Articles

Evidence-Based Perioperative Medicine comes of age: the Perioperative Quality Initiative (POQI)

The 1st POQI Consensus Conference occurred in Durham, NC, on March 4–5, 2016, and was supported by the American Society of Enhanced Recovery (ASER) and Evidence-Based Perioperative Medicine (EBPOM). The confer...

Authors: Timothy E. Miller, Andrew D. Shaw, Michael G. Mythen and Tong J Gan

Erratum to: Proceedings of the American Society for Enhanced Recovery/Evidence Based Peri-Operative Medicine 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine

Authors: Charles R. Horres, Mohamed A. Adam, Zhifei Sun, Julie K. Thacker, Timothy E. Miller and Stuart A. Grant

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative  (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery

Enhanced recovery may be viewed as a comprehensive approach to improving meaningful outcomes in patients undergoing major surgery. Evidence to support enhanced recovery pathways (ERPs) is strong in patients un...

Authors: Robert H. Thiele, Karthik Raghunathan, C. S. Brudney, Dileep N. Lobo, Daniel Martin, Anthony Senagore, Maxime Cannesson, Tong Joo Gan, Michael Monty G. Mythen, Andrew D. Shaw and Timothy E. Miller

Proceedings of the American Society for Enhanced Recovery/Evidence Based Peri-Operative Medicine 2016 Annual Congress of Enhanced Recovery and Perioperative Medicine

A1 Effects of enhanced recovery pathways on renal function

Authors: Charles R. Horres, Mohamed A. Adam, Zhifei Sun, Julie K. Thacker, Timothy J. Miller, Stuart A. Grant, Jeffrey Huang, Kirstie McPherson, Sanjiv Patel, Su Cheen Ng, Denise Veelo, Bart Geerts, Monty Mythen, Su Cheen Ng, Mark Foulger, Tim Collins…

From NELA to EPOCH and beyond: enhancing the evidence base for emergency laparotomy

Around 35,000 patients undergo emergency laparotomy surgery in the UK each year with an in-hospital 30-day mortality estimated as between 11 and 15 %. The recent publication of the First Patient Report of the ...

Authors: Peter M. Odor and Michael P. W. Grocott

Preoperative discussion with patients about delirium risk: are we doing enough?

Postoperative delirium is a common complication in the older surgical population, occurring in 10–50 % of cases. It is thought to be more common if an individual is identified as frail. Postoperative delirium ...

Authors: Judith H. Tomlinson and Judith S. L. Partridge

Coagulation during elective neurosurgery with hydroxyethyl starch fluid therapy: an observational study with thromboelastometry, fibrinogen and factor XIII

Several studies have described hypercoagulability in neurosurgery with craniotomy for brain tumor resection. In this study, hydroxyethyl starch (HES) 130/0.42 was used for hemodynamic stabilization and initial...

Authors: Caroline Ulfsdotter Nilsson, Karin Strandberg, Martin Engström and Peter Reinstrup

Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes

Postoperative pulmonary complications in orthopedic surgery patients have been associated with worse clinical outcomes. Identifying patients with respiratory risk factors requiring enhanced monitoring and mana...

Authors: Roman Melamed, Lori L. Boland, James P. Normington, Rebecca M. Prenevost, Lindsay Y. Hur, Leslie F. Maynard, Molly A. McNaughton, Tyler G. Kinzy, Adnan Masood, Mehdi Dastrange and Joseph A. Huguelet

Significant discrepancies exist between clinician assessment and patient self-assessment of functional capacity by validated scoring tools during preoperative evaluation

Preoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage reg...

Authors: John Whittemore Stokes, Jonathan Porter Wanderer and Matthew David McEvoy

A randomized, double-blind, placebo controlled safety, tolerability, and pharmacokinetic dose escalation study of a gentamicin vancomycin gel in patients undergoing colorectal surgery

Despite numerous interventions promulgated by the Surgical Care Improve Project (SCIP) and other organizations, surgical site infection (SSI) continues to be a significant medical problem. DFA-02 is a novel bi...

Authors: Elliott Bennett-Guerrero, Harold S. Minkowitz, Alvaro M. Segura-Vasi, Jorge E. Marcet, Jennifer A. White, G Ralph Corey and Kent S. Allenby

Primum Non Nocere: is shared decision-making the answer?

Surgical ambition is rising, with the Royal College of Surgeons reporting an increase in the number of procedures by a million over the past decade (Royal College of Surgeons. Surgery and the NHS in Numbers. A...

Authors: Ramai Santhirapala and Ramani Moonesinghe

Fluid resuscitation practice patterns in intensive care units of the USA: a cross-sectional survey of critical care physicians

Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. Theref...

Authors: Timothy E. Miller, Martin Bunke, Paul Nisbet and Charles S. Brudney

Perioperative bridging anticoagulation for atrial fibrillation—the first randomised controlled trial

Patients who have atrial fibrillation (AF) have increased thromboembolic risk. This risk is mitigated through use of anticoagulants, traditionally with vitamin K antagonists such as warfarin, and more recently...

Authors: James Matthew Wight and Malachy Oliver Columb

Variability of anti-staphylococcal antibodies in healthy volunteers and pre-cardiac surgery patients

Pre-operative antibody levels have been shown to be inversely related to development of post-operative complications. Staphylococcal infection is a major source of morbidity following surgery.

Authors: Sarka Moravcova, Bonnie Kyle, Hilary Shanahan, Savvas Giannaris, Andrew Smith and Colin Hamilton-Davies

Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London

Anaesthesia is frequently complicated by intraoperative hypotension (IOH) in the elderly, and this is associated with adverse outcome. The definition of IOH is controversial, and although management guidelines...

Authors: Alex Wickham, David Highton and Daniel Martin

Incidence and characteristic analysis of in-hospital falls after anesthesia

In-hospital falls may result in serious clinical adverse consequences, but the effects of anesthesia in the occurrence of postoperative falls are still undetermined. Anesthesia may theoretically cause postoper...

Authors: Chen-Fuh Lam, Shiu-Ying Hsieh, Jen-Hung Wang, Hui-Shan Pan, Xiu-Zhu Liu, Yu-Ching Ho and Tsung-Ying Chen

Postoperative pulmonary complications following major elective abdominal surgery: a cohort study

Postoperative pulmonary complications (PPC) are an under-reported but major cause of perioperative morbidity and mortality. The aim of this prospective, contemporary, multicentre cohort study of unselected pat...

Authors: Kamlesh Patel, Fatemeh Hadian, Aysha Ali, Graham Broadley, Kate Evans, Claire Horder, Marianne Johnstone, Fiona Langlands, Jake Matthews, Prithish Narayan, Priya Rallon, Charlotte Roberts, Sonali Shah and Ravinder Vohra

Erratum to: ‘Prophylaxis and management of postoperative nausea and vomiting in enhanced recovery protocols’

Authors: Ruchir Gupta and Roy Soto

Intra-operative adherence to lung-protective ventilation: a prospective observational study

Lung-protective ventilation in patients with acute respiratory distress syndrome improves mortality. Adopting this strategy in the perioperative period has been shown to reduce lung inflammation and postoperat...

Authors: Jaimin M. Patel, Roisin Baker, Joyce Yeung and Charlotte Small

Predicting, preventing, and identifying delirium after cardiac surgery

Delirium after cardiac surgery is a major problem. The exact mechanisms behind delirium are not understood. Potential pathways of delirium include neurotransmitter interference, global cognitive disorder, and ...

Authors: Jason B. O’Neal and Andrew D. Shaw

A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery

Oral antiseptics reduce nosocomial infections and ventilator-associated pneumonia in critically ill medical and surgical patients intubated for prolonged periods. However, the role of oral antiseptics given be...

Authors: Philip Spreadborough, Sarah Lort, Sandro Pasquali, Matthew Popplewell, Andrew Owen, Irene Kreis, Olga Tucker and Ravinder S Vohra

Anticipated regret in shared decision-making: a randomized experimental study

Explicit consideration of anticipated regret is not part of the standard shared decision-making protocols. This pilot study aimed to compare decisions about a hypothetical surgery for breast cancer and examine...

Authors: Rebecca M. Speck, Mark D. Neuman, Kimberly S. Resnick, Barbara A. Mellers and Lee A. Fleisher

Prophylaxis and management of postoperative nausea and vomiting in enhanced recovery protocols: Expert Opinion statement from the American Society for Enhanced Recovery (ASER)

International experience and evidence-based practices have shown that reduction in variability through use of protocolized perioperative care improves surgical outcomes and reduces costs to patients and health...

Authors: Ruchir Gupta and Roy Soto

A perioperative consult service results in reduction in cost and length of stay for colorectal surgical patients: evidence from a healthcare redesign project

A major restructuring of perioperative care delivery is required to reduce cost while improving patient outcomes. In a test implementation of this notion, we developed and implemented a perioperative consult s...

Authors: Matthew D. McEvoy, Jonathan P. Wanderer, Adam B. King, Timothy M. Geiger, Vikram Tiwari, Maxim Terekhov, Jesse M. Ehrenfeld, William R. Furman, Lorri A. Lee and Warren S. Sandberg

High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions

The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these ...

Authors: Matthew Weston, Kathryn L Weston, James M. Prentis and Chris P Snowden

How fast can glucose be infused in the perioperative setting?

How the initial infusion rate of glucose solution should be set to avoid hyperglycemia in the perioperative setting is unclear.

Authors: Robert G. Hahn

Perioperative intravenous fluid prescribing: a multi-centre audit

Excessive or inadequate intravenous fluid given in the perioperative period can affect outcomes. A number of guidelines exist but these can conflict with the entrenched practice, evidence base and prescriber k...

Authors: Benjamin Harris, Christian Schopflin, Clare Khaghani and Mark Edwards

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