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  1. Article ; Online: PRO: Implementation Science Has Value in Anesthesiology and Cardiothoracic Surgery.

    Navare, Sagar / Rozental, Olga / Girardi, Natalia

    Journal of cardiothoracic and vascular anesthesia

    2023  Volume 38, Issue 4, Page(s) 1049–1051

    Abstract: Implementation science is a nascent field that aims to study the factors that influence the effectiveness of a given clinical intervention, such as the characteristics of the individuals involved, the internal and external settings, the process of ... ...

    Abstract Implementation science is a nascent field that aims to study the factors that influence the effectiveness of a given clinical intervention, such as the characteristics of the individuals involved, the internal and external settings, the process of implementation, and other factors. Overall, implementation science aims to increase the extent to which an intervention is practiced, and the quality of its delivery to a patient. Although still in its infancy, the applications of implementation science in anesthesiology and cardiothoracic surgery abound. Whether used to adopt novel innovations, avoid the use of obsolete practices, or redeploy existing interventions to improve quality, implementation science holds promise in optimizing how we bring the latest in clinical science to produce tangible benefits to patients and create sustainable change.
    MeSH term(s) Humans ; Implementation Science ; Anesthesiology
    Language English
    Publishing date 2023-11-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2023.11.008
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  2. Article ; Online: Enhanced Recovery After Cardiac Surgery: A Social Determinants of Health Lens.

    Khusid, Elizabeth / Lui, Briana / Hoyler, Marguerite / Rozental, Olga / White, Robert S

    Journal of cardiothoracic and vascular anesthesia

    2023  Volume 37, Issue 10, Page(s) 1855–1858

    MeSH term(s) Humans ; Social Determinants of Health ; Cardiac Surgical Procedures/adverse effects ; Recovery of Function
    Language English
    Publishing date 2023-07-07
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2023.07.001
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  3. Article ; Online: Anesthesia Information Management Systems: Evolution of the Paper Anesthetic Record to a Multisystem Electronic Medical Record Network That Streamlines Perioperative Care.

    Rozental, Olga / White, Robert S

    Journal of anesthesia history

    2019  Volume 5, Issue 3, Page(s) 93–98

    Abstract: Initially devised in the 1890s, the traditional anesthetic record comprises physiological changes, crucial anesthetic or surgical events, and medications administered during the perioperative period. The timely collection of quality data facilitates ... ...

    Abstract Initially devised in the 1890s, the traditional anesthetic record comprises physiological changes, crucial anesthetic or surgical events, and medications administered during the perioperative period. The timely collection of quality data facilitates situational awareness and point-of-care clinical decision making. The burgeoning volume and complexity of data in conjunction with financial incentives and the push for improved clinical documentation by regulatory bodies have prompted the transition away from paper records. Anesthesia Information Management Systems (AIMS) are specialized electronic health record networks that allow the anesthesia record to interface with hospital clinical data repositories, resulting in improvements in quality of care, patient safety, operations management, reimbursement, and translational research. Like most new technological advances, adoption was slow at first due to the challenges of integrating complex systems into daily clinical practice, questions about return on investment, and medicolegal liability. Recent technological advances, coupled with government incentives, have allowed AIMS adoption to reach an acceleration phase among US academic medical centers; widespread utilization of AIMS by 84% of US academic medical centers is expected by 2018-2020. Adoption among nonacademic US and European medical centers still remains low; information concerning Asian countries is limited to literature describing only single-hospital center experiences.
    MeSH term(s) Anesthesiology/history ; Anesthesiology/organization & administration ; Diffusion of Innovation ; Health Information Systems/history ; History, 19th Century ; History, 20th Century ; History, 21st Century ; Information Management/history ; Medical Records ; Medical Records Systems, Computerized/history ; Medical Records Systems, Computerized/instrumentation ; Medical Records Systems, Computerized/trends
    Language English
    Publishing date 2019-05-03
    Publishing country United States
    Document type Historical Article ; Journal Article
    ISSN 2352-4537
    ISSN (online) 2352-4537
    DOI 10.1016/j.janh.2019.04.001
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  4. Article ; Online: Haemodynamic Monitoring Needs for Goal-Directed Fluid Therapy in Lung Resection.

    Rozental, Olga / Thalappillil, Richard / White, Robert S / Tam, Christopher W

    Heart, lung & circulation

    2021  Volume 31, Issue 2, Page(s) 158–161

    MeSH term(s) Fluid Therapy ; Goals ; Hemodynamic Monitoring ; Humans ; Length of Stay ; Lung ; Postoperative Complications
    Language English
    Publishing date 2021-10-13
    Publishing country Australia
    Document type Editorial
    ZDB-ID 2020980-0
    ISSN 1444-2892 ; 1443-9506
    ISSN (online) 1444-2892
    ISSN 1443-9506
    DOI 10.1016/j.hlc.2021.08.024
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  5. Article ; Online: Role of Adherence to Enhanced Recovery After Surgery Programs in Mitigating Health Care Disparities.

    Rozental, Olga / White, Robert S / Weinberg, Roniel

    JAMA surgery

    2019  Volume 155, Issue 1, Page(s) 91–92

    MeSH term(s) Colorectal Surgery ; Digestive System Surgical Procedures ; Enhanced Recovery After Surgery ; Healthcare Disparities ; Humans ; Postoperative Complications
    Language English
    Publishing date 2019-09-24
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2019.3486
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  6. Article ; Online: To Swan or Not to Swan: Indications, Alternatives, and Future Directions.

    Rozental, Olga / Thalappillil, Richard / White, Robert S / Tam, Christopher W

    Journal of cardiothoracic and vascular anesthesia

    2020  Volume 35, Issue 2, Page(s) 600–615

    Abstract: The pulmonary artery catheter (PAC) has revolutionized bedside assessment of preload, afterload, and contractility using measured pulmonary capillary wedge pressure, calculated systemic vascular resistance, and estimated cardiac output. It is placed ... ...

    Abstract The pulmonary artery catheter (PAC) has revolutionized bedside assessment of preload, afterload, and contractility using measured pulmonary capillary wedge pressure, calculated systemic vascular resistance, and estimated cardiac output. It is placed percutaneously by a flow-directed balloon-tipped technique through the venous system and the right heart to the pulmonary artery. Interest in the hemodynamic variables obtained from PACs paved the way for the development of numerous less-invasive hemodynamic monitors over the past 3 decades. These devices estimate cardiac output using concepts such as pulse contour and pressure analysis, transpulmonary thermodilution, carbon dioxide rebreathing, impedance plethysmography, Doppler ultrasonography, and echocardiography. Herein, the authors review the conception, technologic advancements, and modern use of PACs, as well as the criticisms regarding the clinical utility, reliability, and safety of PACs. The authors comment on the current understanding of the benefits and limitations of alternative hemodynamic monitors, which is important for providers caring for critically ill patients. The authors also briefly discuss the use of hemodynamic monitoring in goal-directed fluid therapy algorithms in Enhanced Recovery After Surgery programs.
    MeSH term(s) Animals ; Anseriformes ; Cardiac Output ; Catheterization, Swan-Ganz ; Hemodynamics ; Humans ; Reproducibility of Results ; Thermodilution
    Language English
    Publishing date 2020-07-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2020.07.067
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  7. Article ; Online: Penny-wise and pound-foolish: the challenges of preoperative anaemia management.

    Rozental, Olga / Cushing, Melissa M / Shander, Aryeh / Isbister, James P / Lasocki, Sigismond / Meybohm, Patrick / Muñoz, Manuel / Spahn, Donat R / Weiniger, Carolyn F / Trentino, Kevin M / Girardi, Natalia I

    British journal of anaesthesia

    2023  Volume 131, Issue 2, Page(s) 214–221

    Abstract: The timely correction of anaemia before major surgery is important for optimising perioperative patient outcomes. However, multiple barriers have precluded the global expansion of preoperative anaemia treatment programmes, including misconceptions about ... ...

    Abstract The timely correction of anaemia before major surgery is important for optimising perioperative patient outcomes. However, multiple barriers have precluded the global expansion of preoperative anaemia treatment programmes, including misconceptions about the true cost/benefit ratio for patient care and health system economics. Institutional investment and buy-in from stakeholders could lead to significant cost savings through avoided complications of anaemia and red blood cell transfusions, and through containment of direct and variable costs of blood bank laboratories. In some health systems, billing for iron infusions could generate revenue and promote growth of treatment programmes. The aim of this work is to galvanise integrated health systems worldwide to diagnose and treat anaemia before major surgery.
    MeSH term(s) Humans ; Anemia/diagnosis ; Anemia/therapy ; Iron/therapeutic use ; Erythrocyte Transfusion/adverse effects ; Costs and Cost Analysis ; Preoperative Care
    Chemical Substances Iron (E1UOL152H7)
    Language English
    Publishing date 2023-05-25
    Publishing country England
    Document type Editorial
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2023.04.038
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  8. Article ; Online: Hemodynamic Monitoring Options in COVID-19.

    Rozental, Olga / Thalappillil, Richard / White, Robert S / Kumar, Shreyajit R / Tam, Christopher W

    Journal of cardiothoracic and vascular anesthesia

    2020  Volume 34, Issue 12, Page(s) 3488–3490

    MeSH term(s) COVID-19/complications ; COVID-19/physiopathology ; Hemodynamic Monitoring/methods ; Humans ; Multiple Organ Failure/diagnosis ; Multiple Organ Failure/etiology ; Multiple Organ Failure/physiopathology ; Respiratory Distress Syndrome/diagnosis ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/physiopathology ; Respiratory Insufficiency/diagnosis ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/physiopathology
    Keywords covid19
    Language English
    Publishing date 2020-05-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2020.04.050
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  9. Article ; Online: Disparities in mortality after abdominal aortic aneurysm repair are linked to insurance status.

    Rozental, Olga / Ma, Xiaoyue / Weinberg, Roniel / Gadalla, Farida / Essien, Utibe R / White, Robert S

    Journal of vascular surgery

    2020  Volume 72, Issue 5, Page(s) 1691–1700.e5

    Abstract: Objective: The objective of this study was to determine differences in mortality after abdominal aortic aneurysm (AAA) repair based on insurance type.: Methods: In this retrospective cohort study, data from all-payer patients in nonpsychiatric ... ...

    Abstract Objective: The objective of this study was to determine differences in mortality after abdominal aortic aneurysm (AAA) repair based on insurance type.
    Methods: In this retrospective cohort study, data from all-payer patients in nonpsychiatric hospitals in New York, Maryland, Florida, Kentucky, and California from January 2007 to December 2014 (excluding California, ending December 2011) were extracted from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. There were 90,102 patients ≥18 years old with available insurance data who underwent open AAA repair or endovascular aneurysm repair (EVAR) identified using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes 3844, 3925, and 3971. EVAR patients were identified using the procedure code 3971, and the remainder of cases were categorized as open. Patients were divided into cohorts by insurance type as Medicare, Medicaid, uninsured (self-pay/no charge), other, or private insurance. Patients were further stratified for subgroup analyses by procedure type. Unadjusted rates of in-hospital mortality, the primary outcome, as well as secondary outcomes, such as surgical urgency, 30-day and 90-day readmissions, length of stay, total charges, and postoperative complications, were examined by insurance type. Adjusted odds ratios (ORs) for in-hospital mortality were calculated using multivariate logistic regression models fitted to the data. The multivariate models included patient-, surgical-, and hospital-specific factors with bivariate baseline testing suggestive of association with insurance status in addition to variables that were selected a priori.
    Results: Medicaid and uninsured patients had the highest rates of mortality relative to private insurance beneficiaries in all cohorts. Medicaid patients incurred a 47% increase in the odds of mortality, the highest among the insured, after all AAA repairs (OR, 1.47; 95% confidence interval [CI], 1.23-1.76), whereas uninsured patients experienced a 102% increase in the odds of mortality (OR, 2.02; 95% CI, 1.54-2.67). Subgroup analyses for open AAA repair and EVAR corroborated that Medicaid insurance (open repair OR, 1.37 [95% CI, 1.14-1.64]; EVAR OR, 2.06 [95% CI, 1.40-3.04]) and uninsured status (open repair OR, 1.85 [95% CI, 1.35-2.54]; EVAR OR, 2.96 [95% CI, 1.82-4.81]) were associated with the highest odds of mortality after both procedures separately.
    Conclusions: This study demonstrates that Medicaid insurance and uninsured status are associated with higher unadjusted rates and adjusted ORs for in-hospital mortality after AAA repair relative to private insurance status. Primary payer status therefore serves as an independent predictor of the risk of death subsequent to AAA surgical interventions.
    MeSH term(s) Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/mortality ; Aortic Aneurysm, Abdominal/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Endovascular Procedures/adverse effects ; Female ; Hospital Mortality ; Humans ; Insurance Coverage ; Insurance, Health ; Male ; Medicaid ; Medically Uninsured ; Medicare ; Middle Aged ; Odds Ratio ; Postoperative Complications/epidemiology ; Retrospective Studies ; United States
    Language English
    Publishing date 2020-03-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605700-7
    ISSN 1097-6809 ; 0741-5214
    ISSN (online) 1097-6809
    ISSN 0741-5214
    DOI 10.1016/j.jvs.2020.01.044
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