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  1. Article ; Online: Resumption of Day Surgery Activity in the Acute Phase of COVID-19 Pandemic.

    Palumbo, Piergaspare / Massimi, Fanny / Usai, Sofia / Biondi, Antonio / Monzani, Roberta

    Surgical innovation

    2021  Volume 28, Issue 2, Page(s) 247–248

    MeSH term(s) Ambulatory Surgical Procedures ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/transmission ; Humans ; Infection Control/organization & administration
    Language English
    Publishing date 2021-01-30
    Publishing country United States
    Document type Letter
    ZDB-ID 2182571-3
    ISSN 1553-3514 ; 1553-3506
    ISSN (online) 1553-3514
    ISSN 1553-3506
    DOI 10.1177/1553350620987788
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Protocol Implementation for Normothermia in Surgery Settings in Italy: Budget-Impact Analysis.

    Monzani, Roberta / Barbera, Giovanna / Restelli, Umberto / Galeone, Carlotta / Petrini, Flavia

    Risk management and healthcare policy

    2020  Volume 13, Page(s) 2347–2356

    Abstract: Introduction: Hypothermia is a well-known risk of the perioperative period and considered a preventable effect of anesthesia care. Nevertheless, it is not fully controlled, causing a number of adverse outcomes following surgical operations and thus ... ...

    Abstract Introduction: Hypothermia is a well-known risk of the perioperative period and considered a preventable effect of anesthesia care. Nevertheless, it is not fully controlled, causing a number of adverse outcomes following surgical operations and thus increasing length of stay in hospital and treatment costs. The aim of this study was to assess the budget impact (BI) of the implementation of proactive strategies to prevent inadvertent perioperative hypothermia (IPH) in surgical patients in Italy, as recommended by international guidelines and by a good clinical practice (GCP) guideline of the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care.
    Methods: BI was calculated over a 3-year period from the perspective of the Italian National Health Service (NHS). Model inputs were extracted from national literature when available and otherwise from international sources. The reference analytic model was based on the cost-effectiveness analysis of the National Institute for Health and Care Excellence clinical guidance 65. Estimates were based on assessments made about current malpractice in Italy and on a hypothesis of how future practice might change by implementing the GCP. Model output included overall BI results, variations in the number of warmed patients, medical-device average costs and use of mix.
    Results: The base-case estimate quantified a decrease of 35% in extra days of hospital stay due to IPH and a net BI of -€60.92 million.
    Conclusion: Increasing protocol adoption for preventing IPH would lead to both clinical advantages and significant savings for the NHS. Its large diffusion in Italian hospitals is thus desirable.
    Language English
    Publishing date 2020-10-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 2495128-6
    ISSN 1179-1594
    ISSN 1179-1594
    DOI 10.2147/RMHP.S267923
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Quality of life and patient satisfaction in outpatient thyroid surgery.

    Cozzaglio, Luca / Monzani, Roberta / Zuccarelli, Andrea / Cananzi, Ferdinando / Sicoli, Federico / Ruspi, Laura / Quagliuolo, Vittorio

    Updates in surgery

    2021  Volume 74, Issue 1, Page(s) 317–323

    Abstract: In the last three decades surgeons have begun to perform outpatient thyroid surgery (OTS). Important outcome measures of a day-hospital procedure are the patient's quality of life (QoL) and satisfaction, but information on these issues in the OTS setting ...

    Abstract In the last three decades surgeons have begun to perform outpatient thyroid surgery (OTS). Important outcome measures of a day-hospital procedure are the patient's quality of life (QoL) and satisfaction, but information on these issues in the OTS setting is scanty. The aim of this pilot study was to explore how early discharge after thyroidectomy affects patients' QoL and satisfaction. Postoperative QoL and satisfaction were assessed retrospectively by giving each patient a self-report questionnaire specifically created in our center for OTS and derived from the post-discharge surgical recovery (PSR) scale to assess physical and mental well-being. Twenty-three of 24 patients (96%), 16 women and 7 men with a median age of 48 years (range 16-72), completed the questionnaire, answering 92% of the questions. QoL based on this scale gave a median score of 81.8% (range 62-98.8%). No major or minor complications occurred in the study group. Regarding QoL eight patients (35%) reported feeling "tired all the time" and six patients (26%) reported mild pain, which in two cases resolved spontaneously. Regarding patient satisfaction two-thirds of patients judged OTS positively while the remaining one-third would not recommend it. Our study showed very good uptake by patients of a new questionnaire dedicated to OTS as a possible aid in the identification of areas for improvement of OTS management. However, to be considered a safe procedure with maximum patient compliance and satisfaction, OTS was found to require considerable effort by hospital staff and patients' caregivers compared to inpatient thyroid surgery.
    MeSH term(s) Adolescent ; Adult ; Aftercare ; Aged ; Female ; Humans ; Male ; Middle Aged ; Outpatients ; Patient Discharge ; Patient Satisfaction ; Pilot Projects ; Quality of Life ; Retrospective Studies ; Thyroid Gland ; Young Adult
    Language English
    Publishing date 2021-10-22
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-021-01190-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Dissemination of clinical and scientific practice through social media: a SIAARTI consensus-based document.

    Cortegiani, Andrea / Battaglini, Denise / Amato, Giovanna / Behr, Astrid Ursula / Donadello, Katia / Einav, Sharon / Frigo, Maria Grazia / Fullin, Giorgio / Giannini, Alberto / Ippolito, Mariachiara / Marozzi, Franco / Monzani, Roberta / Monti, Gianpaola / Schultz, Marcus J / Torrano, Vito / Villa, Gianluca / Giarratano, Antonino

    Journal of anesthesia, analgesia and critical care

    2024  Volume 4, Issue 1, Page(s) 21

    Abstract: Background: Dissemination of medical practice and scientific information through social media (SoMe) by clinicians and researchers is increasing. Broad exposure of information can promote connectivity within the scientific community, overcome barriers ... ...

    Abstract Background: Dissemination of medical practice and scientific information through social media (SoMe) by clinicians and researchers is increasing. Broad exposure of information can promote connectivity within the scientific community, overcome barriers to access to sources, increase debate, and reveal layperson perspectives and preferences. On the other hand, practices lacking scientific evidence may also be promoted, laypeople may misunderstand the professional message, and clinician may suffer erosion of professional status. The aim of this project was to enhance awareness and advise the anesthesia community and clinicians at large about the potential risks advocate for responsible use of SoMe to disseminate information related to medical practices and knowledge.
    Methods: A modified Delphi process with prespecified consensus criteria was conducted among a multidisciplinary panel of experts, including anesthesiologists-intensivists, clinical psychologists, and forensic medicine specialists. Six items were identified: Ethics and deontological principles, the practice of sharing information via social media, legal aspects, psychological aspects, self-promotion, and criteria for appropriate dissemination. Statements and rationales were produced and subjected to blinded panelists' votes. After reaching consensus, a document was written which then underwent external review by experts uninvolved in the consensus process. The project was promoted by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI).
    Results: Twelve statements were produced, and consensus was achieved for all. The panel concluded that the general principles guiding dissemination of professional information via SoMe must remain in line with the general principles of ethics, deontology, and scientific validity that guide the medical profession and science in general. Professional equity must be maintained while communicating via SoMe. Medical practices lacking support by scientific evidence should not be disseminated. Patients' informed consent must be obtained before dissemination of information, images, or data. Self-promotion must not be prioritized over any of these principles.
    Conclusions: When sharing medical practices and scientific information on SoMe, healthcare professionals are advised to act conscientiously and ethically. Local regulations should be adhered to. Institutional training on the potential risks and proper of SoMe for such purpose may contribute to preservation of professional integrity.
    Language English
    Publishing date 2024-03-19
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2731-3786
    ISSN (online) 2731-3786
    DOI 10.1186/s44158-024-00157-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: REVersal of nEuromusculAr bLocking Agents in Patients Undergoing General Anaesthesia (REVEAL Study).

    Greco, Massimiliano / Caruso, Pier Francesco / Angelotti, Giovanni / Aceto, Romina / Coppalini, Giacomo / Martinetti, Nicolò / Albini, Marco / Bash, Lori D / Carvello, Michele / Piccioni, Federico / Monzani, Roberta / Montorsi, Marco / Cecconi, Maurizio

    Journal of clinical medicine

    2023  Volume 12, Issue 2

    Abstract: Background: Neuromuscular blocking agent (NMBA) monitoring and reversals are key to avoiding residual curarization and improving patient outcomes. Sugammadex is a NMBA reversal with favorable pharmacological properties. There is a lack of real-world data ...

    Abstract Background: Neuromuscular blocking agent (NMBA) monitoring and reversals are key to avoiding residual curarization and improving patient outcomes. Sugammadex is a NMBA reversal with favorable pharmacological properties. There is a lack of real-world data detailing how the diffusion of sugammadex affects anesthetic monitoring and practice. Methods: We conducted an electronic health record analysis study, including all adult surgical patients undergoing general anesthesia with orotracheal intubation, from January 2016 to December 2019, to describe changes and temporal trends of NMBAs and NMBA reversals administration. Results: From an initial population of 115,046 surgeries, we included 37,882 procedures, with 24,583 (64.9%) treated with spontaneous recovery from neuromuscular block and 13,299 (35.1%) with NMBA reversals. NMBA reversals use doubled over 4 years from 25.5% to 42.5%, mainly driven by sugammadex use, which increased from 17.8% to 38.3%. Rocuronium increased from 58.6% (2016) to 94.5% (2019). Factors associated with NMBA reversal use in the multivariable analysis were severe obesity (OR 3.33 for class II and OR 11.4 for class III obesity, p-value < 0.001), and high ASA score (OR 1.47 for ASA III). Among comorbidities, OSAS, asthma, and other respiratory diseases showed the strongest association with NMBA reversal administration. Conclusions: Unrestricted availability of sugammadex led to a considerable increase in pharmacological NMBA reversal, with rocuronium use also rising. More research is needed to determine how unrestricted and safer NMBA reversal affects anesthesia intraoperative monitoring and practice.
    Language English
    Publishing date 2023-01-10
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12020563
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Epidural analgesia vs systemic opioids in patients undergoing laparoscopic colorectal surgery.

    Turi, Stefano / Gemma, Marco / Braga, Marco / Monzani, Roberta / Radrizzani, Danilo / Beretta, Luigi

    International journal of colorectal disease

    2019  Volume 34, Issue 5, Page(s) 915–921

    Abstract: Purpose: A well-controlled pain is one of the most important targets of enhanced recovery after surgery (ERAS) protocols. Recent studies questioned the role of TEA (thoracic epidural analgesia) in support of less invasive techniques, in particular in ... ...

    Abstract Purpose: A well-controlled pain is one of the most important targets of enhanced recovery after surgery (ERAS) protocols. Recent studies questioned the role of TEA (thoracic epidural analgesia) in support of less invasive techniques, in particular in laparoscopic mini-invasive surgery. The aim of this study is to compare patients undergoing laparoscopic mini-invasive colorectal surgery and receiving different analgesic techniques.
    Methods: Prospectively collected data entered in the electronic registry of POIS (Perioperative Italian Society) specifically designed for ERAS were reviewed. Patients undergoing colorectal laparoscopic surgery were divided in two groups according to TEA or parenteral opioid administration. In comparing TEA and opioid groups, propensity score weights were obtained. Postoperative pain control and time to readiness for discharge (TRD) were considered as primary endpoints of the study. Secondary endpoints were postoperative morbidity, PONV (postoperative nausea and vomiting), hours of mobilization, length of hospital stay (LOS), timing of fluid and solid re-assumption, and recovery of bowel function.
    Results: Fourteen Italian hospitals reported data on 560 patients (283 TEA, 277 opioid group). Patients of the opioid group were able to mobilize for a longer period than TEA group patients but presented a higher incidence of PONV. Pain intensity and TRD were similar in both groups. LOS was significantly reduced in TEA patients; also, this result was clinically irrelevant (5.7 ± 3.21 days TEA group vs 5.8 ± 2.92 opioid group).
    Conclusion: In patients undergoing laparoscopic colorectal surgery, TEA was not associated to a better pain control or to an improvement in postoperative outcome compared with opioid administration.
    MeSH term(s) Aged ; Analgesia, Epidural ; Analgesics, Opioid/therapeutic use ; Colorectal Surgery ; Female ; Guideline Adherence ; Humans ; Laparoscopy ; Male ; Postoperative Period
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2019-03-29
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-019-03284-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Recommendations for outpatient activity in COVID-19 pandemic

    Palumbo Piergaspare / Massimi Fanny / Biondi Antonio / Cirocchi Roberto / De Luca Giuseppe Massimiliano / Giraudo Giorgio / Intini Sergio Giuseppe / Monzani Roberta / Sozio Giampaolo / Usai Sofia

    Open Medicine, Vol 16, Iss 1, Pp 1696-

    2021  Volume 1704

    Abstract: The spread of the COVID-19 disease substantially influenced the International Healthcare system, and the national governments worldwide had before long to decide how to manage the available resources, giving priority to the treatment of the COVID- ... ...

    Abstract The spread of the COVID-19 disease substantially influenced the International Healthcare system, and the national governments worldwide had before long to decide how to manage the available resources, giving priority to the treatment of the COVID-infected patients. Then, in many countries, it was decided to limit the elective procedures to surgical oncology and emergency procedures. In fact, most of the routine, middle-low complexity surgical interventions were reduced, and the day surgery (DS) activities were almost totally interrupted. As a result of this approach, the waiting list of these patients has significantly increased. In the current phase, with a significant decrease in the incidence of COVID-19 cases, the surgical daily activity can be safely and effectively restarted. Adjustments are mandatory to resume the DS activity. The whole separation of pathways with respect to the long-stay and emergency surgery, an accurate preoperative protocol of patient management, with a proper selection and screening of all-day cases, careful scheduling of surgical organization in the operating room, and planning of the postoperative pathway are the goals for a feasible, safe, and effective resumption of DS activity.
    Keywords day surgery ; day case ; covid ; Medicine ; R
    Language English
    Publishing date 2021-11-01T00:00:00Z
    Publisher De Gruyter
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement.

    Cortegiani, Andrea / Tripodi, Vincenzo Francesco / Castioni, Carlo Alberto / Esposito, Clelia / Galdieri, Nicola / Monzani, Roberta / Rispoli, Marco / Simonini, Alessandro / Torrano, Vito / Giarratano, Antonino / Gratarola, Angelo

    Journal of Anesthesia, Analgesia and Critical Care (Online)

    2022  Volume 2, Issue 1, Page(s) 29

    Abstract: Background: The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with ... ...

    Abstract Background: The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with previous Sars-CoV-2 infection to undergo elective surgery. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient's surgical process.
    Methods: The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document were in accordance to the principles of rapid review of the scientific literature and modified Delphi method. The experts produced statements and supporting reasons in the form of an informative text. The overall list of statements was subjected to a vote in order to express the degree of consent.
    Results: Patients should not undergo elective surgery within 7 weeks of infection unless there is the risk of a negative evolution of the disease. To mitigate the risk of postsurgical mortality, a multidisciplinary approach seemed useful in addition to the use of validated algorithms to estimate the risk of perioperative morbidity and mortality; the risk related to SARS-CoV-2 infection should be added. The risk of potential nosocomial contagion from a positive patients should also be considered when deciding to proceed with surgery. Most of the evidence came from previous SARS-CoV-2 variants, so the evidence should be considered indirect.
    Conclusion: A balanced preoperative multidisciplinary risk-benefit evaluation is needed in patients with previous infection by SARS-CoV-2 for elective surgery.
    Language English
    Publishing date 2022-06-22
    Publishing country England
    Document type Journal Article
    ISSN 2731-3786
    ISSN (online) 2731-3786
    DOI 10.1186/s44158-022-00058-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Enhanced recovery after bariatric surgery: an Italian consensus statement.

    Marinari, Giuseppe / Foletto, Mirto / Nagliati, Carlo / Navarra, Giuseppe / Borrelli, Vincenzo / Bruni, Vincenzo / Fantola, Giovanni / Moroni, Roberto / Tritapepe, Luigi / Monzani, Roberta / Sanna, Daniela / Carron, Michele / Cataldo, Rita

    Surgical endoscopy

    2022  Volume 36, Issue 10, Page(s) 7171–7186

    Abstract: Background: Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic ... ...

    Abstract Background: Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care joined in drafting an official statement on ERABS.
    Methods: To assess the effectiveness and safety of ERABS and to develop evidence-based recommendations with regard to pre-, intra-, and post-operative care for obese patients undergoing ERABS, a 13-member expert task force of surgeons and anesthesiologists from Italian certified IFSO center of excellence in bariatric surgery was established and a review of English-language papers conducted. Oxford 2011 Levels of Evidence and U.S. Preventive Services Task Force Grade Definitions were used to grade the level of evidence and the strength of recommendations, respectively. The supporting evidence and recommendations were reviewed and discussed by the entire group at meetings to achieve a final consensus.
    Results: Compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items).
    Conclusions: ERABS is an effective and safe approach. The recommendations allow the proper management of obese patients undergoing ERABS for a better outcome.
    MeSH term(s) Bariatric Surgery/adverse effects ; Humans ; Language ; Laparoscopy/adverse effects ; Obesity/surgery ; Obesity, Morbid/surgery
    Language English
    Publishing date 2022-08-11
    Publishing country Germany
    Document type Consensus Development Conference ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-022-09498-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Day case parathyroidectomy: is this the right way for the patients?

    Rago, Rocco / Forfori, Francesco / Frustaci, Gianluca / Monzani, Roberta / Paracchini, Simone / Franceschini, Francesca / Cetani, Filomena / Materazzi, Gabriele

    Gland surgery

    2020  Volume 9, Issue Suppl 1, Page(s) S6–S13

    Abstract: Background: Minimally-invasive video-assisted parathyroidectomy (MIVAP) can be considered as the primary treatment of choice for single parathyroid adenoma. Often, this technique is performed in a day surgery setting and is associated with regional ... ...

    Abstract Background: Minimally-invasive video-assisted parathyroidectomy (MIVAP) can be considered as the primary treatment of choice for single parathyroid adenoma. Often, this technique is performed in a day surgery setting and is associated with regional anaesthesia (RA). Many studies have already reported the feasibility and safety of MIVAP in day surgery. Here our focus has been on the patient's personal experience with these procedures through an assessment of their recovery at home.
    Methods: We conducted a prospective observational study in the University Hospital of Pisa Day Surgery Unit. Forty-eight patients were enrolled and divided by personal choice of anaesthesia technique: a regional anaesthesia group (RAg) and general anaesthesia group (GAg). Data were extracted from the medical records and three questionnaires: the first was self-compiled at discharge (Q1), while the second (Q2) and the third (Q3) were administered as telephone surveys.
    Results: None of the patients in RAg reported pain longer than 1 day after discharge, whereas 15% of patients in GAg reported pain relief the third day after discharge (P=0.0065). Discharge in RAg was within 3 hours in 12.5% of patients, within 4 hours in 78.1%, and within 5 hours in 9.4%. Discharge in GAg was within 5 hours in 53.8% and in more than 5 hours in 46.1% (P=0.0027).
    Conclusions: Patients highly appreciated day-case parathyroidectomy. Furthermore, the association of RA with MIVAP leads to better results than those of general anaesthesia (GA) and MIVAP. Finally, we point out that it is fundamental that the physicians pay attention to what the patients consider important for them; that is, the personal meaning of the hospitalization.
    Language English
    Publishing date 2020-01-30
    Publishing country China (Republic : 1949- )
    Document type Journal Article
    ZDB-ID 3016969-0
    ISSN 2227-8575 ; 2227-684X
    ISSN (online) 2227-8575
    ISSN 2227-684X
    DOI 10.21037/gs.2019.09.02
    Database MEDical Literature Analysis and Retrieval System OnLINE

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