PROTACs, remain largely underexplored. Here, we report a series of STING-agonist derived PROTACs that promote STING degradation in renal cell carcinoma (RCC) cells. We show that our STING PROTACs activate STING and target activated/phospho-STING for degradation. Locking STING on the endoplasmic reticulum via site-directed mutagenesis disables STING translocation to the proteasome and resultingly blocks STING degradation. We also demonstrate that PROTAC treatment blocks downstream innate immune signaling events and attenuates the anti-viral response. Interestingly, we find that VHL acts as a bona fide E3 ligase for STING in RCC; thus, VHL-recruiting STING PROTACs further promote VHL-dependent STING degradation. Our study reveals the design and biological assessment of VHL-recruiting agonist-derived STING PROTACs, as well as demonstrates an example of hijacking a physiological E3 ligase to enhance target protein degradation via distinct mechanisms.
Collapse
Affiliation(s)
- Zhichuan Zhu
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Biochemistry and Biophysics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Rebecca L Johnson
- Center for Integrative Chemical Biology and Drug Discovery, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Zhigang Zhang
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Laura E Herring
- UNC Proteomics Core Facility, Department of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Guochun Jiang
- Department of Biochemistry and Biophysics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Blossom Damania
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- University of North Carolina Center for AIDS Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lindsey I James
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Center for Integrative Chemical Biology and Drug Discovery, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Pengda Liu
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Biochemistry and Biophysics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
13
|
Abuogi L, Smith C, Kinzie K, Barr E, Bonham A, Johnson RL, Dinnebeil M, McFarland E, Weinberg A. Development and implementation of an interdisciplinary model for the management of breastfeeding in women with HIV in the United States: experience from the Children's Hospital Colorado Immunodeficiency Program. J Acquir Immune Defic Syndr 2023:00126334-990000000-00230. [PMID: 37104739 DOI: 10.1097/qai.0000000000003213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Women with HIV in high-income settings have increasingly expressed a desire to breastfeed their infants. While national guidelines now acknowledge this choice, detailed recommendations are not available. We describe the approach to managing care for breastfeeding women with HIV at a single large-volume site in the US. METHODS We convened an interdisciplinary group of providers to establish a protocol intended to minimize the risk of vertical transmission during breastfeeding. Programmatic experience and challenges are described. A retrospective chart review was conducted to report the characteristics of women who desired to or who did breastfeed between 2015-2022 and their infants. RESULTS Our approach stresses the importance of early conversations about infant feeding, documentation of feeding decisions and management plans, and communication among the healthcare team. Mothers are encouraged to maintain excellent adherence to antiretroviral treatment, maintain an undetectable viral load, and breastfeed exclusively. Infants receive continuous single drug antiretroviral prophylaxis until four weeks after cessation of breastfeeding. From 2015-2022, we counseled 21 women interested in breastfeeding, of whom 10 women breastfed 13 infants for a median of 62 days (range, 1-309). Challenges included mastitis (N=3), need for supplementation (N=4), maternal plasma viral load elevation of 50 to 70 copies/mL (N=2), and difficulty weaning (N=3). Six infants experienced at least 1 adverse event, most of which were attributed to antiretroviral prophylaxis. DISCUSSION Many knowledge gaps remain in the management of breastfeeding among women with HIV in high-income settings, including approaches to infant prophylaxis. An interdisciplinary approach to minimizing risk is needed.
Collapse
Affiliation(s)
- Lisa Abuogi
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Christiana Smith
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Kay Kinzie
- Children's Hospital Colorado, Aurora, CO, USA
| | - Emily Barr
- UT Health Houston, Cizik School of Nursing, Houston, TX, USA
| | - Adrianne Bonham
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - R L Johnson
- Contributing community member, Aurora, CO, USA
| | | | | | - Adriana Weinberg
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
- Departments of Medicine and Pathology, University of Colorado, Aurora, CO, USA
| |
Collapse
|
14
|
Owen AR, Amundson AW, Fruth KM, Duncan CM, Smith HM, Johnson RL, Taunton MJ, Pagnano MW, Berry DJ, Abdel MP. Spinal versus General Anesthesia in Contemporary Revision Total Hip Arthroplasties. J Arthroplasty 2023:S0883-5403(23)00240-1. [PMID: 36931357 DOI: 10.1016/j.arth.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Spinal anesthesia is increasingly used in complex patient populations including revision total hip arthroplasties (THAs). This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anesthesia in a large institutional series of revision THAs. METHODS We retrospectively identified 4,767 revision THAs (4,533 patients) from 2001 to 2016 using our institutional total joint registry. Of these cases, 86% had general and 14% had spinal anesthesia. Demographics between groups were similar with mean age of 66 years, 52% women, and mean BMI of 29. Complications including all-cause re-revisions and reoperations were studied. Data were analyzed using an inverse probability of treatment weighted model based on propensity score that accounted for patient and surgical factors. The mean follow-up was 7 years. RESULTS Patients treated with spinal anesthesia required fewer postoperative oral morphine equivalents (OMEs) (P<0.001) and had lower numeric pain rating scale scores (P<0.001). Spinal anesthesia had a decreased LOS (4.2 vs. 4.8 days; P=0.007), fewer cases of altered mental status (AMS; Odds Ratio (OR) 3.1, P=0.001), fewer blood transfusions (OR 2.3, P<0.001), fewer intensive care unit (ICU) admissions (OR 2.3, P<0.001), fewer re-revisions (OR 1.6, P=0.04), and fewer reoperations (OR 1.5, P=0.02). DISCUSSION Spinal anesthesia was associated with lower OME use and reduced LOS in this large cohort of revision THAs. Furthermore, spinal anesthesia was associated with fewer cases of AMS, transfusion, ICU admission, re-revision, and reoperation after accounting for numerous patient and operative factors.
Collapse
Affiliation(s)
- Aaron R Owen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Adam W Amundson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Kristin M Fruth
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Christopher M Duncan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Hugh M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| |
Collapse
|
15
|
Belzer A, Becerra C, Clune J, Malik M, Leventhal JS, Cowper SE, Johnson RL. Histopathologic features and immunohistochemistry findings to assist the dermatopathologist in differentiating melanocytic matrical carcinoma from melanoma. J Cutan Pathol 2023; 50:471-474. [PMID: 36645720 DOI: 10.1111/cup.14376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Annika Belzer
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Carla Becerra
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - James Clune
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mohsin Malik
- Dermatology Physicians of Connecticut, Shelton, Connecticut, USA
| | | | - Shawn E Cowper
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rebecca L Johnson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
16
|
Valencia Morales DJ, Laporta ML, Johnson RL, Schroeder DR, Sprung J, Weingarten TN. A Case-Control Study of Accidental Falls During Surgical Hospitalizations. Am Surg 2023; 89:61-68. [PMID: 33870764 DOI: 10.1177/00031348211011114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postoperative falls are preventable complications. The study aims were to describe the rate and circumstances surrounding postoperative falls and explore potential associations with patient and procedural characteristics with emphasis on the use of sedative medications. METHODS Medical records of hospitalized patients undergoing non-lower extremity surgery under general anesthesia from January 1, 2010, through April 30, 2018 were reviewed for falls within 72 postoperative hours. Perioperative use of sedatives, sleep aids, gabapentinoids, and opioids were abstracted. Each fall case was matched with two controls on age, sex, and procedure type. Descriptive statistics and multivariable analysis accounting for the matched design were performed. RESULTS There were 343 falls among 200 186 hospitalized surgical patients (incidence of 17.1 [95% CI: 15.4, 19.0] falls per 10 000 procedures) with largest proportion of falls occurring on postoperative day 2 (n = 134, 39.1%). Most falls occurred in the general hospital wards (n = 304, 88.6%) and were unwitnessed (n = 186, 55.9%). The incidence of major injuries was 1.0 (95% CI: .1 - 3.6) per 100 000 procedures. Home use of non-benzodiazepine hypnotics (odds ratio 2.68, 95% CI: 1.47, 4.88, P=.001) and blood transfusions were associated with increased fall risk. Hospital stay was longer in patients who fall (7 [4, 15] vs. 5 [3, 9] days, P < .001). CONCLUSIONS The rate of postoperative falls in our institution was low and frequently unwitnessed. The use of non-benzodiazepine hypnotics is a modifiable risk factor associated with postoperative falls. Serious complications after falls were rare.
Collapse
Affiliation(s)
- Diana J Valencia Morales
- Departments of Anesthesiology and Perioperative Medicine, and Health Sciences Research, Rochester, MN, USA6915
| | - Mariana L Laporta
- Departments of Anesthesiology and Perioperative Medicine, and Health Sciences Research, Rochester, MN, USA6915
| | - Rebecca L Johnson
- Departments of Anesthesiology and Perioperative Medicine, and Health Sciences Research, Rochester, MN, USA6915
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, 6915Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Juraj Sprung
- Departments of Anesthesiology and Perioperative Medicine, and Health Sciences Research, Rochester, MN, USA6915
| | - Toby N Weingarten
- Departments of Anesthesiology and Perioperative Medicine, and Health Sciences Research, Rochester, MN, USA6915
| |
Collapse
|
17
|
Shell DJ, Rectenwald JM, Buttery PH, Johnson RL, Foley CA, Guduru SKR, Uguen M, Rubiano JS, Zhang X, Li F, Norris-Drouin JL, Axtman M, Brian Hardy P, Vedadi M, Frye SV, James LI, Pearce KH. Discovery of hit compounds for methyl-lysine reader proteins from a target class DNA-encoded library. SLAS Discov 2022; 27:428-439. [PMID: 36272689 DOI: 10.1016/j.slasd.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
Methyl-lysine (Kme) reader domains are prevalent in chromatin regulatory proteins which bind post-translational modification sites to recruit repressive and activating factors; therefore, these proteins play crucial roles in cellular signaling and epigenetic regulation. Proteins that contain Kme domains are implicated in various diseases, including cancer, making them attractive therapeutic targets for drug and chemical probe discovery. Herein, we report on expanding the utility of a previously reported, Kme-focused DNA-encoded library (DEL), UNCDEL003, as a screening tool for hit discovery through the specific targeting of Kme reader proteins. As an efficient method for library generation, focused DELs are designed based on structural and functional features of a specific class of proteins with the intent of novel hit discovery. To broadly assess the applicability of our library, UNCDEL003 was screened against five diverse Kme reader protein domains (53BP1 TTD, KDM7B JmjC-PHD, CDYL2 CD, CBX2 CD, and LEDGF PWWP) with varying structures and functions. From these screening efforts, we identified hit compounds which contain unique chemical scaffolds distinct from previously reported ligands. The selected hit compounds were synthesized off-DNA and confirmed using primary and secondary assays and assessed for binding selectivity. Hit compounds from these efforts can serve as starting points for additional development and optimization into chemical probes to aid in further understanding the functionality of these therapeutically relevant proteins.
Collapse
Affiliation(s)
- Devan J Shell
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Justin M Rectenwald
- School of Medicine, Department of Biochemistry and Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Peter H Buttery
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca L Johnson
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Caroline A Foley
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Shiva K R Guduru
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mélanie Uguen
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Juanita Sanchez Rubiano
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Xindi Zhang
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Fengling Li
- Structural Genomics Consortium, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Jacqueline L Norris-Drouin
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Matthew Axtman
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - P Brian Hardy
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Masoud Vedadi
- Structural Genomics Consortium, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Stephen V Frye
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lindsey I James
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kenneth H Pearce
- UNC Eshelman School of Pharmacy, Center for Integrative Chemical Biology and Drug Discovery, Chemical Biology and Medicinal Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| |
Collapse
|
18
|
Owen AR, Amundson AW, Larson DR, Duncan CM, Smith HM, Johnson RL, Taunton MJ, Pagnano MW, Berry DJ, Abdel MP. Spinal versus general anaesthesia in contemporary primary total knee arthroplasties. Bone Joint J 2022; 104-B:1209-1214. [DOI: 10.1302/0301-620x.104b11.bjj-2022-0469.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Aims Spinal anaesthesia has seen increased use in contemporary primary total knee arthroplasties (TKAs). However, controversy exists about the benefits of spinal in comparison to general anaesthesia in primary TKAs. This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anaesthesia in primary TKAs from a single, high-volume academic centre. Methods We retrospectively identified 17,690 primary TKAs (13,297 patients) from 2001 to 2016 using our institutional total joint registry, where 52% had general anaesthesia and 48% had spinal anaesthesia. Baseline characteristics were similar between cohorts with a mean age of 68 years (SD 10), 58% female (n = 7,669), and mean BMI of 32 kg/m2 (SD 7). Pain was evaluated using oral morphine equivalents (OMEs) and numerical pain rating scale (NPRS) data. Complications including 30- and 90-day readmissions were studied. Data were analyzed using an inverse probability of treatment weighted model based on propensity score that included many patient and surgical factors. Mean follow-up was seven years (2 to 18). Results Patients treated with spinal anaesthesia required fewer postoperative OMEs (p < 0.001) and had lower NPRS scores (p < 0.001). Spinal anaesthesia also had fewer cases of altered mental status (AMS; odds ratio (OR) 1.3; p = 0.044), as well as 30-day (OR 1.4; p < 0.001) and 90-day readmissions (OR 1.5; p < 0.001). General anaesthesia was associated with increased risk of any revision (OR 1.2; p = 0.021) and any reoperation (1.3; p < 0.001). Conclusion In the largest single institutional report to date, we found that spinal anaesthesia was associated with significantly lower OME use, lower risk of AMS, and lower overall 30- and 90-day readmissions following primary TKAs. Additionally, spinal anaesthesia was associated with reduced risk of any revision and any reoperation after accounting for numerous patient and operative factors. When possible and safe, spinal anaesthesia should be considered in primary TKAs. Cite this article: Bone Joint J 2022;104-B(11):1209–1214.
Collapse
Affiliation(s)
- Aaron R. Owen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam W. Amundson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dirk R. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher M. Duncan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hugh M. Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca L. Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W. Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
19
|
Cohen MB, Saint Martin M, Gross DJ, Johnson K, Robboy SJ, Wheeler TM, Johnson RL, Black-Schaffer WS. Features of burnout amongst pathologists: A reassessment. Acad Pathol 2022; 9:100052. [PMID: 36247711 PMCID: PMC9554805 DOI: 10.1016/j.acpath.2022.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 10/29/2022] Open
Abstract
There has been little rigorous assessment of burnout among pathologists and pathology trainees. Given this relative dearth of relevant literature on pathologist burnout, this report aims to raise awareness of the issue among those working in and around this specialty. Our results are based on a survey given in conjunction with the American Board of Pathology's (ABPath) biennial Continuing Certification (CC) reporting of activities required of diplomates to maintain certification. The survey was voluntary, open to all diplomates participating in CC, and conducted over two consecutive years (2019 and 2020), with alternate years comprising different sets of diplomates. The data are based on 1256 respondents (820 from 2019 to 436 from 2020). The three highest aggregate reported rates of burnout (reported as experienced nearly all of the time, most of the time, or part of the time) occurred when respondents were in their first year of residency training (41.1%) and when they were in (47.6%) and beyond (46.6%) their first three years of practice. We considered this high-low-high, or U-shaped distribution in recollected burnout over time among pathologists a notable finding and investigated its distribution among respondents. Conversely at every point in their training and practice, from half to three-quarters of respondents reported never or infrequently experiencing burnout. This study represents the largest pathologist cohort survey to date about pathologists' burnout. Importantly, especially for those considering pathology as a career, these data are on the low end of the distribution of burnout among specialties for those in practice.
Collapse
Affiliation(s)
- Michael B. Cohen
- Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest, NC, USA,Corresponding author. Department of Pathology, Medical Center Boulevard, Atrium Health Wake Forest Baptist, Winston-Salem, NC, 27157, USA.
| | | | - David J. Gross
- Policy Roundtable, College of American Pathologists, Washington, DC, USA
| | - Kristen Johnson
- CAP Learning, College of American Pathologists, Northfield, IL, USA
| | | | - Thomas M. Wheeler
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | | | | |
Collapse
|
20
|
Owen AR, Amundson AW, Fruth KM, Duncan CM, Smith HM, Johnson RL, Taunton MJ, Pagnano MW, Berry DJ, Abdel MP. Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties. J Bone Joint Surg Am 2022; 104:1542-1547. [PMID: 35726967 DOI: 10.2106/jbjs.22.00280] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The specific advantages of spinal anesthesia compared with general anesthesia for primary total hip arthroplasty (THA) remains unknown. Therefore, this study aimed to investigate the pain control, length of stay, and postoperative outcomes associated with spinal anesthesia compared with general anesthesia in a large cohort of primary THAs from a single, high-volume academic institution. METHODS We retrospectively identified 13,730 primary THAs (11,319 patients) from 2001 to 2016 using our total joint registry. Of these cases, 58% had general anesthesia and 42% had spinal anesthesia. The demographic characteristics were similar between groups, with mean age of 64 years, 51% female, and mean body mass index (BMI) of 31 kg/m 2 . Data were analyzed using an inverse probability of treatment weighted model based on a propensity score that accounted for numerous patient and operative factors. The mean follow-up was 6 years. RESULTS Patients treated with spinal anesthesia had lower Numeric Pain Rating Scale (NPRS) scores (p < 0.001) and required fewer postoperative oral morphine equivalents (OMEs) at all time points evaluated (p < 0.001). Patients treated with spinal anesthesia also had shorter hospital length of stay (p = 0.02), fewer altered mental status events (odds ratio [OR], 0.7; p = 0.02), and fewer intensive care unit (ICU) admissions (OR, 0.7; p = 0.01). There was no difference in the incidence of deep vein thrombosis (p = 0.8), pulmonary embolism (p = 0.4), 30-day readmissions (p = 0.17), 90-day readmissions (p = 0.18), all-cause revisions (p = 0.17), or all-cause reoperations (p = 0.14). CONCLUSIONS In this large, single-institution study, we found that spinal anesthesia was associated with reduced pain scores and OME use postoperatively. Furthermore, spinal anesthesia resulted in fewer altered mental status events and ICU admissions. These data favor the use of spinal anesthesia in primary THAs. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Aaron R Owen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Adam W Amundson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kristin M Fruth
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Christopher M Duncan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hugh M Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
21
|
Ahmed HM, Atterton BP, Crowe GG, Barratta JL, Johnson M, Viscusi E, Adhikary S, Albrecht E, Boretsky K, Boublik J, Breslin DS, Byrne K, Ch'ng A, Chuan A, Conroy P, Daniel C, Daszkiewicz A, Delbos A, Dirzu DS, Dmytriiev D, Fennessy P, Fischer HBJ, Frizelle H, Gadsden J, Gautier P, Gupta RK, Gürkan Y, Hardman HD, Harrop-Griffiths W, Hebbard P, Hernandez N, Hlasny J, Iohom G, Ip VHY, Jeng CL, Johnson RL, Kalagara H, Kinirons B, Lansdown AK, Leng JC, Lim YC, Lobo C, Ludwin DB, Macfarlane AJR, Machi AT, Mahon P, Mannion S, McLeod DH, Merjavy P, Miscuks A, Mitchell CH, Moka E, Moran P, Ngui A, Nin OC, O'Donnell BD, Pawa A, Perlas A, Porter S, Pozek JP, Rebelo HC, Roqués V, Schroeder KM, Schwartz G, Schwenk ES, Sermeus L, Shorten G, Srinivasan K, Stevens MF, Theodoraki K, Turbitt LR, Valdés-Vilches LF, Volk T, Webster K, Wiesmann T, Wilson SH, Wolmarans M, Woodworth G, Worek AK, Moran EML. Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project. Reg Anesth Pain Med 2022; 47:301-308. [PMID: 35193970 PMCID: PMC8961753 DOI: 10.1136/rapm-2021-103136] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/10/2022] [Indexed: 01/09/2023]
Abstract
Background and objectives Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%–74% agreement. Results Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.
Collapse
Affiliation(s)
- Hassan M Ahmed
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Benjamin P Atterton
- Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Gillian G Crowe
- Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Jaime L Barratta
- Department of Anesthesiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Mark Johnson
- Department of Anaesthesia, Fiona Stanley Hospital and Freemantle Hospitals, Perth, Western Australia, Australia
| | - Eugene Viscusi
- Department of Anesthesiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sanjib Adhikary
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Eric Albrecht
- Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Karen Boretsky
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jan Boublik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Dara S Breslin
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Kelly Byrne
- Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
| | - Alan Ch'ng
- Department of Anaesthesia, Fiona Stanley Hospital and Freemantle Hospitals, Perth, Western Australia, Australia
| | - Alwin Chuan
- Department of Anaesthesia, Liverpool Hospital, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Patrick Conroy
- Department of Anaesthesia, Tallaght University Hospital, Dublin, Ireland
| | - Craig Daniel
- Department of Anaesthesia and Pain Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Andrzej Daszkiewicz
- Faculty of Medical Sciences, Unit of Pain Research and Treatment, Medical University of Silesia, Zabrze, Poland
| | - Alain Delbos
- Department of Anaesthesia, Clinique Medipole Garonne, Toulouse, France
| | - Dan Sebastian Dirzu
- Department of Anesthesia and Intensive Care, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
| | - Dmytro Dmytriiev
- Department of Anaesthesiology, Intensive Care and Pain Medicine, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Paul Fennessy
- Department of Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - H Barrie J Fischer
- Retired Consultant Anaesthetist, Worcester Royal Hospital, Worcester, UK
| | - Henry Frizelle
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jeff Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Philippe Gautier
- Department of Anesthesia, Clinique Sainte Anne Saint Remi, Bruxelles, Belgium
| | - Rajnish K Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yavuz Gürkan
- Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Turkey
| | - Harold David Hardman
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Peter Hebbard
- Ultrasound Education Unit, University of Melbourne, Melbourne, Victoria, Australia.,Department of Anaesthesia, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Department of Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Jakub Hlasny
- Department of Anaesthesiology and Intensive Care, F D Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Christina L Jeng
- Department of Anesthesiology, Perioperative and Pain Medicine and Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Brian Kinirons
- Department of Anaesthesia, Galway University Hospitals, Galway, Ireland
| | | | - Jody C Leng
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care, Stanford, California, USA
| | - Yean Chin Lim
- Department of Anesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
| | - Clara Lobo
- Department of Anaesthesia, Hospital das Forças Armadas, Porto, Portugal
| | - Danielle B Ludwin
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alan James Robert Macfarlane
- Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary, Glasgow, UK.,School of Medicine, University of Glasgow, Glasgow, UK
| | - Anthony T Machi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Padraig Mahon
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | - Stephen Mannion
- Department of Anaesthesia, South Infirmary Victoria University Hospital, Cork, Ireland
| | - David H McLeod
- Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Peter Merjavy
- Department of Anaesthesia, Craigavon Area University Teaching Hospital, Craigavon, UK
| | - Aleksejs Miscuks
- Department of Anaesthesiology, Hospital of Traumatology and Orthopaedics, University of Latvia, Riga, Latvia
| | - Christopher H Mitchell
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Eleni Moka
- Department of Anaesthesiology, Creta InterClinic Hospital, Hellenic Healthcare Group, Heraklion-Crete, Greece
| | - Peter Moran
- Department of Anaesthesia, Galway University Hospitals, Galway, Ireland
| | - Ann Ngui
- Department of Anaesthesia, Fiona Stanley Hospital and Freemantle Hospitals, Perth, Western Australia, Australia
| | - Olga C Nin
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Brian D O'Donnell
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | - Amit Pawa
- Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anahi Perlas
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven Porter
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - John-Paul Pozek
- Department of Anesthesiology, University of Kansas Health System, Kansas City, Kansas, USA
| | - Humberto C Rebelo
- Department of Anaesthesiology, Hospital Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Vicente Roqués
- Department of Anaesthesia and Intensive Care Medicine, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Kristopher M Schroeder
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gary Schwartz
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Luc Sermeus
- Department of Anesthesia, Cliniques Universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium
| | - George Shorten
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital, Cork, Ireland.,School of Medicine, University College Cork, Cork, Ireland.,Insight II, SFI Research Centre, Cork, Ireland
| | | | - Markus F Stevens
- Department of Anesthesiology, Amsterdam Univeristy Medical Centers, Amsterdam, Netherlands
| | - Kassiani Theodoraki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece
| | - Lloyd R Turbitt
- Department of Anaesthesia, Royal Victoria Hospital, Belfast, UK
| | | | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital, Homburg, Germany.,Faculty of Medicine, Saarland University, Homburg, Germany
| | - Katrina Webster
- Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - T Wiesmann
- Department of Anesthesiology & Intensive Care Medicine, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany.,Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum, Schwäbisch Hall, Germany
| | - Sylvia H Wilson
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Morné Wolmarans
- Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Glenn Woodworth
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - E M Louise Moran
- Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| |
Collapse
|
22
|
Simpson JB, Sekela JJ, Graboski AL, Borlandelli VB, Bivins MM, Barker NK, Sorgen AA, Mordant AL, Johnson RL, Bhatt AP, Fodor AA, Herring LE, Overkleeft H, Lee JR, Redinbo MR. Metagenomics combined with activity-based proteomics point to gut bacterial enzymes that reactivate mycophenolate. Gut Microbes 2022; 14:2107289. [PMID: 35953888 PMCID: PMC9377255 DOI: 10.1080/19490976.2022.2107289] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023] Open
Abstract
Mycophenolate mofetil (MMF) is an important immunosuppressant prodrug prescribed to prevent organ transplant rejection and to treat autoimmune diseases. MMF usage, however, is limited by severe gastrointestinal toxicity that is observed in approximately 45% of MMF recipients. The active form of the drug, mycophenolic acid (MPA), undergoes extensive enterohepatic recirculation by bacterial β-glucuronidase (GUS) enzymes, which reactivate MPA from mycophenolate glucuronide (MPAG) within the gastrointestinal tract. GUS enzymes demonstrate distinct substrate preferences based on their structural features, and gut microbial GUS enzymes that reactivate MPA have not been identified. Here, we compare the fecal microbiomes of transplant recipients receiving MMF to healthy individuals using shotgun metagenomic sequencing. We find that neither microbial composition nor the presence of specific structural classes of GUS genes are sufficient to explain the differences in MPA reactivation measured between fecal samples from the two cohorts. We next employed a GUS-specific activity-based chemical probe and targeted metaproteomics to identify and quantify the GUS proteins present in the human fecal samples. The identification of specific GUS enzymes was improved by using the metagenomics data collected from the fecal samples. We found that the presence of GUS enzymes that bind the flavin mononucleotide (FMN) is significantly correlated with efficient MPA reactivation. Furthermore, structural analysis identified motifs unique to these FMN-binding GUS enzymes that provide molecular support for their ability to process this drug glucuronide. These results indicate that FMN-binding GUS enzymes may be responsible for reactivation of MPA and could be a driving force behind MPA-induced GI toxicity.
Collapse
Affiliation(s)
- Joshua B. Simpson
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josh J. Sekela
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda L. Graboski
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valentina B. Borlandelli
- Department of Bioorganic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Marissa M. Bivins
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalie K. Barker
- UNC Proteomics Core Facility, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alicia A. Sorgen
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Angie L. Mordant
- UNC Proteomics Core Facility, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca L. Johnson
- Center for Integrative Chemical Biology and Drug Discovery, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aadra P. Bhatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony A. Fodor
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Laura E. Herring
- UNC Proteomics Core Facility, Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hermen Overkleeft
- Department of Bioorganic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - John R. Lee
- Department of Medicine, Division of Nephrology and Hypertension, New York, New York, USA
| | - Matthew. R. Redinbo
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biochemistry and Biophysics, Department of Microbiology and Immunology, and the Institute for Biological and Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
23
|
Johnson RL, Frank RD, Abdel MP, Habermann EB, Chamberlain AM, Mantilla CB. Frailty Transitions One Year After Total Joint Arthroplasty: A Cohort Study. J Arthroplasty 2022; 37:10-18.e2. [PMID: 34531097 DOI: 10.1016/j.arth.2021.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total joint arthroplasty (TJA) is prevalent and offered to patients regardless of frailty status experiencing pain, disability, and functional decline. This study aims to describe changes in levels of frailty 1 year after TJA. METHODS We identified a retrospective cohort of adult patients undergoing primary TJA between 2005 and 2016 using an institutional total joint registry. Associations between categorized frailty deficit index (FI) and change in FI were analyzed using linear regression models. Mortality, deep periprosthetic joint infection, and reoperation were analyzed using time to event methods. RESULTS In total, 5341 patients (37.6% non-frail, 39.4% vulnerable, and 23.0% frail) with items necessary to determine FI at 1 year after TJA were included. Preoperatively, 29% of vulnerable patients improved to non-frail 1 year later, compared to only 11% regressing to frail. Four in 10 frail patients improved to vulnerable/non-frail. Improvements in activities of daily living (ADL) were more evident in frail and vulnerable patients, with >30% reduction in the percentage of patients expressing difficulties with walking, climbing stairs, and requiring ADL assistance 1 year after TJA. Increases in frailty 1 year after TJA were associated with significantly increased rates of mortality (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.24-1.82, P < .001), deep periprosthetic joint infection (HR 3.98, 95% CI 1.85-8.58, P < .001), and reoperation (HR 1.80, 95% CI 1.19-2.72, P = .005). CONCLUSION Frailty states are dynamic with patient frailty shown to be modifiable 1 year after TJA. Preoperative frailty measurement is an important step toward identifying those that may benefit most from TJA and for postoperative frailty surveillance.
Collapse
Affiliation(s)
- Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ryan D Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; Department of Health Sciences and Research, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Carlos B Mantilla
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
24
|
Mariano ER, Dickerson DM, Szokol JW, Harned M, Mueller JT, Philip BK, Baratta JL, Gulur P, Robles J, Schroeder KM, Wyatt KEK, Schwalb JM, Schwenk ES, Wardhan R, Kim TS, Higdon KK, Krishnan DG, Shilling AM, Schwartz G, Wiechmann L, Doan LV, Elkassabany NM, Yang SC, Muse IO, Eloy JD, Mehta V, Shah S, Johnson RL, Englesbe MJ, Kallen A, Mukkamala SB, Walton A, Buvanendran A. A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med 2021; 47:118-127. [PMID: 34552003 DOI: 10.1136/rapm-2021-103083] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/22/2022]
Abstract
The US Health and Human Services Pain Management Best Practices Inter-Agency Task Force initiated a public-private partnership which led to the publication of its report in 2019. The report emphasized the need for individualized, multimodal, and multidisciplinary approaches to pain management that decrease the over-reliance on opioids, increase access to care, and promote widespread education on pain and substance use disorders. The Task Force specifically called on specialty organizations to work together to develop evidence-based guidelines. In response to this report's recommendations, a consortium of 14 professional healthcare societies committed to a 2-year project to advance pain management for the surgical patient and improve opioid safety. The modified Delphi process included two rounds of electronic voting and culminated in a live virtual event in February 2021, during which seven common guiding principles were established for acute perioperative pain management. These principles should help to inform local action and future development of clinical practice recommendations.
Collapse
Affiliation(s)
- Edward R Mariano
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA .,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David M Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA.,Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Joseph W Szokol
- Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Michael Harned
- Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jeffrey T Mueller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Beverly K Philip
- American Society of Anesthesiologists, Schaumburg, Illinois, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jaime L Baratta
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Padma Gulur
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Robles
- Department of Urology, Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Karla E K Wyatt
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas, USA.,Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richa Wardhan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Todd S Kim
- Department of Orthopedic Surgery, Palo Alto Medical Foundation, Burlingame, California, USA
| | - Kent K Higdon
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Deepak G Krishnan
- Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Gary Schwartz
- AABP Integrative Pain Care, Brooklyn, New York, USA.,Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Lisa Wiechmann
- Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Lisa V Doan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Stephen C Yang
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Iyabo O Muse
- Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Jean D Eloy
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vikas Mehta
- Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Shalini Shah
- Department of Anesthesiology & Perioperative Care, University of California Irvine School of Medicine, Orange, California, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amanda Kallen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Ashley Walton
- American Society of Anesthesiologists, Washington, District of Columbia, USA
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
25
|
Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM, Mariano ER, Johnson RL, Go G, Hargett MJ, Lee BH, Wendel P, Brouillette M, Kim SJ, Baaklini L, Wetmore DS, Hong G, Goto R, Jivanelli B, Athanassoglou V, Argyra E, Barrington MJ, Borgeat A, De Andres J, El-Boghdadly K, Elkassabany NM, Gautier P, Gerner P, Gonzalez Della Valle A, Goytizolo E, Guo Z, Hogg R, Kehlet H, Kessler P, Kopp S, Lavand'homme P, Macfarlane A, MacLean C, Mantilla C, McIsaac D, McLawhorn A, Neal JM, Parks M, Parvizi J, Peng P, Pichler L, Poeran J, Poultsides L, Schwenk ES, Sites BD, Stundner O, Sun EC, Viscusi E, Votta-Velis EG, Wu CL, YaDeau J, Sharrock NE. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature. Reg Anesth Pain Med 2021; 46:971-985. [PMID: 34433647 DOI: 10.1136/rapm-2021-102750] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.
Collapse
Affiliation(s)
- Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Janis Bekeris
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Dace Bekere
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca L Johnson
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - George Go
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Mary J Hargett
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Bradley H Lee
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Pamela Wendel
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Mark Brouillette
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Sang Jo Kim
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Lila Baaklini
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Douglas S Wetmore
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Genewoo Hong
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Rie Goto
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Bridget Jivanelli
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Vassilis Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eriphili Argyra
- Faculty of Medicine, Aretaieion University Hospital, Athens, Greece
| | - Michael John Barrington
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Alain Borgeat
- Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Jose De Andres
- Anesthesia, Critical Care and Multidisciplinary Pain Management Department, Valencia University General Hospital, Valencia, Spain.,Anesthesia Unit, Surgical Specialties Department, School of Medicine, University of Valencia, Valencia, Spain
| | | | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University Of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philippe Gautier
- Department of Anesthesiology and Resuscitation, Clinique Sainte-Anne Saint-Remi, Brussels, Belgium
| | - Peter Gerner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Alejandro Gonzalez Della Valle
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Enrique Goytizolo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Zhenggang Guo
- Department of Anesthesiology, Peking Universtiy Shougang Hospital, Beijing, China
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Henrik Kehlet
- Department of Clinical Medicine, Rigshosp, Copenhagen, Denmark
| | - Paul Kessler
- Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Sandra Kopp
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Alan Macfarlane
- School of Medicine, Dentistry & Nursing, Glasgow Royal Infirmary and Stobhill Ambulatory Hospital, Glasgow, UK
| | - Catherine MacLean
- Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York, New York, USA.,Center for the Advancement of Value in Musculoskeletal Care, Weill Cornell Medical College, New York, New York, USA
| | - Carlos Mantilla
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexander McLawhorn
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Joseph M Neal
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA.,Benaroya Research Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Parks
- Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Javad Parvizi
- Orthopedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Philip Peng
- Anesthesia, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lukas Pichler
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Jashvant Poeran
- Orthopaedics/Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lazaros Poultsides
- Department of Orthopaedic Surgery, New York Langone Orthopaedic Hospital, New York, New York, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian D Sites
- Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire, USA
| | - Ottokar Stundner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria.,Department of Anesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Eric C Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eugene Viscusi
- Department of Anesthesiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Effrossyni Gina Votta-Velis
- Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Jacques YaDeau
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| | - Nigel E Sharrock
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Critical Care and Pain Management, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
26
|
El-Boghdadly K, Wolmarans M, Stengel AD, Albrecht E, Chin KJ, Elsharkawy H, Kopp S, Mariano ER, Xu JL, Adhikary S, Altıparmak B, Barrington MJ, Bloc S, Blanco R, Boretsky K, Børglum J, Breebaart M, Burckett-St Laurent D, Capdevila X, Carvalho B, Chuan A, Coppens S, Costache I, Dam M, Egeler C, Fajardo M, Gadsden J, Gautier PE, Grant SA, Hadzic A, Hebbard P, Hernandez N, Hogg R, Holtz M, Johnson RL, Karmakar MK, Kessler P, Kwofie K, Lobo C, Ludwin D, MacFarlane A, McDonnell J, McLeod G, Merjavy P, Moran E, O'Donnell BD, Parras T, Pawa A, Perlas A, Rojas Gomez MF, Sala-Blanch X, Saporito A, Sinha SK, Soffin EM, Thottungal A, Tsui BCH, Tulgar S, Turbitt L, Uppal V, van Geffen GJ, Volk T, Elkassabany NM. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med 2021; 46:571-580. [PMID: 34145070 DOI: 10.1136/rapm-2020-102451] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. METHODS We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement. RESULTS Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified. CONCLUSIONS Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.
Collapse
Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
| | - Angela D Stengel
- American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, USA
| | - Eric Albrecht
- Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Ki Jinn Chin
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Hesham Elsharkawy
- Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jeff L Xu
- Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Sanjib Adhikary
- Anesthesiology and Perioperative Medicine, Penn State, University Park, Pennsylvania, USA
| | | | | | - Sébastien Bloc
- Anesthesiology Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France.,Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, Île-de-France, France
| | - Rafael Blanco
- Anaesthesia and Intensive Care, King's College Hospital Dubai, Abu Dhabi, UAE
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts, USA
| | - Jens Børglum
- Department of Anesthesiology, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | | | | | - Xavier Capdevila
- Anesthesiology and Critical Care department, Hôpital Lapeyronie, Montpellier, Languedoc-Roussillon, France
| | | | - Alwin Chuan
- University of New South Wales Faculty of Medicine, Putney, New South Wales, Australia
| | | | - Ioana Costache
- Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Mette Dam
- Anaesthesiology, Zealand University Hospital Koge, Koge, Sjælland, Denmark
| | | | - Mario Fajardo
- Anesthesiology, Hospital Universitario de Mostoles, Mostoles, Madrid, Spain
| | - Jeff Gadsden
- Duke University Medical Center, Durham, North Carolina, USA
| | | | - Stuart Alan Grant
- Anesthesiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium.,NYSORA, New York, New York, USA
| | - Peter Hebbard
- Department of Anesthesia Northeast Health Wangaratta, Ultrasound Education Group, The University of Melbourne Rural Health Academic Centre - Wangaratta, Wangaratta, Victoria, Australia
| | - Nadia Hernandez
- Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoj Kumar Karmakar
- Department of Anesthesia and Intensice Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Paul Kessler
- Anesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Kwesi Kwofie
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Clara Lobo
- Anestesiologia, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | | | - Alan MacFarlane
- Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Graeme McLeod
- Department of Anaesthesia, Ninewells Hospital, Dundee, UK.,Instittute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | | | - Eml Moran
- Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Brian D O'Donnell
- Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | | | - Amit Pawa
- Department of Anaesthesia, St Thomas' Hospital, London, UK.,Regional Anaesthesia - UK, London, UK
| | - Anahi Perlas
- Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Andrea Saporito
- Anesthesia, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Switzerland
| | - Sanjay Kumar Sinha
- Anesthesiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | | | - Ban C H Tsui
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Serkan Tulgar
- Anesthesiology and reanimatiom, Maltepe Universitesi Tip Fakultesi, Maltepe, Turkey
| | - Lloyd Turbitt
- Royal Victoria Hospital Laboratory and Mortuary Services, Belfast, UK
| | - Vishal Uppal
- Anesthesia, Dalhousie University - Faculty of Health Professions, Halifax, Nova Scotia, Canada
| | - Geert J van Geffen
- Anesthesiology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany.,Saarland University, Saarbrucken, Saarland, Germany
| | - Nabil M Elkassabany
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
27
|
Pleticha J, Niesen AD, Kopp SL, Johnson RL. Caffeine supplementation as part of enhanced recovery after surgery pathways: a narrative review of the evidence and knowledge gaps. Can J Anaesth 2021; 68:876-879. [PMID: 33564991 DOI: 10.1007/s12630-021-01943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022] Open
Abstract
Caffeine is used daily by 85% of United States adults and caffeine withdrawal is a major cause of perioperative headache. Studies have shown that caffeine supplementation in chronic caffeinators reduces the incidence of perioperative headache. This narrative review discusses the perioperative implications of caffeine withdrawal and outlines the benefits of and strategies of caffeine supplementation in the perioperative period. It is time to "wake up and smell the coffee" on integration of caffeine into established enhanced recovery after surgery protocols as a mechanism to consistently provide perioperative caffeine replacement.
Collapse
Affiliation(s)
- Josef Pleticha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Adam D Niesen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Sandra L Kopp
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
28
|
Pulos BP, Johnson RL, Laughlin RS, Njathi-Ori CW, Kor TM, Schroeder DR, Warner ME, Habermann EB, Warner MA. Perioperative Ulnar Neuropathy: A Contemporary Estimate of Incidence and Risk Factors. Anesth Analg 2021; 132:1429-1437. [PMID: 33617180 DOI: 10.1213/ane.0000000000005407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Retrospective and prospective studies 2 decades ago from the authors' institution reported the incidence of perioperative ulnar neuropathy persisting for at least several months in a noncardiac adult surgical population to be between 30 and 40 per 100,000 cases. The aim of this project was to assess the incidence and explore risk factors for perioperative ulnar neuropathy in a recent cohort of patients from the same institution using a similar definition for ulnar neuropathy. METHODS We performed a retrospective incidence and case-control study of all adults (≥18 years) undergoing noncardiac procedures with anesthesia services between 2011 and 2015. Each incident case of persistent ulnar neuropathy within 6 months of surgery was matched by age, sex, procedure date, and procedure type to 5 surgical patient controls. For the case-control study, separate conditional logistic regression analyses were performed to assess specific risk factors including the patient's body position and arm position, as well as body mass index (BMI), surgical duration, and selected patient comorbidities. RESULTS Persistent ulnar neuropathy of at least 2 months duration was found in 22 of 324,124 anesthetics for patients who underwent these procedures during the study period for an incidence rate of 6.8 (95% confidence interval [CI], 4.3-10.3) per 100,000 anesthetics. The incidence of ulnar neuropathy was higher in men compared to women (10.7 vs 3.0 per 100,000; P = .016). From the matched case-control study, the odds of ulnar neuropathy increased with higher BMI (odds ratio [OR] = 1.67 [1.16-2.42] per 5 kg/m2 increase in BMI; P = .006), history of cancer (OR = 6.46 [1.64-25.49]; P = .008), longer procedures (OR = 1.53 [1.18-1.99] per hour; P = .001), and when 1 or both arms were tucked during surgery (OR = 6.16 [1.85-20.59]; P = .003). CONCLUSIONS The incidence of persistent perioperative ulnar neuropathy observed in this study was lower than the incidence reported 2 decades ago from the same institution and using a similar definition for ulnar neuropathy. Several of the previously reported risk factors continue to be associated with the development of persistent perioperative ulnar neuropathy, providing ongoing targets for practice changes that might further decrease the incidence of this problem.
Collapse
Affiliation(s)
- Bridget P Pulos
- From the Department of Anesthesiology and Perioperative Medicine
| | | | | | | | - Todd M Kor
- From the Department of Anesthesiology and Perioperative Medicine
| | - Darrell R Schroeder
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics
| | - Mary E Warner
- From the Department of Anesthesiology and Perioperative Medicine
| | | | - Mark A Warner
- From the Department of Anesthesiology and Perioperative Medicine
| |
Collapse
|
29
|
D'Souza RS, Langford BJ, Olsen DA, Johnson RL. Ultrasound-Guided Local Anesthetic Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee (IPACK) Block for Primary Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. Local Reg Anesth 2021; 14:85-98. [PMID: 34012290 PMCID: PMC8126972 DOI: 10.2147/lra.s303827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
Posterior knee pain after total knee arthroplasty (TKA) is common despite multimodal analgesia and regional anesthesia use. This review included randomized controlled trials (RCTs) comparing analgesic outcomes after inclusion of local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block versus pathways without iPACK. Electronic databases (MEDLINE, Cochrane Library, Web of Science, Scopus) were searched from inception to 10/11/2020. Eligible studies evaluated iPACK use on primary outcomes: opioid consumption and pain scores with movement. Secondary outcomes included rest pain, patient satisfaction, length of stay (LOS), gait distance, knee range of motion (ROM), and complications. Bias and quality were appraised using the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. Eight RCTs (777 patients) were included. iPACK block use demonstrated similar opioid consumption in the PACU (4/7 RCTs) and 24 hours after TKA (5/7 RCTs) compared to without iPACK (moderate-quality GRADE evidence). Additionally, iPACK block use demonstrated lower movement pain scores in PACU (3/5 RCTs) but similar or higher pain scores after 24 hours (5/7 RCTs; low-quality GRADE evidence). Studies consistently reported no difference in gait distance (4/4 RCTs) or complications (7/7 RCTs) between treatment arms (high-quality GRADE evidence), although differing effect estimates were observed with resting pain, satisfaction, LOS, and knee ROM. This review provides a foundation of knowledge on iPACK efficacy. While evidence does not currently support widespread inclusion of iPACK within enhanced recovery pathways for TKA, limitations suggest further study is warranted.
Collapse
Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Brendan J Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - David A Olsen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| |
Collapse
|
30
|
Black-Schaffer WS, Robboy SJ, Gross DJ, Crawford JM, Johnson K, Austin M, Karcher DS, Johnson RL, Powell SZ, Sanfrancesco J, Cohen MB. Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications. Acad Pathol 2021; 8:23742895211002816. [PMID: 33889716 PMCID: PMC8040604 DOI: 10.1177/23742895211002816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
This article presents findings from a 4-year series of surveys of new-in-practice pathologists, and a survey of physician employers of new pathologists, assessing how pathology graduate medical education prepares its graduates for practice. Using the methodology described in our previous study, we develop evidence for the importance of residency training for various practice areas, comparing findings over different practice settings, sizes, and lengths of time in practice. The principal findings are (1) while new-in-practice pathologists and their employers report residency generally prepared them well for practice, some areas—billing and coding, laboratory management, molecular pathology, and pathology informatics—consistently were identified as being important in practice but inadequately prepared for in residency; (2) other areas—autopsy pathology, and subspecialized apheresis and blood donor center blood banking services—consistently were identified as relatively unimportant in practice and excessively prepared for in residency; (3) the notion of a single comprehensive model for categorical training in residency is challenged by the disparity between broad general practice in some settings and narrower subspecialty practice in others; and (4) the need for preparation in some areas evolves during practice, raising questions about the appropriate mode and circumstance for training in these areas. The implications of these findings range from rebalancing the emphasis among practice areas in residency, to reconsidering the structure of graduate medical education in pathology to meet present and evolving future practice needs.
Collapse
Affiliation(s)
- W Stephen Black-Schaffer
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David J Gross
- College of American Pathologists, Washington, DC, USA
| | - James M Crawford
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Melissa Austin
- Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Donald S Karcher
- George Washington University Medical Center, Washington, DC, USA
| | | | - Suzanne Z Powell
- Weill Cornell Medical College Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | | | - Michael B Cohen
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
31
|
Johnson RL, Habermann EB, Johnson MQ, Abdel MP, Chamberlain AM, Mantilla CB. How Is Surgical Risk Best Assessed? A Cohort Comparison of Measures in Total Joint Arthroplasty. J Arthroplasty 2021; 36:851-856.e3. [PMID: 33071030 DOI: 10.1016/j.arth.2020.09.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We designed this study to determine whether a Frailty Deficit Index (FI) confers added risk stratification beyond more traditional methods. The associations of preoperative scores on FI, American Society of Anesthesiologists (ASA) physical status, and Charlson Comorbidity Index (CCI) with complications after total joint arthroplasty (TJA) were compared. METHODS Using a single institution cohort of adult patients ≥50 years undergoing primary or revision TJA from 2005 to 2016, we assessed how well the FI, CCI, and ASA scores predicted risk of mortality, infection, and reoperation. We performed 7 models for each outcome: FI, ASA, and CCI alone, FI + ASA, FI + CCI, ASA + CCI, and FI + ASA + CCI. Cox proportional hazards regression methods were used to calculate the concordance (C-) statistic, a measure of discrimination. RESULTS Of 18,397 TJAs included, 98.9% were alive 1 year postoperatively. For mortality, all models had concordance between 0.76 and 0.79, with the FI + ASA + CCI model performing highest (C-statistic 0.79; 95% confidence interval [CI] 0.76-0.82). Unadjusted, FI had the strongest concordance (C-statistic 0.77). In FI + ASA + CCI, each increase in 1 comorbidity (of 32 total comorbidities) in the FI was significantly associated with a 12% increase in the rate of mortality (hazard ratio [HR] 1.12, 95% CI 1.07-1.17, P < .001), 10% increase in infection (HR 1.10, 95% CI 1.06-1.14; P < .001), and 6% increase in reoperation (HR 1.06, 95% CI 1.05-1.08, P < .001). CONCLUSION Identifying at-risk patients preoperatively is crucial and may result in adjustment of postoperative care. FI was independently associated with risk of adverse outcomes following TJA even after taking into account other predictive measures.
Collapse
Affiliation(s)
- Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MA
| | - Elizabeth B Habermann
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Madeline Q Johnson
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Carlos B Mantilla
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MA
| |
Collapse
|
32
|
Ottolini KM, Litke-Wager CA, Johnson RL, Schulz EV. Serratia Chorioamnionitis and Culture Proven Sepsis in a Preterm Neonate: A Case Report and Review of the Literature. Pediatr Infect Dis J 2021; 40:e62-e65. [PMID: 33093431 DOI: 10.1097/inf.0000000000002962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Serratia marcescens is a well-known cause of nosocomial infectious outbreaks in the neonatal intensive care unit, with a high mortality rate in the vulnerable preterm population. However, it is not typically associated with neonatal sepsis secondary to intrapartum vertical transmission. We present the case of a preterm male born at 25 weeks and 4 days of gestation in Okinawa, Japan with culture-proven S. marcescens chorioamnionitis and sepsis, as well as a review of the previously published literature. METHODS We conducted a literature search utilizing MeSH indexing with the headings [chorioamnionitis], [Serratia], and [infant, newborn] limited to "humans" with a publication date range between 1950 and 2020. RESULTS All reported cases of preterm S. marcescens chorioamnionitis occurred in coastal locations. The majority of cases resulted in spontaneous abortion, and we found no published reports of confirmed S. marcescens chorioamnionitis in conjunction with viable preterm delivery and positive neonatal cultures. In the case presented herein, S. marcescens chorioamnionitis with associated neonatal sepsis was confirmed by positive placental and blood cultures. Bacterial clearance was achieved following an antibiotic course consisting of 5 days of gentamicin and 14 days of meropenem therapy. CONCLUSIONS S. marcescens is an uncommon cause of chorioamnionitis that can have devastating neonatal consequences, especially in the at-risk preterm population.
Collapse
Affiliation(s)
- Katherine M Ottolini
- From the Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
| | - Carrie A Litke-Wager
- From the Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
| | - Rebecca L Johnson
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
| | - Elizabeth V Schulz
- From the Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
| |
Collapse
|
33
|
Johnson RL. The American Board of Pathology's 2020 Continuing Certification Program. Arch Pathol Lab Med 2021; 145:1089-1094. [PMID: 33406235 DOI: 10.5858/arpa.2020-0385-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Certification by the American Board of Pathology (ABPath) is a valued credential that serves patients, families, and the public and improves patient care. The ABPath establishes professional and educational standards and assesses the knowledge of candidates for initial certification in pathology. Diplomates certified in 2006 and thereafter are required to participate in Continuing Certification (CC; formerly Maintenance of Certification) in order to maintain certification. OBJECTIVE.— To inform and update the pathology community on the history of board certification, the requirements for CC, ABPath CertLink, changes to the CC program, and ABPath compliance with recommendations from the American Board of Medical Specialties Vision Commission; to demonstrate the value of CC participation for diplomates with non-time-limited certification. DATA SOURCES.— This review uses ABPath archived minutes of the CC Committee and the Board of Trustees, the ABPath CC Booklet of Information, the collective knowledge of the ABPath staff and trustees, and the American Board of Medical Specialties 2018-2019 Board Certification Report. CONCLUSIONS.— The ABPath continues to update the CC program to make it more relevant and meaningful and less burdensome for diplomates. Adding ABPath CertLink to the program has been a significant enhancement for the assessment of medical knowledge and has been well received by diplomates.
Collapse
|
34
|
Johnson RL. American Board of Pathology Examination Pass Rates. Arch Pathol Lab Med 2020; 144:1447. [PMID: 33238312 DOI: 10.5858/arpa.2020-0394-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
|
35
|
Laporta ML, Kruthiventi SC, Mantilla CB, Johnson RL, Sprung J, Portner ER, Schroeder DR, Weingarten TN. Three Risk Stratification Tools and Postoperative Pneumonia After Noncardiothoracic Surgery. Am Surg 2020; 87:1207-1213. [PMID: 33342277 DOI: 10.1177/0003134820956299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative in-hospital pneumonia is a serious complication. This study aims to investigate the association between 3 preoperative stratification tools (American Society of Anesthesiologists Physical Status [ASA-PS] score, Charlson Comorbidity Index [CCI], and Rockwood Frailty Deficit Index [FI]) and risk for postoperative pneumonia. METHODS We identified adult patients who developed postoperative pneumonia following noncardiothoracic surgery under general anesthesia, between January 1, 2016 and December 31, 2017. Patients with postoperative pneumonia were 1:1 matched to control subjects based on age, sex, and the exact type of operations. Medical records were reviewed to identify variables that may be associated with risk for developing postoperative pneumonia. Analyses adjusted for clinical characteristics were performed using the conditional logistic regression, taking into account 1:1 matched set case-control study design. RESULTS We identified 211 cases of postoperative pneumonia, and all 3 tested stratification tools were associated with increased risk: ASA-PS (after all adjustments of American Society of Anesthesiologists (ASA) III, odds ratio 4.17 [95% confidence interval 1.74-10.01]; ASA > III 24.03 [6.54-88.32]), CCI (CCI values > 3, 1.29 [1.02-1.63] per unit CCI score), and frail FI score 3.25 (1.45-7.27). Because of incomplete intake documentation, the FI could not be calculated in 57 (13.5%) patients, but these "unknown frailty" patients were also at increased risk for postoperative pneumonia, 3.15 (1.29-7.72). DISCUSSION Three commonly used stratification indices (ASA-PS score, CCI, and FI) were associated with increased risk for postoperative pneumonia. Patients unable to complete intake form to calculate the FI were also at increased risk.
Collapse
Affiliation(s)
- Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Carlos B Mantilla
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Erica R Portner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
36
|
Caine EA, Mahan SD, Johnson RL, Nieman AN, Lam N, Warren CR, Riching KM, Urh M, Daniels DL. Targeted Protein Degradation Phenotypic Studies Using HaloTag CRISPR/Cas9 Endogenous Tagging Coupled with HaloPROTAC3. ACTA ACUST UNITED AC 2020; 91:e81. [PMID: 33332748 PMCID: PMC7818660 DOI: 10.1002/cpph.81] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
To assess the role of a protein, protein loss phenotypic studies can be used, most commonly through mutagenesis RNAi or CRISPR knockout. Such studies have been critical for the understanding of protein function and the identification of putative therapeutic targets for numerous human disease states. However, these methodological approaches present challenges because they are not easily reversible, and if an essential gene is targeted, an associated loss of cell viability can potentially hinder further studies. Here we present a reversible and conditional live‐cell knockout strategy that is applicable to numerous proteins. This modular protein‐tagging approach regulates target loss at the protein, rather than the genomic, level through the use of HaloPROTAC3, which specifically degrades HaloTag fusion proteins via recruitment of the VHL E3 ligase component. To enable HaloTag‐mediated degradation of endogenous proteins, we provide protocols for HaloTag genomic insertion at the protein N or C terminus via CRISPR/Cas9 and use of HaloTag fluorescent ligands to enrich edited cells via Fluorescence‐Activated Cell Sorting (FACS). Using these approaches, endogenous HaloTag fusion proteins present in various subcellular locations can be degraded by HaloPROTAC3. As detecting the degradation of endogenous targets is challenging, the 11‐amino‐acid peptide tag HiBiT is added to the HaloTag fusion to allows the sensitive luminescence detection of HaloTag fusion levels without the use of antibodies. Lastly, we demonstrate, through comparison of HaloPROTAC3 degradation with that of another fusion tag PROTAC, dTAG‐13, that HaloPROTAC3 has a faster degradation rate and similar extent of degradation. © 2020 The Authors. Basic Protocol 1: CRISPR/Cas9 insertion of HaloTag or HiBiT‐HaloTag Basic Protocol 2: HaloPROTAC3 degradation of endogenous HaloTag fusions
Collapse
Affiliation(s)
| | | | | | | | - Ngan Lam
- Promega Corporation, Madison, Wisconsin
| | - Curtis R Warren
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut
| | | | | | | |
Collapse
|
37
|
Maniker RB, Johnson RL, Tran DQ. In Response. Anesth Analg 2020; 131:e230. [PMID: 33094980 DOI: 10.1213/ane.0000000000005161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robert B Maniker
- Department of Anesthesiology and Perioperative Medicine, Columbia University College of Physicians and Surgeons, New York, New York,
| | - Rebecca L Johnson
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - De Q Tran
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
38
|
Niesen AD, Jacob AK, Law LA, Sviggum HP, Johnson RL. Complication rate of ultrasound-guided paravertebral block for breast surgery. Reg Anesth Pain Med 2020; 45:813-817. [DOI: 10.1136/rapm-2020-101402] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023]
Abstract
Background and objectivesThoracic paravertebral blockade is often used as an anesthetic and/or analgesic technique for breast surgery. With ultrasound guidance, the rate of complications is speculated to be lower than when using landmark-based techniques. This investigation aimed to quantify the incidence of pleural puncture and pneumothorax following non-continuous ultrasound-guided thoracic paravertebral blockade for breast surgery.MethodsPatients who received thoracic paravertebral blockade for breast surgery were identified by retrospective query of our institution’s electronic database over a 5-year period. Data collected included patient demographics, level of block, type and volume of local anesthetic, occurrence of pleural puncture, occurrence of pneumothorax, evidence of local anesthetic toxicity, and patient vital signs. The incidence of block complications, including pleural puncture, pneumothorax, and local anesthetic toxicity, were ascertained.Results529 patients underwent 2163 thoracic paravertebral injections. Zero pleural punctures were identified during block performance; however, two patients were found to have a pneumothorax on postoperative chest X-ray (3.6 per 1000 surgeries, 95% CI 0.5 to 13.6; 0.9 per 1000 levels blocked, 95% CI 0.1 to 3.3). There were no cases of local anesthetic systemic toxicity or associated lipid emulsion therapy administration.ConclusionsPneumothorax following non-continuous ultrasound-guided thoracic paravertebral block using a parasagittal approach is an uncommon occurrence, with a similar rate to pneumothorax following breast surgery alone.
Collapse
|
39
|
Robboy SJ, Gross D, Park JY, Kittrie E, Crawford JM, Johnson RL, Cohen MB, Karcher DS, Hoffman RD, Smith AT, Black-Schaffer WS. Reevaluation of the US Pathologist Workforce Size. JAMA Netw Open 2020; 3:e2010648. [PMID: 32672830 PMCID: PMC7366184 DOI: 10.1001/jamanetworkopen.2020.10648] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There is currently no national organization that publishes its data that serves as the authoritative source of the pathologist workforce in the US. Accurate physician numbers are needed to plan for future health care service requirements. OBJECTIVE To assess the accuracy of current pathologist workforce estimates in the US by examining why divergency appears in different published resources. DESIGN, SETTING, AND PARTICIPANTS This study examined the American Board of Pathology classification for pathologist primary specialty and subspecialties and analyzed previously published reports from the following data sources: the Association of American Medical Colleges (AAMC), the Accreditation Council for Graduate Medical Education (ACGME), a 2013 College of American Pathologists (CAP) report, a commercially available version of the American Medical Assoication (AMA) Physician Masterfile, and an unpublished data summary from June 10, 2019. MAIN OUTCOMES AND MEASURES Number of physicians classified as pathologists. RESULTS The most recent AAMC data from 2017 (published in 2018) reported 12 839 physicians practicing "anatomic/clinical pathology," which is a subset of the whole. In comparison, the current AMA Physician Masterfile, which is not available publicly, listed 21 292 active pathologists in June 2019. The AMA Physician Masterfile includes all pathologists in 15 subspecialized training areas as identified by the ACGME. By contrast, AAMC's data, which derive from the AMA Physician Masterfile data, only count physicians primarily associated with 3 general categories of pathologists and 1 subspecialty category (ie, chemical pathology). Thus, the AAMC pathology workforce estimate does not include those whose principal work is in 11 subspecialty areas, such as blood banking or transfusion medicine, cytopathology, hematopathology, or microbiology. An additional discrepancy relates to the ACGME residency (specialties) and fellowship (subspecialties) training programs in which pathologists with training in dermatopathology appear as dermatologists and pathologists with training in molecular genetic pathology appear as medical geneticists. CONCLUSIONS AND RELEVANCE This analysis found that most sources reported only select categories of the pathologist workforce rather than the complete workforce. The discordant nature of reporting may pertain to other medical specialties that have undergone increased subspecialization during the past 2 decades (eg, surgery and medicine). Reconsideration of the methods for determining the pathologist workforce and for all workforces in medicine appears to be needed.
Collapse
Affiliation(s)
- Stanley J. Robboy
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - David Gross
- College of American Pathologists, Washington, DC
| | - Jason Y. Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth Kittrie
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, Rockville, Maryland
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Michael B. Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald S. Karcher
- Department of Pathology, The George Washington University Medical Center, Washington, DC
| | - Robert D. Hoffman
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | |
Collapse
|
40
|
Schwenk ES, Johnson RL. Spinal versus general anesthesia for outpatient joint arthroplasty: can the evidence keep up with the patients? Reg Anesth Pain Med 2020; 45:934-936. [DOI: 10.1136/rapm-2020-101578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/23/2022]
Abstract
Total joint arthroplasty (TJA) is transitioning to be an outpatient rather than an inpatient procedure under national and institutional pressures to increase volumes while reducing hospital costs and length of stay. Innovative surgical and anesthesia techniques have allowed for earlier ambulation and physical therapy participation, maximizing the chance that an appropriately selected patient may be discharged within a day of surgery. The choice of anesthesia type is a modifiable factor that has a major impact on both surgical outcomes and discharge readiness. Recent large database studies have provided evidence for improved outcomes, including decreased mortality, with the use of spinal anesthesia. However, few randomized, controlled trials exist and database studies have limitations. Modern general anesthesia techniques, including total intravenous anesthesia and infusions targeted to anesthetic depth, may make some of these differences insignificant, especially when newer regional anesthesia and local infiltration analgesia techniques are incorporated into TJA enhanced recovery protocols. Multimodal analgesia for all TJA patients may also help minimize differences in pain. Perhaps even more important than anesthesia technique is the proper selection of patients likely to meet the necessary milestones for early discharge. In this article, we provide two contrasting viewpoints on the optimal primary anesthetic for outpatient TJA.
Collapse
|
41
|
Edinger JD, Walmboldt F, Holm K, Johnson RL, Simmons B, Tsai S, Morin C. 0509 Use of Blinded Hypnotic Tapering for Hypnotic Discontinuation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study tested a blinded tapering approach to reduce patients’ anxiety and help them discontinue their hypnotics.
Methods
The study sample included 78 (M age = 55.2 ± 12.8 yrs.; 65.4% women) users of benzodiazepine and benzodiazepine receptor agonists. Following baseline assessments, enrollees first completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage either remained unchanged (CTRL) or was reduced by 25% or 10% every two weeks. At the end of the 20-week period the study blind was eliminated and those who completed one of the two blinded tapering protocols entered a 3-month follow-up period, whereas CTRL participants were offered an open label taper before completing the follow-up.
Results
Among those who completed one of the blinded tapering protocols, 92.9% totally discontinued their medication use by the end of the 20-week tapering phase, whereas 77.3% in the CTRL group discontinued hypnotic use by the end of their open label tapering. At follow-up 72.1% of those who completed blinded tapering remained medication free whereas only 52% of those who underwent open-label tapering remained medication free. Comparisons at follow-up showed those who received the open-label taper continued to use hypnotics on average 2-3 nights/week compared to about 1 time every other week for the blinded taper group (p = .05). The average weekly diazepam equivalent dose of medication used by the open label tapering group was about 5 times higher than the average weekly dose used by the blind tapering group (p = .025).
Conclusion
CBTI combined with blinded hypnotic tapering is a promising treatment approach for helping hypnotic users overcome their medication dependence.
Support
National Institute of Drug Abuse, Grant # R34 DA042329-01
Collapse
Affiliation(s)
- J D Edinger
- National Jewish Health, Denver, CO
- Duke University Medical Center, Durham, NC
| | | | - K Holm
- National Jewish Health, Denver, CO
| | | | | | - S Tsai
- National Jewish Health, Denver, CO
| | - C Morin
- Laval University, Quebec City, QC, CANADA
| |
Collapse
|
42
|
Affiliation(s)
- Robert B Maniker
- From the Department of Anesthesiology and Perioperative Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Rebecca L Johnson
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - De Q Tran
- Department of Anesthesiology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
43
|
Handlogten KS, Johnson RL, Schulte PJ, Hanson A, Granberg CF, Potter DD, Harrison TE, Haile DT. Neuraxial analgesia to improve analgesia in pediatric patients undergoing abdominal surgery: A propensity matched retrospective study. J Clin Anesth 2020; 64:109806. [PMID: 32361687 DOI: 10.1016/j.jclinane.2020.109806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/18/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn S Handlogten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Phillip J Schulte
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Andrew Hanson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - D Dean Potter
- Department of Pediatric Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tracy E Harrison
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dawit T Haile
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
44
|
Johnson RL, Frank RD, Habermann EB, Chamberlain AM, Abdel MP, Schroeder DR, Mantilla CB. Neuraxial anesthesia is associated with improved survival after total joint arthroplasty depending on frailty: a cohort study. Reg Anesth Pain Med 2020; 45:405-411. [DOI: 10.1136/rapm-2019-101250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022]
Abstract
BackgroundFrailty increases risk for complications after total joint arthroplasty (TJA). Whether this association is influenced by anesthetic administered is unknown. We hypothesized that use of neuraxial (spinal or epidural) anesthesia is associated with better outcomes compared with general anesthesia, and that the effect of anesthesia type on outcomes differs by frailty status.MethodsThis single-institution cohort study included all patients (≥50 years) from January 2005 through December 2016 undergoing unilateral, primary and revision TJA. Using multivariable Cox regression, we assessed relationships between anesthesia type, a preoperative frailty deficit index (FI) categorized as non-frail (FI <0.11), vulnerable (FI 0.11 to 0.20), and frail (FI >0.20), and complications (mortality, infection, wound complications/hematoma, reoperation, dislocation, and periprosthetic fracture) within 1 year after surgery. Interactions between anesthesia type and frailty were tested, and stratified models were presented when an interaction (p<0.1) was observed.ResultsAmong 18 458 patients undergoing TJA, more patients were classified as frail (21.5%) and vulnerable (36.2%) than non-frail (42.3%). Anesthesia type was not associated with complications after adjusting for age, joint, and revision type. However, in analyzes stratified by frailty, vulnerable patients under neuraxial block had less mortality (HR=0.49; 95% CI 0.27 to 0.89) and wound complications/hematoma (HR=0.71; 95% CI 0.55 to 0.90), whereas no difference in risk by anesthesia type was observed among patients found non-frail or frail.ConclusionsNeuraxial anesthesia use among vulnerable patients was associated with improved survival and less wound complications. Calculating preoperative frailty prior to TJA informs perioperative risk and enhances shared-decision making for selection of anesthesia type.
Collapse
|
45
|
Heyboer EM, Johnson RL, Kwiatkowski MR, Pankratz TC, Yoder MC, DeGlopper KS, Ahlgrim GC, Dennis JM, Johnson JB. Nickel-Mediated Cross-Coupling of Boronic Acids and Phthalimides for the Synthesis of Ortho-Substituted Benzamides. J Org Chem 2020; 85:3757-3765. [PMID: 31994396 DOI: 10.1021/acs.joc.9b03396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The decarbonylative coupling of phthalimides with aryl boronic acids provides ready access to a broad range of ortho-substituted benzamides. This nickel-mediated methodology extends reactivity from previously described air-sensitive diorganozinc reagents of limited availability to easily handled and widely commercially available boronic acids. The decarbonylative coupling is tolerant of a broad range of functional groups and demonstrates little sensitivity to steric factors on either of the coupling partners.
Collapse
Affiliation(s)
- Ethan M Heyboer
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| | - Rebecca L Johnson
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| | - Megan R Kwiatkowski
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| | - Trey C Pankratz
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| | - Mason C Yoder
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| | | | - Grace C Ahlgrim
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| | - Joseph M Dennis
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| | - Jeffrey B Johnson
- Department of Chemistry, Hope College, Holland, Michigan 49423, United States
| |
Collapse
|
46
|
Abstract
Postsurgical neuropathies represent an infrequent but potentially devastating complication of surgery that may result in significant morbidity with medicolegal implications. Elucidation of this phenomenon has evolved over the past few decades, with emerging evidence for not only iatrogenic factors contributing to this process but also inflammatory causes. This distinction can be important; for instance, cases in which inflammatory etiologies are suspected may benefit from further investigations including nerve biopsy and may benefit from treatment in the form of immunotherapy. In contrast, postsurgical neuropathies due to perioperative causes including anesthesia, traction, compression, and transection will not benefit in the same manner. This article summarizes early and current literature surrounding the frequency of new neurologic deficits after various surgical types, potential causes including anatomical and inflammatory considerations, and roles for treatment. To capture the scope of the issue, a literature review was conducted for human studies in English via MEDLINE and EMBASE from January 1, 1988 to March 31, 2018. Search terms included anesthesia and/or surgical procedures, operative, peripheral nervous system diseases, trauma, mononeuropathy, polyneuropathy, peripheral nervous system, nerve compression, neuropathy, plexopathy, postoperative, postsurgical, perioperative, complication. We excluded case series with less than 10 patients and review papers. We then narrowed the studies to those presented highlighting key concepts in postsurgical neuropathy.
Collapse
|
47
|
Johnson RL, Abdel MP, Frank RD, Chamberlain AM, Habermann EB, Mantilla CB. Frailty Index Is Associated With Periprosthetic Fracture and Mortality After Total Knee Arthroplasty. Orthopedics 2019; 42:335-343. [PMID: 31408522 DOI: 10.3928/01477447-20190812-05] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/22/2019] [Indexed: 02/03/2023]
Abstract
This cohort study of adult (≥50 years) patients aimed to calculate a validated, preoperative frailty deficit index (FI) and used it to compare outcomes following total knee arthroplasty (TKA), primary and revision, from 2005 through 2016. Using multivariable logistic and Cox regression, the authors analyzed whether FI, adjusted for age, predicts outcomes prior to hospital discharge, within 90 days, and within 365 days. They classified 9818 patients undergoing TKA (7920 primary and 1898 revision; median age, 69 years) as frail (21%), vulnerable (39%), and non-frail (40%). Frail, relative to non-frail, patients were more often female with more systemic diseases (American Society of Anesthesiologists classification, ≥III). While in-hospital, frail patients were found to have increased odds of reoperation (odds ratio, 2.52) and wound complications/hematoma (odds ratio, 2.15). Within 90 days, there was increased risk for periprosthetic fracture (>4-fold) and mortality (>9-fold) following TKA after age adjustment. Within the first year, frail patients were at heightened risk for death (hazard ratio, 8.08), any patient infection (hazard ratio, 1.97), wound complications/hematoma (hazard ratio, 2.16), periprosthetic fracture (hazard ratio, 3.03), and reoperation (hazard ratio, 1.41). At no time point were significant associations found with arthrofibrosis, aseptic loosening, or patellar clunk syndrome. One-fifth of patients undergoing primary and revision TKAs are frail and at notable risk for complications. Calculating a preoperative FI should guide pre-habilitation efforts (eg, chronic disease management, wellness) before and postoperative surveillance after TKA. [Orthopedics. 2019; 42(6):335-343.].
Collapse
|
48
|
Munoz-Price LS, Ledeboer NA, Tickler IA, Johnson RL, Park T, Goering R, Oppenheim B, Tenover FC. 2399. Ribotype Diversity of Clostridioides difficile strains obtained during screening tests. Open Forum Infect Dis 2019. [PMCID: PMC6809652 DOI: 10.1093/ofid/ofz360.2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Clostridioides difficile is an organism acquired not only in healthcare settings but also in community settings. For the past several years our hospital has performed screening tests to detect asymptomatic carriage of C. difficile. We now aim to better understand the ribotypes and degree of diversity among these C. difficile strains obtained in a systematic screening.
Methods
This study was performed at a 600 bed teaching affiliated hospital in Milwaukee, WI, where surveillance testing is performed in selected units upon admission and weekly thereafter using nucleic acid amplification test (NAAT; Xpert® C. difficile; Cepheid, Sunnyvale, CA). Screening tests are obtained regardless of symptoms. NAAT positive samples underwent anaerobic cultures in C. difficile selective broth (CCMB-TAL) for 24–48 hr and then to Brucella blood agar plates (BA) for 48–72 hr to confirm C. difficile presence. PCR-ribotyping was performed as previously described by Stubbs et al. with minor modifications. The results were compared with a database containing >3,000 clinical isolates including C. difficile reference strains from the Cardiff ribotype collection.
Results
A total of 104 strains belonging to 93 unique patients were processed. Patients had a mean age of 60 years (range: 18 - 89) and 49% were females. Most patients were hospitalized in the hematology oncology units (55.7%) or in the solid-organ transplant step down unit (9.6%). A total of 25 different ribotypes were identified. The most common ribotype was 014/020 (23; 22%), followed by ribotype 56 (13; 12.5%), 106 (12; 11.5%), 027 (11; 10.5%), 002 (6; 5.7%), and 078/126 (5; 4.81).
Regarding the timing of admission, 70 strains were obtained within 4 days from hospital admission and the remaining 34 were obtained afterwards. Both groups had ribotype 014/020 as the most frequently detected ribotype but 027 were the second most commonly detected at the time of admission (table). A total of 7 patients had more than one stool sample processed and 5 of them had discordant ribotypes at different time points.
Conclusion
Systematic screening tests for C. difficile carriage in a single center showed a large heterogeneity of ribotypes with the majority not being 027. Additionally, most patients tested more than once carried different ribotypes.
Disclosures
All authors: No reported disclosures.
Collapse
|
49
|
Swerdlow SH, Monaghan SA, Douglas AR, Johnson K, Johnson RL. Harmonization of Training, Training Requirements, Board Certification, and Practice of Hematopathology. Am J Clin Pathol 2019; 152:625-637. [PMID: 31338515 DOI: 10.1093/ajcp/aqz084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Hematopathology (HP) is a rapidly changing field with insufficient data to provide guidance to program directors (PDs), the Accreditation Council for Graduate Medical Education, or the American Board of Pathology. METHODS Two surveys were performed-one for HP PDs and one, given twice, for HP diplomates doing Maintenance of Certification/Continuing Certification reporting in 2017 to 2018. RESULTS Bone marrow (BM), lymph node (LN), and flow cytometry interpretations and peripheral blood/fluid reviews are performed by more than 80% of hematopathologists and are the areas with the greatest amount of training. A smaller proportion of hematopathologists is involved in other HP-related activities. Most PDs believed fellows should perform BM procedures. Interpretation of 400 or more LNs and 500 BMs was PDs' median expectations for fellows. PDs and HP diplomates considered coagulation and benign RBC disorders overemphasized on the certification examination. CONCLUSIONS These results highlight how varied the practice of HP is and can provide guidance to HP PDs, those responsible for assessing HP programs, and the American Board of Pathology.
Collapse
Affiliation(s)
- Steven H Swerdlow
- Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- American Board of Pathology, Tampa, FL
| | - Sara A Monaghan
- Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | |
Collapse
|
50
|
D'Souza RS, Johnson RL, Bettini L, Schulte PJ, Burkle C. Room for Improvement: A Systematic Review and Meta-analysis on the Informed Consent Process for Emergency Surgery. Mayo Clin Proc 2019; 94:1786-1798. [PMID: 31486381 DOI: 10.1016/j.mayocp.2019.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare recall of complications and surgical details discussed during informed consent and perception of the consent process in patients undergoing emergent vs elective surgery. METHODS Studies were identified from PubMed, Cochrane, Web of Science, and Scopus from January 1, 1966, through April 18, 2018. Included studies compared patient recall and perception regarding informed consent in those undergoing emergent vs elective surgery. Pooled odds ratios (ORs) were calculated for recall of complications and surgical details, patient satisfaction, perception of sufficient information being delivered on surgical risks, report of having read written consent, and factors that interfered with consent. RESULTS Eleven observational studies (3178 patients) were included. The rate of recall of surgical complications (255 of 504 [50.6%] vs 321 of 446 [72.0%]; OR, 0.29; 95% CI, 0.11-0.80) was lower in patients undergoing emergent vs elective surgery. Meta-analysis revealed a decreased rate of patient satisfaction with the consent process (319 of 459 [69.5%] vs 882 of 1064 [82.9%]; OR. 0.53; 95% CI, 0.34-0.83) and fewer patients having read the consent form (130 of 395 [32.9%] vs 424 of 714 [59.4%]; OR, 0.35; 95% CI, 0.27-0.46) when undergoing emergent compared with elective surgery. Patients undergoing emergent surgery listed pain, analgesic medications, and fatigue as factors likely to interfere with consent. CONCLUSION Patients undergoing emergent surgery have poor recall of the informed consent process and surgical complications. Furthermore, patients report lower rates of satisfaction, and with fewer patients reading written consent documentation, our findings illuminate problems with the current communication process. There is a need to develop effective tools to improve informed consent in emergency surgery.
Collapse
Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Layne Bettini
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Christopher Burkle
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|