Articles

The incidence of un-indicated preoperative testing in a tertiary academic ambulatory center: a retrospective cohort study

Despite existing evidence and guidelines advocating for appropriate risk stratification, ambulatory surgery in low-risk patients continues to be accompanied by a battery of routine tests prior to surgery. Usin...

Authors: Onyi C. Onuoha, Michael B. Hatch, Todd A. Miano and Lee A. Fleisher

Cost-effectiveness of a cardiac output-guided haemodynamic therapy algorithm in high-risk patients undergoing major gastrointestinal surgery

The use of cardiac output monitoring to guide intra-venous fluid and inotropic therapies may improve peri-operative outcomes, but uncertainty exists regarding clinical effectiveness and robust cost-effectivene...

Authors: Zia Sadique, David A. Harrison, Richard Grieve, Kathryn M. Rowan and Rupert M. Pearse

Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit

Structured preoperative assessment has been reported to improve operating room efficiency as measured by metrics such as day of surgery cancellations (DOSCs). However, not all patients require comprehensive as...

Authors: Ronald P. Olson and Ishwori B. Dhakal

Potential return on investment for implementation of perioperative goal-directed fluid therapy in major surgery: a nationwide database study

Preventable postsurgical complications are increasingly recognized as a major clinical and economic burden. A recent meta-analysis showed a 17–29 % decrease in postoperative morbidity with goal-directed fluid ...

Authors: Frederic Michard, William K. Mountford, Michelle R. Krukas, Frank R. Ernst and Sandy L. Fogel

Validity of the Postoperative Morbidity Survey after abdominal aortic aneurysm repair—a prospective observational study

Currently, there is no standardised tool used to capture morbidity following abdominal aortic aneurysm (AAA) repair. The aim of this prospective observational study was to validate the Postoperative Morbidity ...

Authors: Ben A. Goodman, Alan M. Batterham, Elke Kothmann, Louise Cawthorn, David Yates, Helen Melsom, Karen Kerr and Gerard R. Danjoux

Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery

The European Medicines Agency does not recommend the use of hydroxyethyl starch-based volume replacement solutions in critically ill patients due to an increased risk of renal failure. However, this recommenda...

Authors: N. Li, S. Statkevicius, B. Asgeirsson and U. Schött

Variation in haemodynamic monitoring for major surgery in European nations: secondary analysis of the EuSOS dataset

The use of cardiac output monitoring may improve patient outcomes after major surgery. However, little is known about the use of this technology across nations.

Authors: Tahania Ahmad, Christian M. Beilstein, Cesar Aldecoa, Rui P. Moreno, Zsolt Molnár, Vesna Novak-Jankovic, Christoph K. Hofer, Michael Sander, Andrew Rhodes and Rupert M. Pearse

The whole truth and nothing but the truth: the need for full reporting of randomised trials

The use of cardiac output monitoring to guide fluid and inotropic therapy in surgical patients has remained a controversial topic for more than 40 years. The reasons for this are numerous and complex, but key ...

Authors: Rupert M. Pearse

Stroke volume variation to guide fluid therapy: is it suitable for high-risk surgical patients? A terminated randomized controlled trial

Perioperative goal-directed fluid therapy (GDFT) may improve outcome after high-risk surgery. Minimal invasive measurement of stroke volume variation (SVV) has been recommended to guide fluid therapy. We inten...

Authors: Ib Jammer, Mari Tuovila and Atle Ulvik

How efficient is patient discharge following lower limb arthroplasty?

Appropriately timed patient discharge is essential for optimal patient care and efficient hospital functioning. The post-operative morbidity survey (POMS) is the only validated prospective method of measuring ...

Authors: Elizabeth Ashby, Claire Matejowsky, Michael G Mythen, Fares S Haddad and Michael PW Grocott

Design and methodology of SNAP-1: a Sprint National Anaesthesia Project to measure patient reported outcome after anaesthesia

Patient satisfaction is an important metric of health-care quality. Accidental awareness under general anaesthesia (AAGA) is a serious complication of anaesthesia care which may go unrecognised in the immediat...

Authors: Suneetha Ramani Moonesinghe, Eleanor Mary Kate Walker and Madeline Bell

Perioperative fluid therapy: a statement from the international Fluid Optimization Group

Perioperative fluid therapy remains a highly debated topic. Its purpose is to maintain or restore effective circulating blood volume during the immediate perioperative period. Maintaining effective circulating...

Authors: Lais Helena Camacho Navarro, Joshua A Bloomstone, Jose Otavio Costa Auler Jr, Maxime Cannesson, Giorgio Della Rocca, Tong J Gan, Michael Kinsky, Sheldon Magder, Timothy E Miller, Monty Mythen, Azriel Perel, Daniel A Reuter, Michael R Pinsky and George C Kramer

Perioperative clinical and economic outcomes associated with replacing first-generation high molecular weight hydroxyethyl starch (Hextend®) with low molecular weight hydroxyethyl starch (Voluven®) at a large medical center

Several plasma volume expander alternatives exist to enhance intravascular volume status in patients undergoing surgery. The optimal intravascular volume expander in the perioperative setting is currently unkn...

Authors: Raquel R Bartz, William D White and Tong J Gan

Goal-directed therapy: what we know and what we need to know

Goal-directed therapy (GDT) utilizes monitoring techniques to help guide clinicians with administering fluids, vasopressors, inotropes, or other treatments to patients in various clinical settings. Multiple st...

Authors: Jason B O’Neal and Andrew D Shaw

The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival

The benefit of the post-anaesthesia care unit (PACU) with respect to an early detection of postoperative complications is beyond dispute. From a patient perspective, prevention and optimal management of pain, ...

Authors: Michael T Ganter, Stephan Blumenthal, Seraina Dübendorfer, Simone Brunnschweiler, Tim Hofer, Richard Klaghofer, Andreas Zollinger and Christoph K Hofer

Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution: an observational study

In particular surgical conditions, a balanced anesthesia with a high-antinociceptive contribution is required. This may induce cardiovascular impairment and thus compromise tissue oxygenation. In this prospect...

Authors: Jaap Jan Vos, Marieke Poterman, Laura N Hannivoort, Victor W Renardel De Lavalette, Michel MRF Struys, Thomas WL Scheeren and Alain F Kalmar

Postsurgical behaviors in children with and without symptoms of sleep-disordered breathing

Although some children undergo formal preoperative testing for obstructive sleep apnea, it is likely that many children present for surgery with undetected sleep-related disorders. Given that these children ma...

Authors: Alan R Tait, Terri Voepel-Lewis and Louise M O’Brien

Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures

Complications increase the costs of care of surgical patients. We studied the Premier database to determine the incidence and direct medical costs related to pulmonary complications and compared it to cardiac ...

Authors: Lee A Fleisher and Walter T Linde-Zwirble

Total joint Perioperative Surgical Home: an observational financial review

The numbers of people requiring total arthroplasty is expected to increase substantially over the next two decades. However, increasing costs and new payment models in the USA have created a sustainability gap. A...

Authors: Darren R Raphael, Maxime Cannesson, Ran Schwarzkopf, Leslie M Garson, Shermeen B Vakharia, Ranjan Gupta and Zeev N Kain

Functional recovery is considered the most important target: a survey of dedicated professionals

The aim of this study was to survey the relative importance of postoperative recovery targets and perioperative care items, as perceived by a large group of international dedicated professionals.

Authors: Eirik K Aahlin, Maarten von Meyenfeldt, Cornelius HC Dejong, Olle Ljungqvist, Kenneth C Fearon, Dileep N Lobo, Nicolas Demartines, Arthur Revhaug, Stephen J Wigmore and Kristoffer Lassen

Successful recovery after major surgery: moving beyond length of stay

There is strong evidence that Enhanced Recovery Pathways improve length of hospital stay, readmission rates, and complications after major surgery. However, recovery is a complex process that only finishes whe...

Authors: Timothy E Miller and Monty Mythen

Erratum to: Dose and type of crystalloid fluid therapy in adult hospitalized patients

Authors: Annemieke Smorenberg, Can Ince and A B Johan Groeneveld

Exploring the experience of an enhanced recovery programme for gynaecological cancer patients: a qualitative study

Perioperative enhanced recovery programmes (ERPs), identified as initiatives that improve care and save money, have been adopted by NHS Improvement and are currently being rolled out across many surgical depar...

Authors: Stephanie Archer, Jane Montague and Anish Bali

The impact of complications following open colectomy on hospital finances: a retrospective cohort study

When hospitals suffer financial losses when postoperative complications occur, they may have a direct financial incentive to initiate quality improvement programs. The purpose of this research was to determine...

Authors: David N Flynn, Rebecca M Speck, Najjia N Mahmoud, Guy David and Lee A Fleisher

Serum arterial lactate concentration predicts mortality and organ dysfunction following liver resection

The aim of this study was to determine if the post-operative serum arterial lactate concentration is associated with mortality, length of hospital stay or complications following hepatic resection.

Authors: Matthew G Wiggans, Tim Starkie, Golnaz Shahtahmassebi, Tom Woolley, David Birt, Paul Erasmus, Ian Anderson, Matthew J Bowles, Somaiah Aroori and David A Stell

Association of intraoperative transfusion of blood products with mortality in lung transplant recipients

The impact of intraoperative transfusion on postoperative mortality in lung transplant recipients is still elusive.

Authors: Denise Weber, Silvia R Cottini, Pascal Locher, Urs Wenger, Paul A Stehberger, Mario Fasshauer, Reto A Schuepbach and Markus Béchir

Less invasive methods of advanced hemodynamic monitoring: principles, devices, and their role in the perioperative hemodynamic optimization

The monitoring of the cardiac output (CO) and other hemodynamic parameters, traditionally performed with the thermodilution method via a pulmonary artery catheter (PAC), is now increasingly done with the aid o...

Authors: Christos Chamos, Liana Vele, Mark Hamilton and Maurizio Cecconi

Association between preoperative haemoglobin concentration and cardiopulmonary exercise variables: a multicentre study

Preoperative anaemia and low exertional oxygen uptake are both associated with greater postoperative morbidity and mortality. This study reports the association among haemoglobin concentration ([Hb]), peak oxy...

Authors: James M Otto, Alasdair F O’Doherty, Philip J Hennis, Jackie A Cooper, Michael PW Grocott, Chris Snowdon, John B Carlisle, Michael Swart, Toby Richards and Hugh E Montgomery

Dose and type of crystalloid fluid therapy in adult hospitalized patients

In this narrative review, an overview is given of the pros and cons of various crystalloid fluids used for infusion during initial resuscitation or maintenance phases in adult hospitalized patients. Special em...

Authors: Annemieke Smorenberg, Can Ince and AB Johan Groeneveld

Postoperative complications in Australia and New Zealand (the REASON study)

Perioperative medicine is difficult to define, and thus, its progress may be hindered until internationally accepted definitions can be established within the field. The immediate agenda for perioperative phys...

Authors: David A Story

NICE medical technologies guidance: aims for clinical practice

NICE (the National Institute for Health and Care Excellence) produces a range of advice and guidance on medical practice and technologies. NICE was established in 1999, and in 2009 set up its Medical Technolog...

Authors: Bruce Campbell

What evidence is there for intraoperative predictors of perioperative cardiac outcomes? A systematic review

Patients undergo cardiac preoperative evaluation to identify those at risk of adverse perioperative cardiac events. The Revised Cardiac Risk index is commonly used for this task, although it is unable to accur...

Authors: Bruce M Biccard and Reitze N Rodseth

New evidence in trauma resuscitation - is 1:1:1 the answer?

Traumatic injury is a common problem, with over five million worldwide deaths from trauma per year. An estimated 10 to 20% of these deaths are potentially preventable with better control of bleeding. Damage co...

Authors: Timothy E Miller

Designing intelligent anesthesia for a changing patient demographic: a consensus statement to provide guidance for specialist and non-specialist anesthetists written by members of and endorsed by the Society for Obesity and Bariatric Anaesthesia (SOBA)

As a result of the increasing prevalence of obesity in the UK, anesthetists are increasingly encountering overweight and obese patients in routine practice. There is currently a paucity of evidence to guide be...

Authors: Mark C Bellamy and Michael P Margarson

Using bispectral index and cerebral oximetry to guide hemodynamic therapy in high-risk surgical patients

High-risk surgery represents 12.5% of cases but contributes 80% of deaths in the elderly population. Reduction in morbidity and mortality by the use of intervention strategies could result in thousands of live...

Authors: Heena Bidd, Audrey Tan and David Green

Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study

In 2009, the NHS evidence adoption center and National Institute for Health and Care Excellence (NICE) published a review of the use of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs)....

Authors: Stephen J Goodyear, Heng Yow, Mahmud Saedon, Joanna Shakespeare, Christopher E Hill, Duncan Watson, Colette Marshall, Asif Mahmood, Daniel Higman and Christopher HE Imray

The maintenance and monitoring of perioperative blood volume

The assessment and maintenance of perioperative blood volume is important because fluid therapy is a routine part of intraoperative care. In the past, patients undergoing major surgery were given large amounts...

Authors: Takehiko Iijima, Birgitte Brandstrup, Peter Rodhe, Audrius Andrijauskas and Christer H Svensen

Choice of anesthetic technique on plasma concentrations of interleukins and cell adhesion molecules

Whether inflammatory responses to surgery are comparably activated during total intravenous anesthesia (TIVA) and during volatile anesthesia remains unclear. We thus compared the perioperative effects of TIVA ...

Authors: Daniela C Ionescu, Simona Claudia D Margarit, Adina Norica I Hadade, Teodora N Mocan, Nicolae A Miron and Daniel I Sessler

Observational study of the effects of age, diabetes mellitus, cirrhosis and chronic kidney disease on sublingual microvascular flow

Sidestream dark field (SDF) imaging has been used to demonstrate microcirculatory abnormalities in a variety of critical illnesses. The microcirculation is also affected by advancing age and chronic comorbidit...

Authors: Toby Reynolds, Amanda Vivian-Smith, Shaman Jhanji and Rupert M Pearse

Peri-operative care of elderly patients – an urgent need for change: a consensus statement to provide guidance for specialist and non-specialist anaesthetists

Authors: Chris Dodds, Irwin Foo, Kerri Jones, Shiv Kumar Singh and Carl Waldmann

Introduction to the postanaesthetic care unit

High-risk, noncardiac surgery represents only 12.5% of surgical procedures, but 83.3% of deaths. The postanaesthetic care unit (PACU) addresses the need for an improved level of care for these patients by prov...

Authors: Joanna C Simpson and S Ramani Moonesinghe

Preoperative cardiopulmonary exercise testing in England – a national survey

Cardiopulmonary exercise testing (CPET) has become well established in the preoperative assessment of patients presenting for major surgery in the United Kingdom. There is evidence supporting its use in risk-s...

Authors: Sam Huddart, Emily L Young, Rebecca-Lea Smith, Peter JE Holt and Pradeep K Prabhu

Neither dynamic, static, nor volumetric variables can accurately predict fluid responsiveness early after abdominothoracic esophagectomy

Hypotension is common in the early postoperative stages after abdominothoracic esophagectomy for esophageal cancer. We examined the ability of stroke volume variation (SVV), pulse pressure variation (PPV), cen...

Authors: Hironori Ishihara, Eiji Hashiba, Hirobumi Okawa, Junichi Saito, Toshinori Kasai and Toshihito Tsubo

Anaerobic threshold, is it a magic number to determine fitness for surgery?

The use of cardiopulmonary exercise testing (CPET) to evaluate cardiac and respiratory function was pioneered as part of preoperative assessment in the mid 1990s. Surgical procedures have changed since then. T...

Authors: Paul Older

Measuring outcomes after major abdominal surgery during hospitalization: reliability and validity of the Postoperative Morbidity Survey

Measurement of outcomes after major abdominal surgery has traditionally focused on mortality, however the low incidence in elective surgery makes this measure a poor comparator. The Postoperative Morbidity Sur...

Authors: Simon J Davies, James Francis, Jonathan Dilley, R Jonathan T Wilson, Simon J Howell and Victoria Allgar

Protocol-directed insulin infusion sliding scales improve perioperative hyperglycaemia in critical care

Perioperative hyperglycaemia is associated with poor outcomes in patients undergoing cardiac surgery. Frequent postoperative hyperglycaemia in cardiac surgery patients has led to the initiation of an insulin i...

Authors: Man Lin Hui, Arun Kumar and Gary G Adams

Perioperative acute kidney injury

Acute kidney injury (AKI) is a serious complication in the perioperative period, and is consistently associated with increased rates of mortality and morbidity. Two major consensus definitions have been develo...

Authors: Stacey Calvert and Andrew Shaw

Strategies to promote reporting of Surgical Care Improvement Project (SCIP) measures: a pilot survey of anesthesia department leaders

The Surgical Care Improvement Project (SCIP) is a quality improvement initiative focused on reducing surgical complications. Reporting SCIP performance measures helps determine whether hospitals receive the fu...

Authors: Rebecca M Speck, Mark D Neuman, Andrew R Bond and Lee A Fleisher

Perioperative fluid management: Consensus statement from the enhanced recovery partnership

Authors: Monty G Mythen, Michael Swart, Nigel Acheson, Robin Crawford, Kerri Jones, Martin Kuper, John S McGrath and Alan Horgan

Welcome to Perioperative Medicine

Authors: Mark Hamilton and Monty G Mythen