Articles

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

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

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