Days Of Elective Surgery Research Articles

Time Since Prior NSTEMI and Major Adverse Cardiovascular and Cerebrovascular Events After Noncardiac Surgery

Delaying elective noncardiac surgery after a recent acute myocardial infarction is associated with better outcomes, but current American Heart Association recommendations are based on data that are more than 20 years old. To examine the association between the time since a non-ST-segment elevation myocardial infarction (NSTEMI) and the risk of postoperative major adverse cardiovascular and cerebrovascular events (MACCE). This cross-sectional study examined Medicare claims data between 2015 and 2020 for patients 67 years or older who had major noncardiac surgery. Data were analyzed from September 21, 2023, to February 1, 2024. Time elapsed between a prior NSTEMI and surgery. MACCE (30-day mortality, in-hospital myocardial infarction, heart failure, or stroke) and all-cause 30-day mortality. Multivariable logistic regression was used to estimate the association between outcomes and time since a prior NSTEMI. The sample included 5 227 473 surgeries. The mean (SD) age was 75.7 (6.6) years; 2 981 239 (57.0%) were female, and 2 246 234 (43%) were male. There were 42 278 patients (0.81%) with a previous NSTEMI. Compared with patients without a prior NSTEMI, patients with an NSTEMI within 30 days of elective surgery had higher odds of MACCE, regardless of whether they had undergone coronary revascularization (adjusted odds ratio [aOR], 2.15; 95% CI, 1.09-4.23; P = .03) or not (aOR, 2.04; 95% CI, 1.31-3.16; P = .001). The odds of postoperative MACCE leveled off after 30 days in patients who had undergone any coronary revascularization procedure (and after 90 days in patients with drug-eluting stents) and then increased after 180 days (any revascularization at 181-365 days: aOR, 1.46; 95% CI, 1.25-1.71; P < .001; patients with drug-eluting stents at 181-365 days: aOR, 1.73; 95% CI, 1.42-2.12; P < .001). The odds of MACCE did not level off for patients who did not have revascularization. Findings for all-cause 30-day mortality were similar to those for MACCE, except that the odds of mortality in patients with previous NSTEMI who had revascularization leveled off after 60 days in elective surgeries and 90 days for nonelective surgeries (elective 30-day: aOR, 2.88; 95% CI, 1.30-6.36; P = .009; elective 61- to 90-day: aOR, 1.03; 95% CI, 0.57-1.86; P = .92; nonelective 30-day: aOR, 1.91; 95% CI, 1.52-2.40; P < .001; nonelective 91- to 120-day: aOR, 1.00; 95% CI, 0.73-1.37; P = .99). This study found that among older patients undergoing noncardiac surgery who had revascularization, the odds of postoperative MACCE and mortality leveled off between 30 and 90 days and then increased after 180 days. The odds did not level off for patients who did not have revascularization. Delaying elective noncardiac surgery to occur between 90 and 180 days after an NSTEMI may be reasonable for patients who have had revascularization.

Surgeon Gender and Early Complications in Elective Surgery: A Systematic Review and meta-analysis.

To examine the association between surgeon gender and early postoperative complications, including 30-day death and readmission, in elective surgery. Variations between male and female surgeon practice patterns may be a source of bias and gender inequality in the surgical field, perhaps impacting quality of care. However, there are limited and conflicting studies regarding the association between surgeon gender and postoperative outcomes. MEDLINE and Embase were searched in October 2023 for observational studies including patients who underwent elective surgery requiring general or regional anesthesia across multiple surgical specialties. Multiple independent blinded reviewers oversaw the data selection, extraction, and quality assessment according to the PRISMA, MOOSE, and Newcastle Ottawa Scale guidelines. Data were pooled as odds ratios, using a generic inverse-variance random-effects model. Of 944 abstracts screened, 11 studies were included in this systematic review and meta-analysis. A total of 4,440,740 postoperative patients were assessed for a composite primary outcome of mortality, readmission, and other complications within 30 days of elective surgery, with a total of 325,712 (7.3%) surgeries performed by 7,072 (10.9%) female surgeons. There was no association between surgeon gender and the composite of mortality, readmission, and/or complications (odds ratio=0.97, 95% CI 0.95 to 1.00; I2=64.9%; P=0.001). These results support that surgeon gender is not associated with early postoperative outcomes, including mortality, readmission, or other complications in elective surgery. These findings encourage patients, healthcare providers, and stakeholders not to consider surgeon gender as a risk factor for postoperative complications.

Cardiovascular events after elective colorectal cancer surgery in patients with stage I-III disease with no previous cardiovascular disease

Background The risk of cardiovascular events in patients treated for colorectal cancer is debated due to diverging results in previous studies. Colorectal cancer and cardiovascular disease share several risk factors such as physical inactivity, obesity, and smoking. Information about confounding covariates and follow-up time are therefore essential to address the issue. This study aims to investigate the risk of new-onset cardiovascular events for patients with stage I-III colorectal cancer receiving elective surgery compared to a matched population. Material and Methods Using a prospective cohort, we compared cardiovascular events among 876 patients treated with elective surgery for incident stage I-III colorectal cancer diagnosed between January 1st, 2001 and December 31st, 2016 to a cancer-free cohort matched by age, sex, and time since enrollment (N = 3504). Regression analyses were adjusted for lifestyle, cardiovascular risk factors, and comorbidity. Multivariable analyses were used to identify risk factors associated with cardiovascular events in the postoperative (<90 days of elective surgery) and long-term phase (>90 days after elective surgery). Results After a median follow-up of 3.9 years, the hazard ratio (HR) for incident heart failure was 1.53 (95% CI 1.02–2.28) among patients operated for colorectal cancer. The postoperative risk of myocardial infarction or angina pectoris was associated with the use of lipid-lowering drugs. Long-term risks of cardiovascular events were ASA-score of III+IV and lipid-lowering drugs with HRs ranging from 2.20 to 15.8. Further, the use of antihypertensive drugs was associated with an HR of 2.09 (95% CI 1.06–4.13) for angina pectoris or acute myocardial infarction. Heart failure was associated with being overweight, diabetes, and anastomosis leakage. Conclusion We observed an increased hazard of heart failure in patients operated on for stage I-III colorectal cancer compared to cancer-free comparisons. We identified several potential risk factors for cardiovascular events within and beyond 90 days of elective surgery.

Prior Antibiotic Exposure Is Associated With Reoperation After Elective Non-colorectal Surgery.

Recent antibiotic exposure has previously been associated with poor outcomes following elective surgery. The purpose of this study is to evaluate the impact of prior recent antibiotic exposure in a multicenter cohort of Veterans Affairs patients undergoing elective non-colorectal surgery. This is a retrospective cohort study of the Veterans Affairs Surgical Quality Improvement Program, including elective, non-cardiovascular, non-colorectal surgery from 2013 to 2017. Outpatient antibiotic exposure within 90days prior to surgery was identified from the Veterans Affairs outpatient pharmacy database and matched with each case. Primary outcomes included serious complication, any complication, any infection, or surgical site infection. Secondary outcomes included 30-day mortality, length of stay, and Clostridioides difficile infection. Of 21,112 eligible patients, 2885 (13.7%) were exposed to antibiotics within 90days prior to surgery with a duration of 7 (IQR: 5-10) days and prescribed 42 (IQR: 21-64) days prior to surgical intervention. Compared to non-exposed patients, exposed patients had higher unadjusted complication rates, increased length of stay, and rates of return to the operating. Exposure was independently associated with return to the operating room (OR: 1.39; 99% CI: 1.05-1.84). Among Veterans, recent antibiotic exposure within 90days of elective surgery was associated with a 39% increase in the odds of return to the operating room. Further work is needed to evaluate the effects of antibiotic exposure and dysbiosis on surgical outcomes.

The weekday effect on postoperative mortality in elective abdominal surgery: An observational study using propensity score methods

BackgroundAlthough the “weekday effect” may influence postoperative outcomes, controversies regarding its existence remain. The aim of this study was to investigate the association between the day of the week the surgery was performed and postoperative outcomes. MethodsData from 58,646 patients who underwent elective abdominal surgery at Seoul National University Bundang Hospital from May 2003 to February 2018 were retrospectively analyzed. Two elective surgery groups comprising of 33,513 (57.1%) and 25,113 (42.9%) patients who underwent surgery in the early and late days of the week, respectively, were analyzed. Late days of the week was defined as days where surgery was performed within 2 days before weekends or holidays and early days of the week as all other weekdays. These groups were balanced using inverse probability of treatment weighting. The adjusted 30-day mortality and length of hospital stay were compared. ResultsIn the weighted sample, all 52 clinical covariates were comparable between the 2 groups. The weighted sample analysis did not reveal a significant difference in the 30-day mortality between early days of the week and late days of the week (0.19% early days of week vs 0.18% late days of the week; relative risk, 0.97; 95% confidence interval, 0.66–1.50; P = .82). Similarly, the median length of hospital stay showed no significant difference between the 2 groups (median value for both groups, 5.0 days; interquartile range 3.0–8.0; relative risk, 1.00; 95% confidence interval, 0.97–1.03; P = .16). ConclusionA weekday effect associated with the day of elective surgery performed was not found in this study for either the 30-day postoperative mortality or length of hospital stay.

Post Chikungunya Chronic Arthritis: Systemic Inflammatory Status Triggering Acute Coronary Syndrome.

Atherosclerosis, inflammation and coronary plaque destabilization are linked to each other. Infections due to various microbes may trigger Acute Coronary Syndrome (ACS) by systemic inflammation cascade. We have evaluated the prevalence of Post Chikungunya Chronic Arthritis (PCCA) among 400 consecutive ACS patients (Case group) and compared with control group subjected to elective surgery by the prospective case-control observational study. Cases were excluded if standard criteria of ACS were not satisfied and in the control group if the patient suffered a Myocardial Infarction (MI) within 28 days of elective surgery. PCCA duration more than two years or serum IgM anti-CCP positive patients were also excluded from the case as well as a control group. The case and control groups were similar except, less number of heart failure (O.R.7.3, 95% C.I. 3.3-15.9) and chronic kidney injury patients (O.R. 0.5, 95% C.I. 0.3-0.9) in the elective surgery (control) group. PCCA was present in 24 out of 400 ACS cases and 8 out of 400 control group. Among ACS case-patients, those suffering from PCCA tended to be younger and more often women, with more diabetes, hypertension, chronic kidney injury and high mean CRP. In unadjusted analysis PCCA was three times more common in the case versus control (O.R. 3.0, 95% C.I. 1.4- 6.4); results were indistinguishable after multidiscipline adjustment (O.R. 3.0, 95% C.I. 1.3-6.8). PCCA is common among patients with ACS and post-infective systemic inflammation of PCCA may trigger plaque destabilization.

Do Outcomes in Elective Colon and Rectal Cancer Surgery Differ by Weekday? An Observational Study Using Data From the Dutch ColoRectal Audit.

Previous studies showing higher mortality after elective surgery performed on a Friday were based on administrative data, known for insufficient case-mix adjustment. The goal of this study was to investigate the risk of adverse events for patients with colon and rectal cancer by day of elective surgery using clinical data from the Dutch ColoRectal Audit. Prospectively collected data from the 2012-2015 Dutch ColoRectal Audit (n=36,616) were used to examine differences in mortality, severe complications, and failure to rescue by day of elective surgery (Monday through Friday). Monday was used as a reference, analyses were stratified for colon and rectal cancer, and case-mix adjustments were made for previously identified variables. For both colon and rectal cancer, crude mortality, severe complications, and failure-to-rescue rates varied by day of elective surgery. After case-mix adjustment, lower severe complication risk was found for rectal cancer surgery performed on a Friday (odds ratio, 0.84; 95% CI, 0.72-0.97) versus Monday. No significant differences were found for colon cancer surgery performed on different weekdays. No weekday effect was found for elective colon and rectal cancer surgery in the Netherlands. Lower severe complication risk for elective rectal cancer surgery performed on a Friday may be caused by patient selection.

Pre-operative testing for pregnancy in Dublin Day Surgery Units

The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients' pregnancy status prior to elective surgery. This study aims to evaluate practices in Ireland with regard to methods used to exclude pregnancy in premenopausal women attending for day surgery. Postal questionnaires were sent to all consultants in Gynaecology and General Surgery. E-mail questionnaires were sent to all registrar trainees in both specialties. Letters were sent to nine Dublin teaching hospital day surgery units and followed up by telephone consultations. The overall response rate was poor at 34.3 %. Eighty per cent of respondents in the gynaecology specialty have encountered a preoperative patient with a positive pregnancy test at least once during their career versus 28.6 % in the surgical specialty. Only 35 % of gynaecology respondents would routinely inform female reproductive age patients of the need to avoid pregnancy prior to surgery versus 14.3 % in the surgical specialty. On the day of elective surgery, 90 % of gynaecologists would determine the LMP (last menstrual period) versus 35.7 % of surgeons. The policy at all nine Dublin teaching hospitals is to perform a urinary HCG preoperatively but, their policies vary as to whether the patient's LMP, age and medical history are considered when performing a urinary HCG test. It is important that, female patients are counselled appropriately regarding the importance of using adequate contraception or, abstinence in order to avoid pregnancy prior to elective surgical procedures. Our survey shows that, gynaecologists are more likely to give this advice compared to our surgical colleagues. Nevertheless, the number of gynaecologists who do this is surprisingly low (35 %). Urinary HCG is still the standard test used in most units to exclude pregnancy.

Meta-analysis of postoperative mortality after elective repair of abdominal aortic aneurysms detected by screening

The aim of this study was to compare the mortality rate within 30 days of elective surgery for abdominal aortic aneurysm (AAA) in men randomized to an invitation for ultrasound screening with that of men in the control group, whose aneurysms were detected incidentally. Relevant reports from randomized trials of screening were identified through a systematic search of MEDLINE. Four relevant trials were identified, and supplemented with data from the Viborg Vascular screening trial. Data were updated in two studies. Meta-analysis was undertaken with effects calculated as a fixed odds ratio (OR) with 95 per cent confidence interval. Heterogeneity between the studies was assessed by the χ(2) test. There were 25 deaths (2·9 per cent) following elective surgery in 858 men invited for screening compared with 21 (5·5 per cent) of 383 in the control group (OR 0·49, 0·27 to 0·88). There were 18 deaths (2·4 per cent) following elective surgery for 747 screen-detected AAAs compared with 28 (6·1 per cent) following elective repair of 459 incidentally detected aneurysms (OR 0·37, 0·20 to 0·68). The offer of screening identifies men whose early survival following elective AAA repair is better than that of men with an AAA detected incidentally.

Second‐hand smoking and carboxyhemoglobin levels in children: a prospective observational study

To establish baseline noninvasive carboxyhemoglobin (COHb) levels in children and determine the influence of exposure to environmental sources of carbon monoxide (CO), especially environmental tobacco smoke, on such levels. Second-hand smoking may be a risk factor for adverse outcomes following anesthesia and surgery in children (1) and may potentially be preventable. Parents and their children between the ages of 1-12 were enrolled on the day of elective surgery. The preoperative COHb levels of the children were assessed noninvasively using a CO-Oximeter (Radical-7 Rainbow SET Pulse CO-Oximeter; Masimo, Irvine, CA, USA). The parents were asked to complete an environmental air-quality questionnaire. The COHb levels were tabulated and correlated with responses to the survey in aggregate analysis. Statistical analyses were performed using the nonparametric Mann-Whitney and Kruskal-Wallis tests. P < 0.05 was statistically significant. Two hundred children with their parents were enrolled. Children exposed to parental smoking had higher COHb levels than the children of nonsmoking controls. Higher COHb values were seen in the youngest children, ages 1-2, exposed to parental cigarette smoke. However, these trends did not reach statistical significance, and confidence intervals were wide. This study revealed interesting trends of COHb levels in children presenting for anesthesia and surgery. However, the COHb levels measured in our patients were close to the error margin of the device used in our study. An expected improvement in measurement technology may allow screening children for potential pulmonary perioperative risk factors in the future.

Elective surgery days after myocardial infarction: clinical and ethical considerations

We present an unusual case of verified myocardial infarction without surgery. Successful elective lumbar spine surgery was performed 4 days post–myocardial infarction during perioperative β-blockade, after cardiology evaluation recommended surgery without further evaluation. Clinical and ethical considerations are discussed.

Ultrasound in prevention of postoperative immunodeficiency

Phonoprophylaxis of postoperative immunodeficiency was developed and tested in 34 patients. From the first day of hospitalization to the day of elective surgery the patients were daily exposed to ultrasound on the area of the manubrium sterni according to the labile technique through petrolatum or glycerol medium (0.05 W/cm2, 120-150 s, each other day, 4-6 procedures per course). Immune status studies after surgery prove a prophylactic effect of the above ultrasonic procedures.

Preoperative Fasting in Children

Preoperative Fasting in Children

Preoperative fasting in children.

Children undergo a preoperative fast in an attempt to minimize the fluid and solid food component of gastric contents. The importance of a preoperative fast was acknowledged early in the evolution of anesthesia as a discipline of medicine. In response to concerns about the aspiration of gastric contents, a prolonged fast presumably came into vogue. With this practice, it was not unusual to have hungry, irritable children who were prone to hypoglycemia after fasts of 8 ‐12 h or even longer. The purpose of this article is to provide the reader with a narrative review of the literature pertaining to preoperative fasting in children. This article is primarily focused on randomized controlled trials (RCTs), but when not available, literature of lesser intensity was used. We present the physiology of gastric emptying with an emphasis on studies focusing on children in the perioperative period. These studies of gastric emptying were, when possible, divided into studies involving solid food and those involving clear fluids. We then present preoperative fasting of children, which was subdivided by age (neonates, infants, toddlers, and adolescents) and by health (elective versus emergent surgery and healthy versus medically compromised patients). In the concluding portions of this review, we present recommendations for the management of perioperative fasting and recommendations with respect to the need for more research, as more questions remain unanswered than those that have been answered. During preparation of this article, we accepted several links. The linkage between gastric fluid volume and aspiration pneumonia for healthy patients has recently been examined by an ASA taskforce, which concluded that the available data were insufficient to confirm or deny a relationship. Although this means that gastric fluid volume is a surrogate end point for aspiration pneumonia, virtually all studies examining preoperative feeding practices have gastric residual volume as their primary end point. For the purpose of this review, we focus on the end point of gastric residual volume, which is the almost exclusive choice of numerous peer-reviewed investigations. Furthermore, in the practice of anesthesia, patients undergoing emergency surgery have increased gastric contents and are at increased risk of aspiration pneumonia. This is an established link, and if we were to refute it, we would deny the need for rapid-sequence induction plus appropriate airway management during general anesthesia for emergency surgery. Although increased gastric contents increase the risk of aspiration pneumonia, there is no known gastric fluid volume that places a particular patient at clinically relevant risk or eliminates all risk.

Risk factors for cardiovascular death after elective surgery under general anaesthesia

A large epidemiological data set was used to identify 115 patients who died from a cardiovascular cause within 30 days of elective surgery under general anaesthesia. For each patient, a control was identified, matched for age (within 5 yr of the patient), sex, operation and consultant. Patients and controls were compared for cardiovascular risk factors in a matched analysis using conditional logistic regression, and a prognostic model was generated. Three risk factors were included in the final model: previous myocardial infarction (odds ratio 3.18 (95% confidence intervals (CI) 1.22-8.28), P = 0.018), history of hypertension (odds ratio 1.90 (0.99-3.62), P = 0.047) and renal failure (odds ratio 3.56 (1.04-12.10), P = 0.043).

The endoscopic, radiological, and surgical findings in chronic duodenal ulceration.

A prospective study of the endoscopic, radiological, and surgical features of chronic duodenal ulceration has been performed. Double contrast barium meal and upper gastrointestinal endoscopy were both performed within five days of elective surgery for chronic duodenal ulceration on 50 patients. The surgical diagnosis correlated with endoscopy in 88% and radiology in 82%, but if both techniques were employed, an accurate pre-operative diagnosis was achieved in 96% of cases. There was poorer correlation in determining the position of the ulcer within the bulb, with only 41% correlation between all three parameters and complete disagreement in 24%. Surgery correlated with endoscopy in 71% but with radiology in only 41%. The correlation between endoscopy and surgery in the diagnosis of duodenitis was only 42%, suggesting that this should be a histological diagnosis. This study suggests that endoscopy is slightly more precise than radiology in the diagnosis of chronic duodenal ulceration, but with a combination of the two techniques almost 100% accuracy can be achieved.