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Yu P, Benoit J, Huyett P. Sleep study measures on post-operative night one following expansion pharyngoplasty for obstructive sleep apnea. Am J Otolaryngol 2023; 44:103746. [PMID: 36586324 DOI: 10.1016/j.amjoto.2022.103746] [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: 10/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To examine the changes in measures of sleep apnea severity and hypoxemia on the first post-operative night (PON1) following expansion pharyngoplasty as a means to assess the safety of same day discharge after surgery. MATERIALS AND METHODS Prospective cohort study of subjects with moderate-severe obstructive sleep apnea who underwent expansion pharyngoplasty at a single academic sleep surgical practice. A WatchPAT study was performed on the night immediately following surgery (PON1) and comparisons were made to baseline sleep testing. RESULTS Twenty subjects who had a mean age of 45.7 ± 10.8 years old and a mean body-mass index (BMI) of 31.4 ± 3.2 kg/m2 were enrolled. Patients had baseline severe OSA with mean apnea hypopnea index (AHI) 39.4 ± 19.5/h, O2 nadir 80.8 ± 6.1 % and time with oxygen saturation below 88 % (T88) 12.3 ± 13.2 min. Measures of sleep apnea and nocturnal hypoxemia were not significantly different on PON1. AHI was increased by >20 % in 11 (55.0 %) patients. One patient demonstrated a >10 % worsening in O2 nadir, and 8 patients (45.0 %) demonstrated a >20 % worsening in T88. BMI over 32 was associated with elevated odds of worsening in T88, and anesthesia involving ketamine was associated with lower odds of a 20 % worsening in AHI or T88. CONCLUSIONS On PON1 following expansion pharyngoplasty, AHI and nocturnal hypoxemia are stable overall but variable on an individual basis. The decision for admission should therefore be made on a case-by-case basis. Further research is need to elucidate definitive predictors of worsening measures on PON1.
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Affiliation(s)
- Phoebe Yu
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Justin Benoit
- Department of Anesthesiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Phillip Huyett
- Division of Sleep Medicine and Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
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Zhang ZM, Xie XY, Zhao Y, Zhang C, Liu Z, Liu LM, Zhu MW, Wan BJ, Deng H, Tian K, Guo ZT, Zhao XZ. Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases. World J Clin Cases 2022; 10:6865-6875. [PMID: 36051111 PMCID: PMC9297436 DOI: 10.12998/wjcc.v10.i20.6865] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/06/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Major adverse cardiac events (MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.
AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.
METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.
RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-I (Hs-TnI), creatine kinase isoenzyme (CK-MB), myoglobin (MYO), B-type natriuretic peptide (BNP), and D-dimer (D-D) levels were significantly increased (P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic (ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.
CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.
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Affiliation(s)
- Zong-Ming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xi-Yuan Xie
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yue Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Li-Min Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Ming-Wen Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Bai-Jiang Wan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hai Deng
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Kun Tian
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Zhen-Tian Guo
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xi-Zhe Zhao
- Department of Cardiology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
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Dorken Gallastegi A, Mikdad S, Kapoen C, Breen KA, Naar L, Gaitanidis A, El Hechi M, Pian-Smith M, Cooper JB, Antonelli DM, MacKenzie O, Del Carmen MG, Lillemoe KD, Kaafarani HMA. Intraoperative Deaths: Who, Why, and Can We Prevent Them? J Surg Res 2022; 274:185-195. [PMID: 35180495 DOI: 10.1016/j.jss.2022.01.007] [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: 08/20/2021] [Revised: 11/26/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Intraoperative deaths (IODs) are rare but catastrophic. We systematically analyzed IODs to identify clinical and patient safety patterns. METHODS IODs in a large academic center between 2015 and 2019 were included. Perioperative details were systematically reviewed, focusing on (1) identifying phenotypes of IOD, (2) describing emerging themes immediately preceding cardiac arrest, and (3) suggesting interventions to mitigate IOD in each phenotype. RESULTS Forty-one patients were included. Three IOD phenotypes were identified: trauma (T), nontrauma emergency (NT), and elective (EL) surgery patients, each with 2 sub-phenotypes (e.g., ELm and ELv for elective surgery with medical arrests or vascular injury and bleeding, respectively). In phenotype T, cardiopulmonary resuscitation was initiated before incision in 42%, resuscitative thoracotomy was performed in 33%, and transient return of spontaneous circulation was achieved in 30% of patients. In phenotype NT, ruptured aortic aneurysms accounted for half the cases, and median blood product utilization was 2,694 mL. In phenotype ELm, preoperative evaluation did not include electrocardiogram in 12%, cardiac consultation in 62%, stress test in 87%, and chest x-ray in 37% of patients. In phenotype ELv, 83% had a single peripheral intravenous line, and vascular injury was almost always followed by escalation in monitoring (e.g., central/arterial line), alert to the blood bank, and call for surgical backup. CONCLUSIONS We have created a framework for IOD that can help with intraoperative safety and quality analysis. Focusing on interventions that address appropriateness versus futility in care in phenotypes T and NT, and on prevention and mitigation of intraoperative vessel injury (e.g., intraoperative rescue team) or preoperative optimization in phenotype EL may help prevent IODs.
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Affiliation(s)
- Ander Dorken Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Mikdad
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolijn Kapoen
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kerry A Breen
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - Leon Naar
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - Apostolos Gaitanidis
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - Majed El Hechi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts
| | - May Pian-Smith
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey B Cooper
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts; Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Donna M Antonelli
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olivia MacKenzie
- Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marcela G Del Carmen
- Department of Obstetrics, Gynecology & Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Massachusetts General Physicians Organization, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, Massachusetts.
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Lorkowski J, Maciejowska-Wilcock I. Surgical Safety Checklist: Polychromatic or Achromatic Design. Adv Exp Med Biol 2021. [PMID: 34970728 DOI: 10.1007/5584_2021_699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Surgical Safety Checklist (SSC) has been created based on the recommendations of the WHO and obligatorily introduced worldwide. SSC is used to increase the patient's safety and reduce complications while in the hospital, especially in the perioperative period. The original SSC template was of a multicolor polychromatic design. However, an achromatic black-and-white or gray-gray design on plain printer paper appears often used in clinical practice. This review aims to assess the level of SSC use in the polychromatic versus achromatic versions and the pros and cons of using either in practice. We used the Google browser for the identification and collection of SSC graphic images available as of June 2021 using the following search commands: "surgical safety checklist WHO" or "surgical safety checklist" or "SSC WHO." The commands were repeated in 103 languages representing the five continents with the back answers provided in 41 languages. The successive top 10 thematically relevant images or fewer if not available in the cases of some foreign languages were considered for analysis, providing a mean of 5 ±2 images per language. The numbers of achromatic and polychromatic two-color or multicolor images were calculated. The number of images corresponding to the respective color designs ranged as follows: 0-6 (27.6%), 0-9 (41.6%), and 0-6 (27.6%) We conclude that polychromatic imaging of SSC documents predominates in practical use. The polychromatic SSC design catches the doctor's eye, which likely increases the effectiveness of completing the document.
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Zheng X, Peng L, Cao D, Han X, Xu H, Yang L, Ai J, Wei Q. Holmium laser enucleation of the prostate in benign prostate hyperplasia patients with or without oral antithrombotic drugs: a meta-analysis. Int Urol Nephrol 2019; 51:2127-2136. [PMID: 31494858 DOI: 10.1007/s11255-019-02278-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/22/2019] [Accepted: 09/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The continuous intake of antithrombotic drugs during holmium laser enucleation of the prostate (HoLEP) remains nonconsensual. We aim to pool those controversial evidence and provide practical guidance of oral antithrombotics on HoLEP for benign prostate hyperplasia (BPH). METHOD PubMed, Embase and CENTRAL database were systematically searched up to June 2019 for trials on patients with and without oral antithrombotics undergoing HoLEP. Number of events and mean value with standard deviation were, respectively, extracted for dichotomous and continuous parameters. Subgroup analyses of anticoagulation and antiplatelet were also performed. All statistical analyses were conducted with Review Manager v.5.3 software. Newcastle-Ottawa Scale (NOS) was used to assess the quality of selected trials. RESULT Nine studies with 5528 patients were eventually selected, and patients included were generally older than 65 years. It revealed that the non-antithrombotic group had a lower rate of blood transfusion (OR 0.21, 95% CI 0.10-0.45, P < 0.0001), bladder tamponade (OR 0.30, 95% CI 0.13-0.69, P = 0.004) and acute urine retention (OR 0.52, 95% CI 0.30-0.89, P = 0.02). Operation time was also shorter (MD - 10.31, 95% CI - 12.76 to - 7.85, P < 0.00001) in the non-antithrombotic group, but the heterogeneity was considerable (I2 = 75%). Subgroup analyses were generally consistent with the primary analysis except the non-anticoagulation and anticoagulation group having similar operation time (MD 6.66, 95% CI - 7.15 to 20.48, P = 0.34). CONCLUSION The current study confirmed that continuous intake of antithrombotic drugs could significantly increase the risk of bleeding and blood transfusion, bladder tamponade and acute urine retention.
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Affiliation(s)
- Xiaonan Zheng
- West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Han
- West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hang Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Jones KC, Ritzman T. Perioperative Safety: Keeping Our Children Safe in the Operating Room. Orthop Clin North Am 2018; 49:465-476. [PMID: 30224008 DOI: 10.1016/j.ocl.2018.05.008] [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: 02/02/2023]
Abstract
The entire operating room team is responsible for the safety of children in the operating room. As a leader in the operating room, the surgeon is impactful in ensuring that all team members are committed to providing this safe environment. This is achieved by the use of perioperative huddles or briefings, the use of appropriate surgical checklists, operating room standardization, surgeons proficient in the care they provide, and team members that embrace Just Culture.
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Affiliation(s)
- Kerwyn C Jones
- Department of Orthopedic Surgery, Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, USA.
| | - Todd Ritzman
- Department of Orthopedic Surgery, Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, USA
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Abstract
Making mistakes is part of being human and human error is normal in all areas of life (Bromiley and Mitchell 2009). In some contexts this is of little consequence, but in environments where human safety and well-being are at stake it is vital that such error is minimised. The operating theatre is one such safety critical environment. Research suggests, however, that certain factors predispose to human error. Some or all of these factors may be present in the operating theatre and, therefore, have the potential to compromise patient safety.
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Affiliation(s)
- Fiona Roche
- Queen Elizabeth University Hospital, Glasgow, UK
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Faßbender P, Haddad A, Bürgener S, Peters J. Validation of a photoplethysmography device for detection of obstructive sleep apnea in the perioperative setting. J Clin Monit Comput 2018; 33:341-345. [PMID: 29749570 DOI: 10.1007/s10877-018-0151-2] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/04/2018] [Indexed: 02/03/2023]
Abstract
Obstructive sleep apnea (OSA) is a risk factor for perioperative complications, but many OSA patients present undiagnosed. While polysomnography (PSG) is the "gold standard" for diagnosis, its application is technology-intense, time-consuming, expensive, and requires specialists, often delaying surgery. Thus, miniaturized devices were developed for OSA screening aimed at ruling out major OSA while measuring a lesser number of biological signals. We evaluated the accuracy of a photoplethysmography (PPG)-based device for OSA detection. 48 patients with established or strongly suspected (STOP-Questionnaire) OSA scheduled for surgery underwent in their preoperative nights parallel recordings by PPG and a classic polygraphy (PG) devices (SomnoLab2®). We compared the diagnostic accuracy of the PPG in diagnosing mild [Apnea-/Hypopnea-Index (AHI) 5-14 events/h] and moderate-to-severe OSA (AHI > 15). PPG and PG-derived AHI correlated significantly (r = 0.85, p < 0.0001) and high area under curve (AUC) in receiver operator characteristics (ROC) values were seen for both AHI thresholds (0.93 and 0.95, respectively). For an AHI > 5, sensitivity was 100%, specificity 44%, positive predictive value (PPV) 62%, negative predictive value (NPV) 100%, likelihood ratio (LHR) 1.79, and Cohen κ was 0.43. For an AHI > 15, sensitivity was 92%, specificity 77%, PPV 60%, NPV 96%, LHR 4.04, and Cohen κ was 0.59. In a typical perioperative cohort of confirmed and suspected OSA patients, PPG reliably detected OSA patients while showing some false-positive results. Such devices are helpful for preoperative OSA screening.
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Affiliation(s)
- Philipp Faßbender
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen and Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Germany.
| | - Ali Haddad
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen and Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Silja Bürgener
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen and Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Jürgen Peters
- Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen and Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Germany
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Keijzer WW, Agha RA, Greig A. WHO Safer Surgery checklist compliance amongst paediatric emergency plastic surgery patients in an UK hospital. Ann Med Surg (Lond) 2017; 21:49-52. [PMID: 28794866 PMCID: PMC5537375 DOI: 10.1016/j.amsu.2017.07.049] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction The WHO Safer Surgery checklist has become an important component of perioperative safety. Our objective, was to determine the compliance of completing the checklist for paediatric emergency plastic surgery patients at our unit. Methods An initial baseline was performed with 70 patients over two months at our unit. Following this, we raised awareness at an audit meeting and closed the audit loop using 80 patients over two months. The audit is reported in line with SQUIRE 2.0 criteria. Results Initial compliance was 88% overall and this increased to 91% post-intervention. Compliance with the individual stages in both cycles was for sign-in: 85%–86%, for time-out 92%–98% and for sign-out 86%–89%. Around one in four checklists were not scanned in both periods. Conclusion This audit showed a high overall level of compliance in the checklists that were scanned and available for scrutiny. We have identified the areas that most need improvement and suggest ways for doing so. This study has shown the value of raising awareness of the WHO checklist for optimizing perioperative safety. An overall increase in checklist compliance from 88% to 91% was found. We have identified the areas that most need improvement and suggest ways for doing so.
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Affiliation(s)
- Welmoed W Keijzer
- Department of Plastic Surgery, Guy's and St Thomas Hospital, London, SE1 7EH, UK
| | - Riaz A Agha
- Department of Plastic Surgery, Guy's and St Thomas Hospital, London, SE1 7EH, UK
| | - Aina Greig
- Department of Plastic Surgery, Guy's and St Thomas Hospital, London, SE1 7EH, UK
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Mehta JH, Cattano D, Brayanov JB, George EE. Assessment of perioperative minute ventilation in obese versus non-obese patients with a non-invasive respiratory volume monitor. BMC Anesthesiol 2017; 17:61. [PMID: 28446134 PMCID: PMC5405482 DOI: 10.1186/s12871-017-0352-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/02/2016] [Accepted: 04/21/2017] [Indexed: 12/04/2022] Open
Abstract
Background Monitoring the adequacy of spontaneous breathing is a major patient safety concern in the post-operative setting. Monitoring is particularly important for obese patients, who are at a higher risk for post-surgical respiratory complications and often have increased metabolic demand due to excess weight. Here we used a novel, noninvasive Respiratory Volume Monitor (RVM) to monitor ventilation in both obese and non-obese orthopedic patients throughout their perioperative course, in order to develop better monitoring strategies. Methods We collected respiratory data from 62 orthopedic patients undergoing elective joint replacement surgery under general anesthesia using a bio-impedance based RVM with an electrode PadSet placed on the thorax. Patients were stratified into obese (BMI ≥ 30) and non-obese cohorts and minute ventilation (MV) at various perioperative time points was compared against each patient’s predicted minute ventilation (MVPRED) based on ideal body weight (IBW) and body surface area (BSA). The distributions of MV measurements were also compared across obese and non-obese cohorts. Results Obese patients had higher MV than the non-obese patients before, during, and after surgery. Measured MV of obese patients was significantly higher than their MVPRED from IBW formulas, with BSA-based MVPRED being a closer estimate. Obese patients also had greater variability in MV post-operatively when treated with standard opioid dosing. Conclusions Our study demonstrated that obese patients have greater variability in ventilation post-operatively when treated with standard opioid doses, and despite overall higher ventilation, many of them are still at risk for hypoventilation. BSA-based MVPRED formulas may be more appropriate than IBW-based ones when estimating the respiratory demand of obese patients. The RVM allows for the continuous and non-invasive assessment of respiratory function in both obese and non-obese patients.
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Affiliation(s)
- Jaideep H Mehta
- University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Davide Cattano
- University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Jordan B Brayanov
- Respiratory Motion Inc., 411 Waverley Oaks Rd #150, Waltham, MA, 02452, USA.
| | - Edward E George
- Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
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