Preoperative Care

Latest Issue of OR Manager
December 2017

Preop cognitive screening predicts postop complications in older total joint patients

Editor's Note Poor preoperative cognition, as assessed by preoperative Mini-Cog screening, is prevalent among older total joint patients and predictive of adverse outcomes, including postoperative delirium, longer hospital stay, and greater likelihood of discharge to a place other than home, this study finds. Of 211 patients 65 years of age…

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By: Judy Mathias
November 7, 2017
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Standardized ambulatory surgery protocol reduces postop pain, ED visits

Editor's Note Standardizing clinical processes for outpatient hernia repairs reduced postoperative pain and unplanned returns to the emergency department (ED), finds this study presented October 23 at the American College of Surgeons 2017 Clinical Congress in San Diego. Researchers developed a standardized eight-step protocol that incorporated best practices and enhanced…

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By: Judy Mathias
October 25, 2017
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ACS NSQIP pilot identifies geriatric–specific risk factors that affect surgical outcomes

Editor's Note A new pilot study from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) finds that adding geriatric-specific risk factors to traditional risk factors could significantly improve the ability of surgeons to predict poor surgical outcomes in older patients. The study involved 36,399 older surgical…

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By: Judy Mathias
October 18, 2017
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Preadmission frailty predicts adverse outcomes in geriatric trauma patients

Editor's Note In this study, preadmission clinical frailty independently predicted adverse discharge destination (ie, death or discharge to a long-term, chronic or acute care facility) in geriatric trauma patients. The analysis of 266 trauma patients 65 years and older using the Clinical Frailty Scale (CFS) and the laboratory Frailty Index…

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By: Judy Mathias
September 11, 2017
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STOP-Bang screening associated with risk of postop complications in OSA patients

Editor's Note This meta-analysis found that patients at higher risk for obstructive sleep apnea (OSA), as determined by preoperative STOP-Bang screening, had a higher risk of postoperative adverse events and longer length of hospital stay, compared with lower risk-OSA patients. The analysis included 10 studies with 23,609 patients (7,877 high-risk…

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By: Judy Mathias
August 28, 2017
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The Perioperative Patient Journey: From Pre- to Postoperative Care in the ASC

After this session you’ll be able to: 1. Describe the three primary advantages of calling your patients preoperatively. 2. Explain how to successfully manage the flow of the patients through the preoperative area. 3. Discuss how to best prepare patients and their families for discharge. Why this is important: Take…

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Orthopedic PSH a prime model for value-based care—Part 2

Organizations that have adopted the perioperative surgical home (PSH) model of patient care have reaped the benefits of improved outcomes and a healthier bottom line. In particular, the PSH has a proven track record for colorectal surgery and orthopedic surgery. In part 1 of this two-part series (OR Manager, August…

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By: Cynthia Saver, MS, RN
August 22, 2017
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Outcomes in patients diagnosed with OSA during preop screening vs previously diagnosed

Editor's Note In this study, patients diagnosed on the day of surgery as moderate to high risk for obstructive sleep apnea (OSA) had similar rates of adverse respiratory events (ie, perioperative hypoxemia and difficult airway management) as patients who had been diagnosed with OSA previously. However, those diagnosed with OSA…

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By: Judy Mathias
August 14, 2017
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Cognitive assessment helps predict survival in frail surgical patients

Editor's Note Adding cognitive assessment to frailty assessment predicted poor postoperative outcomes and survival in frail patients better than either measurement alone, this study finds. The study included 330 patients having major surgery who were assessed with a four-level composite frailty scoring system, which was created by combining the Fried…

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By: Judy Mathias
August 10, 2017
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Preop elderly assessment tool identifies postop complication risks

Editor's Note Screening elderly patients preoperatively using the Vulnerable Elders Surgical Pathways and Outcomes Assessment (VESPA) tool helped identify patients at higher risk of postoperative complications in this study. A total of 736 patients 70 years of age or older were assessed in a preoperative clinic from July 9, 2008,…

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By: Judy Mathias
August 4, 2017
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Effect of postop hyperglycemia, preop hemoglobin on outcomes in diabetic patients

Editor's Note Early postoperative hyperglycemia was linked to increased readmissions after gastrointestinal surgery in insulin-dependent diabetic patients, but elevated preoperative hemoglobinA1c was not, this study finds. Higher preoperative hemoglobinA1c levels were associated with increased postoperative glucose level checks and insulin use as well as lower rates of postoperative complications. Though…

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By: Judy Mathias
August 2, 2017
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It Starts with You: Compassionate Connected Care

After this session you’ll be able to: 1. Describe how cross-domain analytics, including patient experience, nurse experience, and NDNQI data, have influenced strategies to reduce patient and caregiver suffering. 2. Discuss the importance of returning to the “why” of perioperative leadership. 3. Demonstrate how to implement Compassionate Connected Care™ themes…

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