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Xu W, Suo Z, Qu Y, Zhou B, Zheng Y, Ni C. Retrospective and prospective: insights from a decade of anesthesiology trends for perioperative health care. Front Med (Lausanne) 2025; 12:1547487. [PMID: 40357306 PMCID: PMC12066421 DOI: 10.3389/fmed.2025.1547487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 04/14/2025] [Indexed: 05/15/2025] Open
Abstract
This study analyzes research trends in anesthesiology over the past decade (2013-2023) by conducting a systematic keyword analysis of articles published in leading anesthesia journals, including Anesthesia, British Journal of Anesthesia, Anesthesiology, Journal of Clinical Anesthesia, and Anesthesia & Analgesia. Using the Bibliometrix software package (R version 3.5.6), we identified temporal patterns and journal-specific preferences in research themes. Early trends emphasized pain management, neuromuscular blockade, and perioperative physiology, while the COVID-19 pandemic shifted focus toward respiratory management and pandemic-related concerns. In recent years, research priorities have increasingly highlighted perioperative brain health, including postoperative cognitive dysfunction and delirium, alongside the integration of artificial intelligence to optimize perioperative care. These findings reflect the evolving landscape of anesthesiology, with a growing emphasis on mitigating postoperative complications and addressing the cognitive outcomes of surgical patients-issues of relevance to aging populations. By bridging gaps between research innovations and clinical application, this study underscores the importance of multidisciplinary collaboration to enhance patient outcomes and inform public health strategies in the perioperative setting.
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Affiliation(s)
- Wenjie Xu
- Department of Anesthesiology, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zizheng Suo
- Department of Anesthesiology, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinyin Qu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Bowen Zhou
- Department of Anesthesiology, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiang Zheng
- Department of Anesthesiology, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hall DE, Hagan D, Ashcraft L, Wilson M, Arya S, Johanning JM. The Surgical Pause: The Importance of Measuring Frailty and Taking Action to Address Identified Frailty. Jt Comm J Qual Patient Saf 2025; 51:167-177. [PMID: 39799070 PMCID: PMC11867859 DOI: 10.1016/j.jcjq.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2025]
Abstract
CONCEPTUAL FRAMEWORK The Surgical Pause is a rapid, scalable strategy for health care systems to optimize perioperative outcomes for high-risk, frail patients considering elective surgery. The first and most important step is to screen for frailty, thereby identifying the 5% to 10% of patients at most risk for postoperative complications, loss of independence, institutionalization, and mortality. The second step is to take action to improve outcomes. Action may include clarifying perioperative goals, optimizing perioperative decision-making, and mitigating frailty-associated risks through prehabilitation. HISTORY OF DISSEMINATION Initially implemented at the Omaha Veterans Affairs (VA) Medical Center in 2012, the Surgical Pause was associated with a nearly three-fold survival advantage among the frail. The program was subsequently replicated at more than 50 VA and private sector hospitals with similarly robust results, leading the Veterans Health Administration (VHA) National Surgery Office to formally adopt the program in January 2024. The Joint Commission and the National Quality Forum recognized the program with the Eisenberg Award for Patient Safety and Quality at the National Level. LESSONS LEARNED Successful dissemination grew from simultaneous real-world quality projects paralleled by rigorous, high-quality, peer reviewed publications demonstrating the need for and impact of the Surgical Pause. Adoption was facilitated in an iterative process to streamline feasibility and leverage existing resources. Success was accelerated by national infrastructure catalyzing a community of practice. CONCLUSION The Surgical Pause is changing surgical culture by proactively identifying frail patients, aligning treatment plans with patient-defined goals, optimizing perioperative decisions, and mitigating frailty-associated risks to deliver both quality and value.
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Ron D, Ballacchino MM, Briggs A, Deiner SG. Clinician perspectives on the perioperative roles and responsibilities of anesthesia, surgery, and primary care. Am J Surg 2025; 241:115948. [PMID: 39245593 DOI: 10.1016/j.amjsurg.2024.115948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/07/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Although high-risk older patients benefit from a multidisciplinary approach to perioperative care, the specific roles and responsibilities of the clinicians involved have yet to be adequately characterized. METHODS Qualitative analysis of semi-structured interviews with four anesthesia preoperative clinic providers, seven surgeons, and nine primary care providers in northern New England. RESULTS The analysis revealed both distinct and overlapping roles and responsibilities. Anesthesia providers were described as a "safety net" and surgeons as "captain of the ship", in charge of getting "all the ducks in a row" to avoid surgery delays and cancellations. Primary care providers saw themselves as the "quarterback", ensuring care continuity and consideration of patient psychosocial factors. CONCLUSIONS While all have a shared responsibility for facilitating patient-centered decision-making and a safe perioperative course, each discipline has different areas of focus and expertise. Role clarification can help optimize the distribution of responsibilities and enhance perioperative communication and collaboration.
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Affiliation(s)
- Donna Ron
- Department of Community and Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Lebanon, NH, 03756, USA; Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Lebanon, NH, 03756, USA.
| | - Madison M Ballacchino
- Jacobs School of Medicine and Biomedical Sciences, 955 Main St, Buffalo, NY, 14203, USA.
| | - Alexandra Briggs
- Department of Surgery, Dartmouth Health and Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA.
| | - Stacie G Deiner
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Lebanon, NH, 03756, USA.
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Mahmoud AS, Sayed AEDH, Mahmoud UT, Mohammed AAA, Darwish MHA. Impact of zinc oxide nanoparticles on the behavior and stress indicators of African catfish (Clarias gariepinus) exposed to heat stress. BMC Vet Res 2024; 20:474. [PMID: 39420344 PMCID: PMC11484423 DOI: 10.1186/s12917-024-04302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/25/2024] [Indexed: 10/19/2024] Open
Abstract
This study was designed to assess the role of nano-zinc oxide in mitigating the deleterious effects of heat stress in African catfish (Clarias gariepinus) by evaluating parameters such as aggressive behavior (biting frequency and chasing duration), hematological indicators, and stress-related biochemical markers. A total of 96 catfish were divided into four distinct groups (24 fish/group): The first group (CON) served as the control group, receiving a diet free of nano-zinc oxide. The second group (HS) was exposed to heat stress at 35 °C ± 1 °C. The third group (ZN) was fed a diet containing nano-zinc oxide at 30 mg/kg of the diet, and the fourth group (ZHN) was exposed to heat stress (35 °C ± 1 °C) and fed a diet containing nano-zinc oxide at 30 mg/kg of the diet. The results clarified that the aggressive behavior and cortisol levels were significantly higher (P < 0.05) in the HS group compared to the CON and ZHN groups. Additionally, the level of acetylcholinesterase (AChE) was significantly lower (P < 0.05) in the HS group compared to the CON and ZHN groups. Meanwhile, a significant (P < 0.05) decrease in red blood cells, hemoglobin, packed cell volume, white blood cells, alkaline phosphatase, and lymphocytes, was observed in fish belonging to the HS group, while the levels of alanine aminotransferase, aspartate aminotransferase, neutrophils, and monocytes showed a significant increase (P < 0.05). Supplementation with nano-zinc oxide significantly recovered most hematological and biochemical parameters. In conclusion, nano-zinc oxide contributed significantly to the regulation of the negative impacts of heat stress on fish by reducing aggressive behavior and cortisol levels. Additionally, it improved the levels of AChE and certain hematological and biochemical parameters.
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Affiliation(s)
- Amr Saber Mahmoud
- Department of Animal, Poultry and Aquatic Life Behavior and Management, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
| | - Alaa El Din H Sayed
- Department of Zoology, Faculty of Science, Assiut University, Assiut, Egypt.
- Molecular Biology Research & Studies Institute, Assiut University, Assiut, Egypt.
| | - Usama T Mahmoud
- Department of Animal, Poultry and Aquatic Life Behavior and Management, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A A Mohammed
- Department of Animal, Poultry and Aquatic Life Behavior and Management, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
- Department of Animal Husbandry and Livestock Development, School of Veterinary Medicine, Badr University in Assiut, Assiut, Egypt
| | - Madeha H A Darwish
- Department of Animal, Poultry and Aquatic Life Behavior and Management, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
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Pagano L, Gumuskaya O, Long JC, Arnolda G, Patel R, Pagano R, Braithwaite J, Francis-Auton E, Hirschhorn A, Sarkies MN. Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic Review. J Adv Nurs 2024. [PMID: 39384558 DOI: 10.1111/jan.16524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 09/18/2024] [Accepted: 09/23/2024] [Indexed: 10/11/2024]
Abstract
AIMS To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries. DESIGN Systematic review. DATA SOURCES Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023. METHODS Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions. RESULTS The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions. CONCLUSIONS Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals. IMPACT These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives. REPORTING METHOD This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. No patient or public contribution. TRIAL REGISTRATION CRD42023413817.
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Affiliation(s)
- Lisa Pagano
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Oya Gumuskaya
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Romika Patel
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Pagano
- School of Education, Faculty of Education and Arts, Australian Catholic University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Hirschhorn
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Implementation Science Academy, Sydney Health Partners, University of Sydney, Sydney, New South Wales, Australia
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Ron D, Gunn CM, Havidich JE, Ballacchino MM, Burdick TE, Deiner SG. Preoperative Communication Between Anesthesia, Surgery, and Primary Care Providers for Older Surgical Patients. Jt Comm J Qual Patient Saf 2024; 50:326-337. [PMID: 38360446 DOI: 10.1016/j.jcjq.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care-related events, increased costs, and patient and physician dissatisfaction. METHODS Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center. RESULTS In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information. CONCLUSION Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.
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Abstract
Preoperative care exists as part of perioperative continuum during which anesthesiologists and surgeons optimize patients for surgery. These multispecialty efforts are important, particularly for patients with complex medical histories and those requiring major surgery. Preoperative care improves planning and determines the clinical pathway and discharge disposition. The role of nonmedical social factors in the preoperative planning is not well described in anesthesiology. Research to improve outcomes based on social factors is not well described for anesthesiologists but could be instrumental in decreasing disparities and advancing health equity in surgical patients.
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Affiliation(s)
- Mofya S Diallo
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, 4650 Sunset Boulevard, MS#3, Los Angeles, CA 90027, USA.
| | - Romana Hasnain-Wynia
- Academic Affairs and Public Health, Denver Health, University of Colorado School of Medicine, 601 Broadway Street, 9th Floor, MC 6551, Denver, CO 80203, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA
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Madden K, Pallapothu S, Young Shing D, Adili A, Bhandari M, Carlesso L, Khan M, Kleinlugtenbelt YV, Krsmanovic A, Nowakowski M, Packham T, Romeril E, Tarride JE, Thabane L, Tushinski DM, Wallace C, Winemaker M, Shanthanna H. Opioid reduction and enhanced recovery in orthopaedic surgery (OREOS): a protocol for a feasibility randomised controlled trial in patients undergoing total knee arthroplasty. Pilot Feasibility Stud 2024; 10:30. [PMID: 38360686 PMCID: PMC10868001 DOI: 10.1186/s40814-024-01457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Knee arthritis is a leading cause of limited function and long-term disability in older adults. Despite a technically successful total knee arthroplasty (TKA), around 20% of patients continue to have persisting pain with reduced function, and low quality of life. Many of them continue using opioids for pain control, which puts them at risk for potential long-term adverse effects such as dependence, overdose and risk of falls. Although persisting pain and opioid use after TKA have been recognised to be important issues, individual strategies to decrease their burden have limitations and multi-component interventions, despite their potential, have not been well studied. In this study, we propose a multi-component pathway including personalized pain management, facilitated by a pain management coordinator. The objectives of this pilot trial are to evaluate feasibility (recruitment, retention, and adherence), along with opioid-free pain control at 8 weeks after TKA. METHODS This is a protocol for a multicentre pilot randomised controlled trial using a 2-arm parallel group design. Adult participants undergoing unilateral total knee arthroplasty will be considered for inclusion and randomised to control and intervention groups. Participants in the intervention group will receive support from a pain management coordinator who will facilitate a multicomponent pain management pathway including (1) preoperative education on pain and opioid use, (2) preoperative risk identification and mitigation, (3) personalized post-discharge analgesic prescriptions and (4) continued support for pain control and recovery up to 8 weeks post-op. Participants in the control group will undergo usual care. The primary outcomes of this pilot trial are to assess the feasibility of participant recruitment, retention, and adherence to the interventions, and key secondary outcomes are persisting pain and opioid use. DISCUSSION The results of this trial will determine the feasibility of conducting a definitive trial for the implementation of a multicomponent pain pathway to improve pain control and reduce harms using a coordinated approach, while keeping an emphasis on patient centred care and shared decision making. TRIAL REGISTRATION Prospectively registered in Clinicaltrials.gov (NCT04968132).
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Affiliation(s)
- Kim Madden
- Department of Surgery, McMaster University, Hamilton, Canada.
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada.
- Department of Health Research Methods, McMaster University, Hamilton, Canada.
| | | | | | - Anthony Adili
- Department of Surgery, McMaster University, Hamilton, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Canada
| | - Lisa Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Moin Khan
- Department of Surgery, McMaster University, Hamilton, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | | | - Adrijana Krsmanovic
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Matilda Nowakowski
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Tara Packham
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Eric Romeril
- Hamilton Health Sciences-Juravinski Hospital, Hamilton, Canada
| | - Jean-Eric Tarride
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Canada
- Center for Health Economics and Policy Analyses, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Canada
| | - Daniel M Tushinski
- Department of Surgery, McMaster University, Hamilton, Canada
- Hamilton Health Sciences-Juravinski Hospital, Hamilton, Canada
| | - Christine Wallace
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | | | - Harsha Shanthanna
- Department of Surgery, McMaster University, Hamilton, Canada
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
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Huang L, Zeng B, Cao Y, Wan Y, Zhang Z. Impact of enhancing patient pro-activity in improved perioperative care outcomes: A narrative review. J Clin Anesth 2023; 91:111256. [PMID: 37714029 DOI: 10.1016/j.jclinane.2023.111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Affiliation(s)
- LingJie Huang
- Department of Anesthesiology, The First People's Hospital of Chenzhou, Xiangnan University, Chenzhou, Hunan, 423000, China; Department of Anesthesiology, The First People's Hospital of Chenzhou, The ChenZhou Affiliated Hosipital, Hengyang Medical School, University of South China, Chenzhou, Hunan, 423000, China
| | - Bin Zeng
- Department of Anesthesiology, The First People's Hospital of Chenzhou, Xiangnan University, Chenzhou, Hunan, 423000, China
| | - YanFei Cao
- Department of Anesthesiology, The First People's Hospital of Chenzhou, Xiangnan University, Chenzhou, Hunan, 423000, China
| | - YuWeng Wan
- Department of Anesthesiology, The First People's Hospital of Chenzhou, Xiangnan University, Chenzhou, Hunan, 423000, China
| | - ZhiMing Zhang
- Department of Anesthesiology, The First People's Hospital of Chenzhou, Xiangnan University, Chenzhou, Hunan, 423000, China; Department of Anesthesiology, The First People's Hospital of Chenzhou, The ChenZhou Affiliated Hosipital, Hengyang Medical School, University of South China, Chenzhou, Hunan, 423000, China.
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Alfons MS, Ibrahim ATA, Harabawy ASA, Al-Salahy MB, Badr G. Cytoprotective effect of propolis on heat stress induces alteration to histological, ultrastructural, and oxidative stress in catfish (Clarias gariepinus). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:114152-114165. [PMID: 37855965 PMCID: PMC10663252 DOI: 10.1007/s11356-023-30386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
Our study helps to evaluate the immune response, antioxidative status, and resistance against heat stress (HS) in Clarias gariepinus treated with propolis extraction; the results will contribute to theories of fish physiology and immunity under high-temperature conditions. Forty-five fish were divided into three equal groups: the control, the HS group at 36 °C, and the HS treated with alcoholic extraction of propolis that dissolved in water for 3 weeks. The results of our study suggested that the stress response differs among tissues thymus, spleen, and liver. All the tissues showed alteration in morphological and cytological structure at the light microscope (LM) and transmission electron microscope (TEM); thymus showed edema and thymocyte destruction; the spleen detected collagen deposition, and the liver displayed endoplasmic reticulum amplification (ER). In addition, we examined oxidative stress and antioxidant defenses (lipid peroxidation, catalase, and glutathione) of the spleen and measured blood biochemical parameters (alanine transaminase and aspartic transaminase levels) after heat stress. However, this toxic effect of HS was neutralized by the propolis extraction. To conclude, propolis is recommended to cope with the impacts of heat stress on catfish (Clarias gariepinus) by improving immunity and antioxidative resistance.
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Affiliation(s)
- Mariana S Alfons
- Zoology Department, Faculty of Science, Fish Biology Lab, New Valley University, New Valley, El Kharga, 72511, Egypt
| | - Ahmed Th A Ibrahim
- Zoology Department, Faculty of Science, Fish Biology Lab, New Valley University, New Valley, El Kharga, 72511, Egypt.
| | - Ahmed S A Harabawy
- Zoology Department, Faculty of Science, Fish Biology Lab, New Valley University, New Valley, El Kharga, 72511, Egypt
| | - Mohamed B Al-Salahy
- Zoology Department, Faculty of Science, Assiut University, Assiut, 71516, Egypt
| | - Gamal Badr
- Zoology Department, Faculty of Science, Assiut University, Assiut, 71516, Egypt
- Laboratory of Immunology, Zoology Department, Faculty of Science, Assiut University, Assiut, 71516, Egypt
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Pal N, Nelson M, Butterworth J. Preoperative Medical Consultation-Questioning a Long-Standing Practice. JAMA Intern Med 2023; 183:1034. [PMID: 37459068 DOI: 10.1001/jamainternmed.2023.2920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - Mark Nelson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
| | - John Butterworth
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia
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Pagano L, Hemmert C, Hirschhorn A, Francis-Auton E, Arnolda G, Long JC, Braithwaite J, Gumley G, Hibbert PD, Churruca K, Hutchinson K, Partington A, Hughes C, Gillatt D, Ellis LA, Testa L, Patel R, Sarkies MN. Implementation of consensus-based perioperative care pathways to reduce clinical variation for elective surgery in an Australian private hospital: a mixed-methods pre-post study protocol. BMJ Open 2023; 13:e075008. [PMID: 37495386 PMCID: PMC10373689 DOI: 10.1136/bmjopen-2023-075008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Addressing clinical variation in elective surgery is challenging. A key issue is how to gain consensus between largely autonomous clinicians. Understanding how the consensus process works to develop and implement perioperative pathways and the impact of these pathways on reducing clinical variation can provide important insights into the effectiveness of the consensus process. The primary objective of this study is to understand the implementation of an organisationally supported, consensus approach to implement perioperative care pathways in a private healthcare facility and to determine its impact. METHODS A mixed-methods Effectiveness-Implementation Hybrid (type III) pre-post study will be conducted in one Australian private hospital. Five new consensus-based perioperative care pathways will be developed and implemented for specific patient cohorts: spinal surgery, radical prostatectomy, cardiac surgery, bariatric surgery and total hip and knee replacement. The individual components of these pathways will be confirmed as part of a consensus-building approach and will follow a four-stage implementation process using the Exploration, Preparation, Implementation and Sustainment framework. The process of implementation, as well as barriers and facilitators, will be evaluated through semistructured interviews and focus groups with key clinical and non-clinical staff, and participant observation. We anticipate completing 30 interviews and 15-20 meeting observations. Administrative and clinical end-points for at least 152 participants will be analysed to assess the effectiveness of the pathways. ETHICS AND DISSEMINATION This study received ethical approval from Macquarie University Human Research Ethics Medical Sciences Committee (Reference No: 520221219542374). The findings of this study will be disseminated through peer-reviewed publications, conference presentations and reports for key stakeholders.
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Affiliation(s)
- Lisa Pagano
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Cameron Hemmert
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Hirschhorn
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Graham Gumley
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Partington
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Cliff Hughes
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David Gillatt
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Romika Patel
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Sridhar S, Mouat-Hunter A, McCrory B. Rural implementation of the perioperative surgical home: A case-control study. World J Orthop 2023; 14:123-135. [PMID: 36998383 PMCID: PMC10044325 DOI: 10.5312/wjo.v14.i3.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/01/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Perioperative surgical home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas.
AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study.
METHODS The research study was conducted at an 83-bed, licensed level-III trauma rural community hospital. A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts (n = 2305). To evaluate the importance of PSH in the rural surgical system, a case-control study was performed to compare TJR surgical outcomes (LOS, discharge disposition, and 90-d readmission) of the PSH cohort against two control cohorts [Control-1 PSH (C1-PSH) (n = 1413) and Control-2 PSH (C2-PSH) (n = 892)]. Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t-test were performed for continuous variables. The general linear models (Poisson regression and binomial logistic regression) were performed to fit adjusted models.
RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h) (P value < 0.05). Similarly, the PSH cohort had lower percentages of discharges to other facilities (PSH = 3.5%, C1-PSH = 15.5%, C2-PSH = 6.7%) (P value < 0.05). There was no statistical difference observed in 90-d readmission between control and PSH cohorts. However, the PSH implementation reduced the 90-d readmission percentage (PSH = 4.7%, C1-PSH = 6.1%, C2-PSH = 3.6%) lower than the national average 30-d readmission percentage which is 5.5%. The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician co-management. The elements of PSH including preoperative assessment, patient education and optimization, and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital.
CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS, increased direct-to-home discharge, and reduced 90-d readmission percentages.
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Affiliation(s)
- Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation, College of Public Health, The Ohio State University, Columbus, OH 43210, United States
| | - Amy Mouat-Hunter
- Preanesthesia Clinic, Bozeman Health, Bozeman, MT 59715, United States
| | - Bernadette McCrory
- Mechanical and Industrial Engineering, Montana State University, Bozeman, MT 59715, United States
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14
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Jones S, Mulaikal TA. End of Life: What Is the Anesthesiologist's Role? Adv Anesth 2022; 40:1-14. [PMID: 36333041 DOI: 10.1016/j.aan.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Anesthesiologists receive extensive training in the area of perioperative care and the specialized skills required to maintain life during surgery and complex procedures. Integrated into almost every facet of contemporary medicine, they interact with patients at multiple stages of their health care journeys. While traditionally thought of as the doctors best equipped to save lives, they may also be some of the best doctors to help navigate the chapters at the end of life. Successfully navigating end-of-life care, particularly in the COVID-19 era, is a complicated task. Competing ethical principles of autonomy and nonmaleficence may often be encountered as sophisticated medical technologies offer the promise of extending life longer than ever before seen. From encouraging patients to actively engage in advance care planning, normalizing the conversations around the end of life, employing our skills to relieve pain and suffering associated with dying, and using our empathy and communication skills to also care for the families of dying patients, there are many ways for the anesthesiologist to elevate the care provided at the end of life. The aim of this article is to review the existing literature on the role of the anesthesiologist in end-of-life care, as well as to encourage future development of our specialty in this area.
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Affiliation(s)
- Stephanie Jones
- Columbia University Irving Medical Center, Division of Critical Care Medicine, 622 W. 168th St, New York, NY 10032, USA
| | - Teresa A Mulaikal
- Division of Cardiothoracic and Critical Care, Columbia University Medical Center, 622 W. 168th St., PH 5 Stem 133, New York, NY 10032, USA.
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15
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Sridhar S, Whitaker B, Mouat-Hunter A, McCrory B. Predicting Length of Stay using machine learning for total joint replacements performed at a rural community hospital. PLoS One 2022; 17:e0277479. [PMID: 36355762 PMCID: PMC9648742 DOI: 10.1371/journal.pone.0277479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Predicting patient's Length of Stay (LOS) before total joint replacement (TJR) surgery is vital for hospitals to optimally manage costs and resources. Many hospitals including in rural areas use publicly available models such as National Surgical Quality Improvement Program (NSQIP) calculator which, unfortunately, performs suboptimally when predicting LOS for TJR procedures. OBJECTIVE The objective of this research was to develop a Machine Learning (ML) model to predict LOS for TJR procedures performed at a Perioperative Surgical Home implemented rural community hospital for better accuracy and interpretation than the NSQIP calculator. METHODS A total of 158 TJR patients were collected and analyzed from a rural community hospital located in Montana. A random forest (RF) model was used to predict patient's LOS. For interpretation, permuted feature importance and partial dependence plot methods were used to identify the important variables and their relationship with the LOS. RESULTS The root mean square error for the RF model (0.7) was lower than the NSQIP calculator (1.21). The five most important variables for predicting LOS were BMI, Duke Activity Status-Index, diabetes, patient's household income, and patient's age. CONCLUSION This pilot study is the first of its kind to develop an ML model to predict LOS for TJR procedures that were performed at a small-scale rural community hospital. This pilot study contributes an approach for rural hospitals, making them more independent by developing their own predictions instead of relying on public models.
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Affiliation(s)
- Srinivasan Sridhar
- Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana, United States of America
| | - Bradley Whitaker
- Electrical and Computer Engineering, Montana State University, Bozeman, Montana, United States of America
| | | | - Bernadette McCrory
- Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana, United States of America
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16
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Systematic Review of Enhanced Recovery After Surgery in Patients Undergoing Cranial Surgery. World Neurosurg 2021; 158:279-289.e1. [PMID: 34740831 DOI: 10.1016/j.wneu.2021.10.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Enhanced Recovery after Surgery (ERAS) pathways are increasingly being integrated in neurosurgical patient management. The full extent of ERAS in cranial surgery is not well studied. We performed a systematic review examining ERAS in cranial surgery patients to 1) identify the extent to which ERAS is integrated in cranial neurosurgical procedures and 2) assess effectiveness of ERAS interventions for patients undergoing these procedures. METHODS A systematic review of MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, PsychInfo, and Google Scholar was conducted according to PRISMA guidelines (CRD42020197187). Studies eligible for inclusion assessed patients undergoing any cranial surgical procedure using an ERAS or ERAS-like pathway, defined by ≥2 ERAS protocol elements per the ERAS Society's RECOvER Checklist and the recommendations of Hagan et al. 2016 (not including patient education, criteria for discharge, or tracking of postdischarge outcomes). RESULTS Nine studies were included in qualitative synthesis, 2 of which were randomized controlled trials. All studies showed a moderate risk of bias. The most common ERAS elements used were screening and/or optimization and formal discharge criteria. The least common ERAS elements used were fasting/carbohydrate loading and antithrombotic prophylaxis. Complication rates were similar in studies comparing ERAS with non-ERAS groups. ERAS interventions were associated with reduced length of stay, with comparable and/or improved patient satisfaction. CONCLUSIONS ERAS is a safe and potentially favorable perioperative pathway for select patients undergoing cranial surgery. Future studies of ERAS in cranial surgery patients should emphasize postoperative optimizations and patient-reported outcome measures as key features.
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Anesthesia preoperative clinics: redefining the value proposition. Int Anesthesiol Clin 2021; 59:59-72. [PMID: 34433183 DOI: 10.1097/aia.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Current multidisciplinary approaches to preventing chronic postoperative pain. Br J Anaesth 2021; 127:331-335. [PMID: 34090681 DOI: 10.1016/j.bja.2021.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
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Wang E, Thomas JJ, Rodriguez ST, Kennedy KM, Caruso TJ. Virtual reality for pediatric periprocedural care. Curr Opin Anaesthesiol 2021; 34:284-291. [PMID: 33935176 DOI: 10.1097/aco.0000000000000983] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Commercial availability of virtual reality headsets and software has exponentially grown over the last decade as it has become more sophisticated, less expensive, and portable. Although primarily used by the general public for entertainment, virtual reality has been adopted by periprocedural clinicians to improve patient experiences and treatments. The purpose of this review is to explore recently reported evidence for virtual reality effectiveness for pediatric periprocedural care and discuss considerations for clinical implementation. RECENT FINDINGS In the preprocedure setting, practitioners use virtual reality to introduce children to periprocedural environments, distract attention from preprocedural vascular access, and increase cooperation with anesthesia induction. Intraprocedure, virtual reality decreases sedation requirements, and in some instances, eliminates anesthesia for minor procedures. Virtual reality also augments pain reduction therapies in the acute and extended rehabilitation periods, resulting in faster recovery and improved outcomes. Virtual reality seems to be well treated for pediatric use, given close clinical care and carefully curated content. SUMMARY Given the multiple clinical applications of virtual reality to supplement pediatric periprocedural care, practitioners should consider developing clinical programs that reliably provide access to virtual reality. Future research should focus on identification of patient characteristics and types of software that yield optimal patient outcomes.
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Affiliation(s)
- Ellen Wang
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford
| | - James J Thomas
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Samuel T Rodriguez
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford
| | | | - Thomas J Caruso
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford
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20
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Conley C, Facchin M, Gu Q, Mukerji S, Cohen R, O'Brien S, Nurhussien L, Ferrari L. The virtual pediatric perioperative home, experience at a major metropolitan safety net hospital. Paediatr Anaesth 2021; 31:686-694. [PMID: 33711208 DOI: 10.1111/pan.14179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Successes from anesthesiologist-led perioperative surgical homes in the adult patient population have inspired similar initiatives by pediatric hospitals. Typically the care coordination for these perioperative homes is run through hospital-funded, on-site, preanesthesia clinics. Preliminary data from pediatric perioperative homes have shown promising results in improved patient outcomes and decreased length of hospital stay. The majority of pediatric surgeries within the country are performed in nonpediatric hospitals. Such centers may not have the infrastructure or financial resources for a freestanding pediatric preanesthesia clinic. Faced with this situation at the largest safety net hospital in New England, the authors present their experience designing and implementing a "Virtual Pediatric Perioperative Home," a telemedicine-based triage and preanesthetic optimization for pediatric patients at Boston Medical Center, Boston, MA. METHODS A retrospective chart review of all pediatric anesthesia cases at Boston Medical Center from February 1, 2019, to January 31, 2020, as well as the number of pediatric cases canceled or postponed on the day of surgery for any reason during the same time period was conducted. RESULTS From February 1, 2019, to January 31, 2020, 1546 anesthetics were performed in children 18 years and under. Of those, 63 were designated as emergent and hence excluded from our analysis. 153 of the total 1483 (9.4%) of nonemergent bookings were canceled or postponed on the day of surgery. This represented a marked decline from our previous year's 13.7% same-day cancellation rate for pediatric patients. The most common reason for case cancellations (41.8%) was acute illness. Cancellation rates varied from month to month, with the highest cancellation rate of the year in September 2019 (18.8%). The departments of Podiatry and Gastroenterology represented the highest cancellation rates as a denominator of their case volumes, 15.4% and 15.2%, respectively. Younger children had 2.4 times the odds (95% CI: 1.720, 3.4) of cancellation compared to older children. DISCUSSION The virtual pediatric perioperative home (VPPH) may benefit quality of care while decreasing costs to pediatric patients, families, and hospital systems. While direct financial gains may be difficult to demonstrate, the VPPH has the potential to reduce OR delays and same day cancellations related to questions of medical optimization. In the context of a socioeconomically disadvantaged patient population, our VPPH's team of subspecialists created inroads for at risk children to establish or reestablish care for their comorbidities, while collaboration with the Department of Children and Families further streamlined communication and consent for pediatric patients in foster care. CONCLUSIONS The authors describe the design and successful implementation of a telemedicine-based pediatric preanesthesia triage and medical optimization service at a large safety net hospital. By creating a communication network of pediatric subspecialists, the anesthesiologists were able to, at minimal institutional cost, coordinate care for children with a variety of comorbidities leading up to the day of surgery. This yielded a 9.4% same day cancellation rate in a complex, socioeconomically disadvantaged pediatric patient population at a general hospital.
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Affiliation(s)
| | - Mark Facchin
- Department of Anesthesiology, Boston Medical Center, Boston, MA, USA
| | - Qingrou Gu
- Department of Anesthesiology, Boston Medical Center, Boston, MA, USA
| | - Shivali Mukerji
- Department of Anesthesiology, Boston Medical Center, Boston, MA, USA
| | - Robyn Cohen
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Sharon O'Brien
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Lina Nurhussien
- Department of Anesthesiology, Boston Medical Center, Boston, MA, USA
| | - Lynne Ferrari
- Department of Anesthesiology, Boston Children's Hospital, Boston, MA, USA
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Affiliation(s)
- Emily Methangkool
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles
| | - Daniel J Cole
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles
| | - Maxime Cannesson
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles
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