Articles

The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

As the prevalence of obesity is increasing, the number of patients requiring surgical intervention for obesity-related illness is also rising. The aim of this pilot study was to explore predictors of short-ter...

Authors: David Andrew Gilhooly, Michelle Cole and Suneetha Ramani Moonesinghe

Correction to: American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

After publication of this article (Scott et al., 2017), it was noticed that the HTML version contained technical errors regarding the collaborator information of the Perioperative Quality Initiative (POQI) I W...

Authors: Michael J. Scott, Matthew D. McEvoy, Debra B. Gordon, Stuart A. Grant, Julie K. M. Thacker, Christopher L. Wu, Tong J. Gan, Monty G. Mythen, Andrew D. Shaw and Timothy E. Miller

Apnoeic oxygenation by nasal cannula during airway management in children undergoing general anaesthesia: a pilot randomised controlled trial

Airway management is a core clinical skill in anaesthesia. Pre-oxygenation prior to induction of anaesthesia is a standard practice to prevent desaturation. Apnoeic oxygenation in adults is effective and prolo...

Authors: Lafi Olayan, Abdulaleem Alatassi, Jaimin Patel and Sherran Milton

Cardiopulmonary exercise testing (CPET) in the United Kingdom—a national survey of the structure, conduct, interpretation and funding

Cardiopulmonary exercise testing (CPET) is an exercise stress test with concomitant expired gas analysis that provides an objective, non-invasive measure of functional capacity under stress. CPET-derived varia...

Authors: T. Reeves, S. Bates, T. Sharp, K. Richardson, S. Bali, J. Plumb, H. Anderson, J. Prentis, M. Swart and D. Z. H. Levett

The sensitivity of the human thirst response to changes in plasma osmolality: a systematic review

Dehydration is highly prevalent and is associated with adverse cardiovascular and renal events. Clinical assessment of dehydration lacks sensitivity. Perhaps a patient’s thirst can provide an accurate guide to...

Authors: Fintan Hughes, Monty Mythen and Hugh Montgomery

Immunonutrition within enhanced recovery after surgery (ERAS): an unresolved matter

Preoperative malnutrition because of poor oral intake significantly increases the risk of adverse events after surgery and leads to increased length of stay. While immunonutrition has been utilized in the non-...

Authors: Ruchir Gupta and Anthony Senagore

Impact of ASA score misclassification on NSQIP predicted mortality: a retrospective analysis

The ASA physical classification score has a major impact on the observed/expected (O/E) mortality ratio in the NSQIP General Vascular Mortality Model. The difference in predicted mortality is greatest between ...

Authors: Alex Helkin, Sumeet V. Jain, Angelika Gruessner, Maureen Fleming, Leslie Kohman, Michael Costanza and Robert N. Cooney

Comparison of risk-scoring systems in the prediction of outcome after liver resection

Risk prediction techniques commonly used in liver surgery include the American Society of Anesthesiologists (ASA) grading, Charlson Comorbidity Index (CCI) and cardiopulmonary exercise tests (CPET). This study...

Authors: S. Ulyett, G. Shahtahmassebi, S. Aroori, M. J. Bowles, C. D. Briggs, M. G. Wiggans, G. Minto and D. A. Stell

A systematic review and overview of health economic evaluations of emergency laparotomy

Little is known about the economic impact of emergency laparotomy (EL) surgery in healthcare systems around the world. The aim of this systematic review is to describe the primary resource utilisation, healthc...

Authors: Sohail Bampoe, Peter M. Odor, S. Ramani Moonesinghe and Matthew Dickinson

Are physician assistant and patient airway assessments reliable compared to anesthesiologist assessments in detecting difficult airways in general surgical patients?

Airway management remains one of the most important responsibilities of anesthesiologists. Prediction of difficult airway allows time for proper selection of equipment, technique, and personnel experienced in ...

Authors: Erin Payne, Jacqueline Ragheb, Elizabeth S. Jewell, Betsy P. Huang, Angela M. Bailey, Laura M. Fritsch and Milo Engoren

Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol

The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit r...

Authors: Heath McAnally

Association of postoperative nausea/vomiting and pain with breastfeeding success

Successful breastfeeding is a goal set forth by the World Health Organization to improve neonatal care. Increasingly, patients express the desire to breastfeed, and clinicians should facilitate successful brea...

Authors: Ramon Abola, Jamie Romeiser, Suman Grewal, Sabeen Rizwan, Rishimani Adsumelli, Ellen Steinberg and Elliott Bennett-Guerrero

The effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery

This study aims to investigate the effect of natural sounds on the anxiety of patients undergoing coronary artery bypass graft surgery (CABG).

Authors: Mohammad Javad Amiri, Tabandeh Sadeghi and Tayebeh Negahban Bonabi

Surgeons’ views on preoperative medical evaluation: a qualitative study

There is substantial variation in the practice of preoperative medical evaluation (PME) and limited evidence for its benefit, which raises concerns about overuse. Surgeons have a unique role in this multidisci...

Authors: Kevin R. Riggs, Zackary D. Berger, Martin A. Makary, Eric B. Bass and Geetanjali Chander

Fluid resuscitation practices in cardiac surgery patients in the USA: a survey of health care providers

Fluid resuscitation during cardiac surgery is common with significant variability in clinical practice. Our goal was to investigate current practice patterns of fluid volume expansion in patients undergoing ca...

Authors: Solomon Aronson, Paul Nisbet and Martin Bunke

Pre- to postoperative coagulation profile of 307 patients undergoing oesophageal resection with epidural blockade over a 10-year period in a single hospital: implications for the risk of spinal haematoma

Epidural anaesthesia and analgesia are indicated for oesophageal surgery. A rare but serious complication is spinal haematoma, which can occur on insertion, manipulation or withdrawal of catheters. Evidence an...

Authors: Owain Thomas, Emanuel Lybeck, Per Flisberg and Ulf Schött

Enhanced recovery protocols for colorectal surgery and postoperative renal function: a retrospective review

While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied.

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

Preoperative fluid retention increases blood loss during major open abdominal surgery

Quantification of renal fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this fluid retention correlates with fluid req...

Authors: Robert G. Hahn, Hans Bahlmann and Lena Nilsson

The prevalence of pulmonary complications after thoracic and abdominal surgery and associated risk factors in patients admitted at a government hospital in Harare, Zimbabwe-a retrospective study

The burden of HIV/AIDS in Sub-Saharan Africa has presented unusual and challenging acute surgical problems across all specialties. Thoraco-abdominal surgery cuts through muscle and thereby disrupts the normal ...

Authors: Cathrine Tadyanemhandu, Rufaro Mukombachoto, Clement Nhunzvi, Farayi Kaseke, Vasco Chikwasha, Samson Chengetanai and Shamila Manie

Evaluation of operating room reverse Trendelenburg positioning and its effect on postoperative hypoxemia, aspiration, and length of stay: a retrospective study of consecutive patients

In 2014, this group published an investigation of surgical patients from 2012 who had substantial rates of postoperative hypoxemia (POH) and perioperative pulmonary aspiration (POPA). Therefore, we investigate...

Authors: C. Michael Dunham, Barbara M. Hileman, Amy E. Hutchinson, Tamara Antonaccio, Elisha A. Chance, Gregory S. Huang, Gregory Szmaj, Kristen Calabro, Cynthia Bishop and Tyson T. Schrickel

Re-designing the pathway to surgery: better care and added value

The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. S...

Authors: Michael P. W. Grocott, James O. M. Plumb, Mark Edwards, Imogen Fecher-Jones and Denny Z. H. Levett

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1—from the preoperative period to PACU

Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia,” which we define in this paper as a technique that optimize...

Authors: Matthew D. McEvoy, Michael J. Scott, Debra B. Gordon, Stuart A. Grant, Julie K. M. Thacker, Christopher L. Wu, Tong J. Gan, Monty G. Mythen, Andrew D. Shaw and Timothy E. Miller

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia”, which we define in this paper as a technique that optimize...

Authors: Michael J. Scott, Matthew D. McEvoy, Debra B. Gordon, Stuart A. Grant, Julie K. M. Thacker, Christopher L. Wu, Tong J. Gan, Monty G. Mythen, Andrew D. Shaw and Timothy E. Miller

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on measurement to maintain and improve quality of enhanced recovery pathways for elective colorectal surgery

This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement sys...

Authors: S. Ramani Moonesinghe, Michael P. W. Grocott, Elliott Bennett-Guerrero, Roberto Bergamaschi, Vijaya Gottumukkala, Thomas J. Hopkins, Stuart McCluskey, Tong J. Gan, Michael Monty G. Mythen, Andrew D. Shaw and Timothy E. Miller

“Simplified International Recommendations for the Implementation of Patient Blood Management” (SIR4PBM)

More than 30% of the world’s population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused proc...

Authors: Patrick Meybohm, Bernd Froessler, Lawrence T. Goodnough, Andrew A. Klein, Manuel Muñoz, Michael F. Murphy, Toby Richards, Aryeh Shander, Donat R. Spahn and Kai Zacharowski

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery

Colorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cyst...

Authors: Stefan D. Holubar, Traci Hedrick, Ruchir Gupta, John Kellum, Mark Hamilton, Tong J. Gan, Monty G. Mythen, Andrew D. Shaw and Timothy E. Miller

Physical activity levels in locally advanced rectal cancer patients following neoadjuvant chemoradiotherapy and an exercise training programme before surgery: a pilot study

The aim of this pilot study was to measure changes in physical activity level (PAL) variables, as well as sleep duration and efficiency in people with locally advanced rectal cancer (1) before and after neoadj...

Authors: Lisa Loughney, Malcolm A. West, Borislav D. Dimitrov, Graham J. Kemp, Michael PW. Grocott and Sandy Jack

Predictors of total morbidity burden on days 3, 5 and 8 after cardiac surgery

Post-operative morbidity affects up to 36% of cardiac surgical patients. However, few countries reliably record morbidity outcome data, despite patients wanting to be informed of all the risks associated with ...

Authors: Julie Sanders, Jackie Cooper, Michael G. Mythen and Hugh E. Montgomery

Pre-operative anaemia is associated with total morbidity burden on days 3 and 5 after cardiac surgery: a cohort study

Pre-operative anaemia is associated with mortality and red blood cell (RBC) transfusion requirement after cardiac surgery. However, the effect on post-operative total morbidity burden (TMB) is unknown. We expl...

Authors: Julie Sanders, Jackie A. Cooper, Daniel Farrar, Simon Braithwaite, Updeshbir Sandhu, Michael G. Mythen and Hugh E. Montgomery

Implementation of goal-directed fluid therapy during hip revision arthroplasty: a matched cohort study

Several randomized controlled trials (RCTs) have demonstrated that intraoperative goal-directed fluid therapy (GDFT) can decrease postsurgical complications in patients undergoing major abdominal surgery. Howe...

Authors: Marit Habicher, Felix Balzer, Viktor Mezger, Jennifer Niclas, Michael Müller, Carsten Perka, Michael Krämer and Michael Sander

Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery?

Sarcopenia, or loss of skeletal muscle mass and quality, has been studied as part of aging and adverse health outcomes in elderly patients but has only recently been evaluated as a separate condition in cancer...

Authors: Kimberly L. Mei, John A. Batsis, Jeannine B. Mills and Stefan D. Holubar

Associations between ASA Physical Status and postoperative mortality at 48 h: a contemporary dataset analysis compared to a historical cohort

In this study, we examined the association between American Society of Anesthesiologists Physical Status (ASA PS) designation and 48-h mortality for both elective and emergent procedures in a large contemporar...

Authors: Thomas J. Hopkins, Karthik Raghunathan, Atilio Barbeito, Mary Cooter, Mark Stafford-Smith, Rebecca Schroeder, Katherine Grichnik, Richard Gilbert and Solomon Aronson

Coagulative safety of epidural catheters after major upper gastrointestinal surgery: advanced and routine coagulation analysis in 38 patients

The risk of spinal haematoma in patients receiving epidural catheters is estimated using routine coagulation tests, but guidelines are inconsistent in their recommendations on what to do when results indicate ...

Authors: Owain Thomas, Hampus Rein, Karin Strandberg and Ulf Schött

A case management report: a collaborative perioperative surgical home paradigm and the reduction of total joint arthroplasty readmissions

Efforts to mitigate costs while improving surgical care quality have received much scrutiny. This includes the challenging issue of readmission subsequent to hospital discharge. Initiatives attempting to precl...

Authors: Navid Alem, Joseph Rinehart, Brian Lee, Doug Merrill, Safa Sobhanie, Kyle Ahn, Ran Schwarzkopf, Maxime Cannesson and Zeev Kain

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

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