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  1. Article ; Online: Intra-Operative Hypotension is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery.

    Glassman, Steven D / Carreon, Leah Y / Djurasovic, Mladen / Chappell, Desiree / Saasouh, Wael / Daniels, Christy / Mahoney, Colleen / Brown, Morgan / Gum, Jeffrey

    Spine

    2024  

    Abstract: Study design: Retrospective observational cohort.: Objectives: This study explores the impact of Intraoperative hypotension (IOH)on post-op complications for major thoracolumbar spine fusion procedures.: Summary of background data: IOH with mean ... ...

    Abstract Study design: Retrospective observational cohort.
    Objectives: This study explores the impact of Intraoperative hypotension (IOH)on post-op complications for major thoracolumbar spine fusion procedures.
    Summary of background data: IOH with mean arterial pressure (MAP) < 65 mmHg is associated with post-op acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction.
    Methods: 539 thoracolumbar fusion cases, > 6 surgical levels and > 3 hours duration were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1 min intervals. Cummulative duration of MAP < 65 mmHg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI and encephalopathy were noted. Cumulative complications were grouped as none, 1-2 complications, or >3 complications.
    Results: There was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs. 5.6 min, P<0.001) and across the entire procedure (28.1 vs. 19.3 min, P=0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT and post-operative cognitive dysfunction. Comparison of patients with 0 vs. 1-2 vs. 3 or more complications demonstrated that patients with 3 or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had 1-2 or 3 or more complications.
    Conclusion: This study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multi-level lumbar fusion surgery.
    Language English
    Publishing date 2024-05-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/BRS.0000000000005030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1305: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  2. Article: Incidence of intraoperative hypotension during non-cardiac surgery in community anesthesia practice: a retrospective observational analysis.

    Saasouh, Wael / Christensen, Anna L / Xing, Fei / Chappell, Desirée / Lumbley, Josh / Woods, Brian / Mythen, Monty / Dutton, Richard P

    Perioperative medicine (London, England)

    2023  Volume 12, Issue 1, Page(s) 29

    Abstract: Background: Intraoperative hypotension (IOH) is well-described in the academic setting but not in community practice. IOH is associated with risk of postoperative morbidity and mortality. This is the first report of IOH in the community setting using ... ...

    Abstract Background: Intraoperative hypotension (IOH) is well-described in the academic setting but not in community practice. IOH is associated with risk of postoperative morbidity and mortality. This is the first report of IOH in the community setting using the IOH measure definition from the Centers for Medicare and Medicaid Services Merit-based Incentive Payment System program.
    Objectives: To describe the incidence of IOH in the community setting; assess variation in IOH by patient-, procedure-, and facility-level characteristics; and describe variation in risk-adjusted IOH across clinicians.
    Methods: Design Cross-sectional descriptive analysis of retrospective data from anesthesia records in 2020 and 2021. Setting Forty-five facilities affiliated with two large anesthesia providers in the USA. Participants Patients aged 18 years or older having non-emergent, non-cardiac surgery under general, neuraxial, or regional anesthesia. Cases were excluded based on criteria for the IOH measure: baseline mean arterial pressure (MAP) below 65 mmHg prior to anesthesia induction; American Society of Anesthesiologists (ASA) physical status classification of I, V, or VI; monitored anesthesia care only; deliberate induced hypotension; obstetric non-operative procedures; liver or lung transplant; cataract surgery; non-invasive gastrointestinal cases. Main outcomes IOH, using four definitions. Primary definition: binary assessment of whether the case had MAP < 65 mmHg for 15 min or more. Secondary definitions: total number of minutes of MAP < 65 mmHg, total area under MAP of 65 mmHg, time-weighted average MAP < 65 mmHg.
    Results: Among 127,095 non-emergent, non-cardiac cases in community anesthesia settings, 29% had MAP < 65 mmHg for at least 15 min cumulatively, with an overall mean of 12.4 min < 65 mmHg. IOH was slightly more common in patients who were younger, female, and ASA II (versus III or IV); in procedures that were longer and had higher anesthesia base units; and in ambulatory surgery centers. Incidence of IOH varied widely across individual clinicians in both unadjusted and risk-adjusted analyses.
    Conclusion: Intraoperative hypotension is common in community anesthesia practice, including among patients and settings typically considered "low risk." Variation in incidence across clinicians remains after risk-adjustment, suggesting that IOH is a modifiable risk worth pursuing in quality improvement initiatives.
    Language English
    Publishing date 2023-06-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2683800-X
    ISSN 2047-0525
    ISSN 2047-0525
    DOI 10.1186/s13741-023-00318-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.

    Grant, Michael C / Chappell, Desiree / Gan, Tong J / Manning, Michael W / Miller, Timothy E / Brodt, Jessica L

    The Journal of thoracic and cardiovascular surgery

    2023  Volume 166, Issue 6, Page(s) 1695–1706.e2

    Abstract: Background: Opioid-based anesthesia and analgesia is a traditional component of perioperative care for the cardiac surgery patient. Growing enthusiasm for Enhanced Recovery Programs (ERPs) coupled with evidence of potential harm associated with high- ... ...

    Abstract Background: Opioid-based anesthesia and analgesia is a traditional component of perioperative care for the cardiac surgery patient. Growing enthusiasm for Enhanced Recovery Programs (ERPs) coupled with evidence of potential harm associated with high-dose opioids suggests that we reconsider the role of opioids in cardiac surgery.
    Methods: An interdisciplinary North American panel of experts, using a structured appraisal of the literature and a modified Delphi method, derived consensus recommendations for optimal pain management and opioid stewardship for cardiac surgery patients. Individual recommendations are graded based on the strength and level of evidence.
    Results: The panel addressed 4 main topics: the harms associated with historical opioid use, the benefits of more targeted opioid administration, the use of nonopioid medications and techniques, and patient and provider education. A key principle that emerged is that opioid stewardship should apply to all cardiac surgery patients, entailing judicious and targeted use of opioids to achieve optimal analgesia with the fewest potential side effects. The process resulted in the promulgation of 6 recommendations regarding pain management and opioid stewardship in cardiac surgery, focused on avoiding the use of high-dose opioids, as well as encouraging more widespread application of foundational aspects of ERPs, such as the use of multimodal nonopioid medications and regional anesthesia techniques, formal patient and provider education, and structured system-level opioid prescription practices.
    Conclusions: Based on the available literature and expert consensus, there is an opportunity to optimize anesthesia and analgesia for cardiac surgery patients. Although additional research is needed to establish specific strategies, core principles of pain management and opioid stewardship apply to the cardiac surgery population.
    MeSH term(s) Humans ; Adult ; Analgesics, Opioid/adverse effects ; Pain Management/adverse effects ; Pain Management/methods ; Enhanced Recovery After Surgery ; Consensus ; Pain, Postoperative/diagnosis ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Cardiac Surgical Procedures/adverse effects
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-01-28
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3104-5
    ISSN 1097-685X ; 0022-5223
    ISSN (online) 1097-685X
    ISSN 0022-5223
    DOI 10.1016/j.jtcvs.2023.01.020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Intraoperative hypotension in ambulatory surgery centers.

    Saasouh, Wael / Christensen, Anna L / Chappell, Desirée / Lumbley, Josh / Woods, Brian / Xing, Fei / Mythen, Monty / Dutton, Richard P

    Journal of clinical anesthesia

    2023  Volume 90, Page(s) 111181

    Abstract: Study objectives: To measure the incidence of intraoperative hypotension (IOH) during surgery in ambulatory surgery centers (ASCs) and describe associated characteristics of patients and procedures.: Design: Retrospective analysis.: Setting: 20 ... ...

    Abstract Study objectives: To measure the incidence of intraoperative hypotension (IOH) during surgery in ambulatory surgery centers (ASCs) and describe associated characteristics of patients and procedures.
    Design: Retrospective analysis.
    Setting: 20 ASCs.
    Patients: 16,750 patients having non-emergent, non-cardiac surgery; ASA physical status 2 through 4.
    Interventions: None.
    Measurements: We assessed incidence of IOH using the definition from the Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS)-mean arterial pressure (MAP) < 65 mmHg for at least 15 cumulative minutes-and three secondary definitions: minutes of MAP <65 mmHg, area under MAP of 65 mmHg, and time-weighted average MAP <65 mmHg.
    Main results: 30.9% of ASC cases had a MAP <65 mmHg for at least 15 min. The incidence of IOH varied significantly, and was higher among younger adults (age 18-39; 36.2%), females (35.2%), and patients with ASA physical status 2 (32.8%). IOH increased with increasing surgery length, even when time-weighted, and was higher among low complexity (30.6%) than moderate complexity (28.8%) procedures, and highest among high complexity procedures (44.1%).
    Conclusions: There was substantial occurrence of IOH in ASCs, similar to that described in academic hospital settings in previous literature. We hypothesize that this may reflect clinician preference not to intervene in perceived healthy patients or assumptions about ability to tolerate lower blood pressures on behalf of these patients. Future research will determine whether IOH in ACSs is associated with adverse outcomes to the same extent as described in more complex hospital-based surgeries.
    MeSH term(s) Adult ; Female ; Humans ; Aged ; United States ; Adolescent ; Young Adult ; Retrospective Studies ; Cohort Studies ; Ambulatory Surgical Procedures/adverse effects ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Medicare ; Hypotension/etiology ; Hypotension/complications
    Language English
    Publishing date 2023-07-14
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2023.111181
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2622: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  5. Article: Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance.

    Martin, Greg S / Kaufman, David A / Marik, Paul E / Shapiro, Nathan I / Levett, Denny Z H / Whittle, John / MacLeod, David B / Chappell, Desiree / Lacey, Jonathan / Woodcock, Tom / Mitchell, Kay / Malbrain, Manu L N G / Woodcock, Tom M / Martin, Daniel / Imray, Chris H E / Manning, Michael W / Howe, Henry / Grocott, Michael P W / Mythen, Monty G /
    Gan, Tong J / Miller, Timothy E

    Perioperative medicine (London, England)

    2020  Volume 9, Page(s) 12

    Abstract: Background: Optimal fluid therapy in the perioperative and critical care settings depends on understanding the underlying cardiovascular physiology and individualizing assessment of the dynamic patient state.: Methods: The Perioperative Quality ... ...

    Abstract Background: Optimal fluid therapy in the perioperative and critical care settings depends on understanding the underlying cardiovascular physiology and individualizing assessment of the dynamic patient state.
    Methods: The Perioperative Quality Initiative (POQI-5) consensus conference brought together an international team of multidisciplinary experts to survey and evaluate the literature on the physiology of volume responsiveness and perioperative fluid management. The group used a modified Delphi method to develop consensus statements applicable to the physiologically based management of intravenous fluid therapy in the perioperative setting.
    Discussion: We discussed the clinical and physiological evidence underlying fluid responsiveness and venous capacitance as relevant factors in fluid management and developed consensus statements with clinical implications for a broad group of clinicians involved in intravenous fluid therapy. Two key concepts emerged as follows: (1) The ultimate goal of fluid therapy and hemodynamic management is to support the conditions that enable normal cellular metabolic function in order to produce optimal patient outcomes, and (2) optimal fluid and hemodynamic management is dependent on an understanding of the relationship between pressure, volume, and flow in a dynamic system which is distensible with variable elastance and capacitance properties.
    Language English
    Publishing date 2020-04-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2683800-X
    ISSN 2047-0525
    ISSN 2047-0525
    DOI 10.1186/s13741-020-00142-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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