Academic literature on the topic 'Peri-operative data'
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Journal articles on the topic "Peri-operative data"
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Bozzetti, Federico. "Peri-operative nutritional management." Proceedings of the Nutrition Society 70, no. 3 (May 31, 2011): 305–10. http://dx.doi.org/10.1017/s0029665111000486.
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The metabolic response to surgical trauma is mainly characterised by an increase in BMR, a negative N balance, increased gluconeogenesis and increased synthesis of acute-phase proteins. These reactions aim at ensuring the availability of endogenous substrates for healing wounds while the synthesis of acute-phase proteins enhances the scavenging process and helps repair. However, if this process is excessive or continues for too long, it leads to a progressive depletion of body compartment with a consequent adverse outcome. Obviously, the severity of such depletion is magnified if the patient is starving or is already malnourished and the consumption of lean body mass is not compensated by an exogenous supply of nutrients. The nutritional control of this metabolic reaction represents the traditional rationale for nutritional support of surgical patients. Subsequent data have shown that the negative effects of starvation are not simply due to the starvation per se but due to the starving gut, and peri-operative enteral nutrition has proven successful in blunting the metabolic response after injury and improving protein kinetics, net balance and amino acid flux across peripheral tissue and consequently in decreasing the complications. Finally, further clinical research has shown that many post-operative infections may result from immune suppression and that such state might be reversed to some degree by modulation of the immune response through specialised nutritional support in surgical patients, regardless of their nutritional status. This paper will focus on the updated evidence-based research on peri-operative nutrition (parenteral, enteral and immune-enhancing) in patients undergoing major surgery.
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Sessler, D. I. "Big Data - and its contributions to peri-operative medicine." Anaesthesia 69, no. 2 (December 19, 2013): 100–105. http://dx.doi.org/10.1111/anae.12537.
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Morgan, Ryan B., Allie Yan, Ankit Dhiman, Divya Sood, Cecilia T. Ong, Xiaoyang Wu, Ardaman Shergill, Blase N. Polite, Kiran Turaga, and Oliver Eng. "Survival in total preoperative verus perioperative chemotherapy for patients with metastatic high-grade appendiceal adenocarcinoma undergoing CRS/HIPEC." Journal of Clinical Oncology 40, no. 4_suppl (February 1, 2022): 90. http://dx.doi.org/10.1200/jco.2022.40.4_suppl.090.
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90 Background: Due to the relative infrequency of high grade appendiceal adenocarcinoma with peritoneal metastases, there is limited data to guide treatment strategies. Current practices for this disease are largely extrapolated from colon cancer patients with peritoneal metastases, who typically undergo six months of systemic chemotherapy in conjunction with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). The optimal timing of chemotherapy in relation to CRS/HIPEC remains unknown. In this study, we compare the efficacy of peri-operative chemotherapy to pre-operative chemotherapy alone. Methods: This is a retrospective review of patients who underwent CRS/HIPEC for high grade appendiceal cancers from a tertiary referral center from 2014-2020. Outcomes were compared between patients who underwent planned 6 months of chemotherapy followed by CRS/HIPEC (pre-operative group) versus planned 3 months of chemotherapy both pre- and post-operatively (peri-operative group). Results: 85 patients were treated for metastatic high-grade appendiceal cancers during the study period, of whom24 were eligible for inclusion. Of those included, 16 were in the peri-operative group and 8 in the pre-operative group. Most patients were white (75%), non-Hispanic (96%) and female (54%). Patients in the pre-operative group tended to be older (65 vs. 56 years, p = 0.02). For patients with specified histologic grading, poorly differentiated tumors were common (50%). Signet ring cell histology (42%) and mucinous features (67%) were frequent as well. Median overall survival was similar between the pre-operative and peri-operative groups (32.3 vs. 31.6 months, p = 0.97), although patients undergoing peri-operative treatment received fewer total cycles of chemotherapy on average (14.1 vs. 9.5 cycles, p < 0.01). Half of the patients in the peri-operative group (8/16) did not complete their chemotherapy regimen, with 75% discontinuing therapy due to chemotherapy-related toxicities. Within the peri-operative group, a non-significant decrease in median survival was observed for those who did not complete chemotherapy (27.8 vs > 53.6 months, p = 0.22). Conclusions: Peri-operative and total pre-operative chemotherapy strategies are associated with similar survival in patients with high grade appendiceal cancers undergoing CRS/HIPEC. Peri-operative administration may be limited by chemotherapy-related toxicities.
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Diaz-Gil, Alicia, Joanne Brooke, Olga Kozlowska, Sarah Pendlebury, and Debra Jackson. "Care needs of people with dementia in the peri-operative environment: A systematic review." Dementia 19, no. 6 (November 12, 2018): 1889–906. http://dx.doi.org/10.1177/1471301218809225.
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The care of people with dementia within the hospital setting is challenging for healthcare professionals. Hospital design and services are not optimized for people with dementia, owing to the lack of preparation of healthcare professionals and the busy environment of the acute hospital. The peri-operative environment may present particular difficulties but little is known about the experience and care of people with dementia in this setting. The aim of this review was to examine the care of surgical patients who have dementia and their family members in peri-operative environments and describe strategies adopted by healthcare professionals. A systematic search of the following databases was completed: BNI, CINAHL, PubMED and PsychINFO in accordance with PRISMA guidelines. Data were extracted and analysed within a thematic analysis framework as described by Braun and Clarke . Ten papers based on eight studies were included, five (n = 355,010 participants) containing quantitative data and five reporting qualitative data (n = 395 participants). People with dementia who go undergo surgery experienced higher adverse post-operative outcomes such as respiratory problems or urinary tract infections. The key elements in surgical care for people with dementia included: health assessment throughout the surgical trajectory (pre-, intra- and post-operative) and the resources used by healthcare professionals in the peri-operative care. Healthcare professionals reported difficulties in the completion of health assessments due to the cognitive status of people with dementia and a lack of skills in dementia management. The use of restraints was still a common practice and a source of conflict. Dementia-specific training and guidelines focused on the care of surgical patients who have dementia in peri-operative environments are required to improve care and post-operative outcomes. More research is required to develop effective interventions to improve care and decrease the risk of complications for people with dementia in the peri-operative care environment.
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Sylvester, D. C., and A. P. Coatesworth. "Antiplatelet therapy in ENT surgery: a review." Journal of Laryngology & Otology 126, no. 4 (December 19, 2011): 331–36. http://dx.doi.org/10.1017/s0022215111003239.
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AbstractIntroduction:Antiplatelet agents such as aspirin and clopidogrel are increasingly encountered in clinical practice. Otorhinolaryngological surgeons are involved in the peri-operative decision of whether to continue treatment and risk haemorrhage or to discontinue treatment and risk thrombosis.Methods:Literature relating to the risk of spontaneous or operative haemorrhage was reviewed. The morbidity and mortality associated with cessation of agents was evaluated. Published guidelines were also evaluated. A protocol for the management of antiplatelet agents in the peri-operative period, with particular reference to ENT operations, is presented.Conclusion:Significant morbidity and mortality is associated with the premature cessation of antiplatelet agents. Data from cardiac surgery suggest that operative blood loss only marginally increases in patients on aspirin and clopidogrel. However, the management of antiplatelet agents in the peri-operative period should be made after multidisciplinary consultation.
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Jevons, G., H. Edginton, G. Mccall, A. Pillai, and S. Haque. "AB1345-HPR THE MULTIDISCIPLINARY FOOT CLINIC: A SERVICE EVALUATION PROJECT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1960.1–1961. http://dx.doi.org/10.1136/annrheumdis-2020-eular.343.
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Background:Patients with rheumatological foot disease are an overlooked population, and it was noted locally that these patients received a fragmented service; attending multiple appointments for the management of one clinical issue. This led to delays in treatment; significant inter-departmental correspondence and variations in the peri-operative management of disease modifying anti-rheumatic drug (DMARD) and biologic therapies. To remedy this a foot multidisciplinary (MDT) clinic was established, including input from rheumatology, orthopaedic surgery, specialist rheumatology podiatry and physiotherapy. The outcomes from the foot MDT clinic have been analysed in this service evaluation project.Objectives:To evaluate the outcomes of the multidisciplinary foot MDT clinic, with particular reference to concordance to the British Rheumatology Society (BSR) guidelines on peri-operative medicine guidelines.Methods:Data was collected retrospectively across all clinics from January 2017 to February 2019. Clinic letters were obtained, and data was collected using a standardised data collection sheet. Data was collected on patient demographics, rheumatological diagnoses, treatment outcomes from the foot MDT, appropriateness of peri-operative plan and post-operative complications. No data was available on these outcomes prior to the advent of the foot MDT clinic.Results:Data from 12 clinics was analysed (n=40). Patients had a median age of 66 years (IQR 27.5 years); 65% of patients were female and 35% of patients were male. The commonest rheumatological foot disease seen was rheumatoid arthritis (67%), followed by psoriatic arthritis (15%). All patients were treated with biologic or non-biologic DMARDs. Treatment outcomes were as follows: 27.5% were offered surgical treatment; 10% were offered intra-articular (IA) injections under ultrasound guidance; 10% were offered IA injections under general anaesthetic; 25% underwent specialist rheumatology podiatry, and the remaining 30% elected for a conservative approach after careful consideration of treatment options. Of those who were offered surgical treatment, 72% of patients were provided with a peri-operative plan which accorded with British Rheumatology Society (BSR) guidelines. Of those whom underwent surgery, one patient’s surgical treatment was complicated by a post-operative infection; however, the peri-operative DMARD/biologic plan was not felt to be contributing factor.Conclusion:The foot MDT clinic provides a comprehensive review of rheumatological foot conditions, with readily available access to a full range of treatment options. Co-location of all relevant professionals allows for real-time interdepartmental communication; shared decision making between clinicians and patients; avoids multiple appointments; reduces uncertainty with peri-operative planning as well as providing a cost-effective and efficacious service. Discrepancies in the peri-operative plan for medicines arose when the treating orthopaedic surgeon was not present in clinic. In these cases, the plan for surgical treatment was made outside of this clinic, without input from the treating rheumatologist. To improve concordance with BSR peri-operative medicine guidelines, it is recommended that all treatment decisions are made during the clinic, allowing input from all relevant partners. Informal feedback from patients commended the foot MDT, this shall be formalised through further qualitative data.Disclosure of Interests:None declared
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Koea, Jonathan B., Yatin Young, and Kerry Gunn. "Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia." HPB Surgery 2009 (December 15, 2009): 1–8. http://dx.doi.org/10.1155/2009/271986.
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Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV) fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 g/mL at 0.1 mL/kg/hr) or intrathecal morphine (n = 50; 300 g in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively) was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, ), less postoperative IV fluids (median 1200 mL versus 4300 mL, ) than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, ) and had shorter hospital stays than those managed with epidural infusions (4.7 0.9 days versus 6.8 1.2 days, ). Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.
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Thaly, R., K. Shah, and V. Patel. "408 ROBOTIC RADICAL PROSTATECTOMY: PERI-OPERATIVE AND OUTCOME DATA OF 500 CASES." European Urology Supplements 6, no. 2 (March 2007): 124. http://dx.doi.org/10.1016/s1569-9056(07)60406-0.
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Owens, Gemma Louise, Vanitha Sivalingam, Mohamed Abdelrahman, James P. Beirne, Dominic Blake, Anna Collins, Rhianna Davies, et al. "Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynecological oncology patients?" International Journal of Gynecologic Cancer 30, no. 12 (October 12, 2020): 1959–65. http://dx.doi.org/10.1136/ijgc-2020-001834.
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IntroductionOlder patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.MethodsA web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1–7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.ResultsOf the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.ConclusionsObstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.
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Haifler, Miki, Yossi Ventura, Kamil Malsha, Sagi Shpitzer, Amnon Zisman, Jack Baniel, Gilad Amiel, Azik Hoffman, and Shay Golan. "Neoadjuvant chemotherapy-induced sarcopenia to predict perioperative complications following radical cystectomy for bladder cancer." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 478. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.478.
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478 Background: Radical cystectomy (RC) with neoadjuvant chemotherapy (NAC) is the standard of care for muscle invasive bladder cancer and has a high rate of complications. Malnutrition is common among RC patients and is an established risk factor for peri-operative complications. The association of NAC and nutritional status and its effect on post-operative complications is not fully understood. We hypothesize that NAC hinders nutritional status and thus increases complication rates after RC. Methods: We retrospectively examined the records of NAC/RC patients. We included demographic, clinical and pathologic data and type and cycle number of NAC. Nutritional status was assessed with the smooth muscle area (SMA) of the psoas muscle at the level of L4 vertebrae measured on cross-sectional imaging. Patients with missing imaging data were excluded. SMA was measured pre and post NAC. The difference between the measurements was used as a predictor variable (delta_SMA). The outcomes assessed were ileus, infection, rehospitalization and a composite outcome of any complication. Results: The study included 50 patients, from 3 high volume centers in Israel. Median delta_SMA was -197 (-366, -88) mm2. Demographic, clinical and pathologic parameters were similar in patients with and without complications. delta_SMA was an independent predictor of ileus (OR = 0.98, p=0.003), peri-operative infection (OR = 0.98, p=0.0015) and any complications (OR = 0.98, p = 0.011) on univariable analysis. Delta_SMA remained an independent predictor of ilieus (OR 0.97, p=0.014), peri-operative infections (OR 0.95, p=0.023) and any complications (OR 0.98, p=0.01) on multivariable regression analysis. Delta_SMA was not a significant predictor of rehospitalization. Conclusions: In patients undergoing RC, NAC causes a measurable nutritional insult. The change in SMA predicts significant peri-operative complications. Future studies should examine the role of nutritional intervention during NAC in the framework of a clinical trial.
Books on the topic "Peri-operative data"
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Harder, Louise, and Atul Malhotra. Pathophysiology and therapeutic strategy for sleep disturbance in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0225.
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Robust data have shown that sleep disruption and inadequate sleep duration in the general population impact neurocognitive function and produce cardiometabolic sequelae. Despite widespread recognition of the importance of sleep as an essential homeostatic function, there are relatively few data regarding the importance of sleep in critically-ill patients. Obstructive sleep apnoea is a common respiratory condition that is prevalent in the ICU and can be particularly problematic pre-intubation, post-extubation, and in the peri-operative setting. Considerable discussion regarding the impact of sleep versus sedation has occurred, with some insights emerging from improvements in our understanding of basic neurobiology. Sleep disturbance may also have an impact in critically-ill mechanically-ventilated patients by contributing to the development of delirium, which is associated with poor outcomes. However, further data are required to determine the ideal strategy to optimize sleep in the ICU and whether such strategies will in turn improve hard outcomes of critically-ill patients.
Book chapters on the topic "Peri-operative data"
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Balan, Arina Viacheslavovna. "Features of the Anaesthetic Manual in Obese Patients." In Culture. Science. Education: Current Issues, 84–92. Publishing house Sreda, 2020. http://dx.doi.org/10.31483/r-75449.
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The article is devoted to the consideration of features of anaesthetic manual in obese patients. The author outlines that the number of obese people has more than tripled worldwide. The author points out the increasing trend in the incidence of obesity in the Russian Federation in 2020. The purpose of the research is to analyze the data available in the literature on the impact of obesity on the anaesthetic manual and, as a result, the probability of complications in the peri-operative period a as well as the success of surgical interference.
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Chopra, Asmita, and Alessandro Paniccia. "Gallbladder Cancer: Diagnosis and Surgical Management." In Biliary Tract - Review and Recent Progress [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.109208.
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Gallbladder cancer (GBCa) is a biliary tract malignancy that is common in South America and Southeast Asia, where patients often present with abdominal pain and jaundice. However, most cases of GBCa in the United States are diagnosed incidentally following cholecystectomy. The pre-operative diagnosis and evaluation involves imaging with ultrasound, CT, MRI, and PET. In patients with incidental GBCa, the histopathology directs further management. The surgical management of GBCa ranges from a simple cholecystectomy to liver resection with lymphadenectomy. Bile duct and vascular resections are reserved to obtain negative margins. To date, multiple controversies remain in the management of GBCa. The determination of type of surgery is based predominantly on T stage. The need for liver resection for tumor on the peritonealized surface continues to be debated. The added value of neoadjuvant and peri-operative therapy is being actively investigated. Systemic therapy has greatly evolved encompassing the use of capecitabine, gemcitabine-cisplatin, with recent addition of taxanes, HER2 inhibitors, and immunotherapy using PD-L1 inhibitors including Durvalumab. This chapter describes current diagnosis and treatment practices for GBCa especially determinants of surgical management and the benefits of peri-operative systemic therapy highlighting the recent advances and shortcomings.
Conference papers on the topic "Peri-operative data"
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Low, Daniel, Lynn Martin, Michael Richards, and Lloyd Provost. "12 Reducing peri-operative opioids in ambulatory surgery – a quality improvement project using real-world data." In IHI Scientific Symposium, Gaylord Palms Resort & Convention Center Orlando, Florida, 9th December 2019. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/bmjoq-2019-ihi.12.
Full textReports on the topic "Peri-operative data"
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Yue, Lei, Guanzhang Mu, Zengmao Lin, and Haolin Sun. Impact of low-dose intrathecal morphine on orthopedic surgery: a protocol of a systematic review and meta-analysis of randomized controlled trials. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, February 2022. http://dx.doi.org/10.37766/inplasy2022.2.0029.
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Review question / Objective: Patients undergoing orthopedic surgery usually suffer considerably from peri-operative pain and intrathecal morphine (ITM) has recent been used as an effective analgesia method. The intrathecal morphine dose achieving optimal analgesia for orthopedic surgery while minimizing side effects has not yet been determined. There is currently a lack of literature synthesis in the safety and effects of low-dose ITM on orthopedic surgery. Condition being studied: Low-dose intrathecal morphine on orthopedic surgery. Information sources: We will search the following electronic databases, registries and websites on January 11th 2022, unrestricted by date. Grey literature and non-English studies will not be excluded. English Databases: PubMed, Cochrane library and Web of science. Chinese database: Cnki.net Trial registries: ClinicalTrials.gov.