Elective General Surgery Patients Research Articles

The Incidence of Abnormal Preoperative Testing Among Elective Surgery Patients in a Referral Hospital in Southern Saudi Arabia.

Background Preoperative investigations are important to assess the clinical condition of patients who undergo elective surgical procedures. However, there is still debate about the usefulness of performing preoperative investigations. We aimed to determine the prevalence of routine preoperative investigation abnormalities among elective general surgery patients. Methodology This retrospective hospital-record-based study was conducted at the King Abdullah Hospital in Bisha Province, southern Saudi Arabia. General and clinical data of 968 patients who underwent elective surgical interventions from February 2022 to January 2023 were retrieved and analyzed. Result A total of 968 patients (578 females and 390 males) aged between 14 and 80 years were included in the study. Four hundred and eleven (42.5%) patients were in the age groupof 40 years and above. The commonly detected comorbidities among the patients were diabetes (15%), hypertension (12%), respiratory diseases (7.5%), and cardiac diseases (2.5%). Abnormalities related to hemoglobin (31%), total leucocyte count (12.7%), and platelets (8.5%) were found in 968 patients. Around 15% of patients had increased creatinine levels. Hypokalemia was observed in 6.8% of patients. Increased liver enzymes were reported in limited proportions (10% to 14%) of patients. Slightly abnormal radiological findings were reported for chest X-ray (CXR) (2.8%), electrocardiogram (ECG) (2%), and Doppler echocardiography (Echo) (0.8%). A statistically significant association between the age of the patient and abnormal findings of ECG (p <.001), Echo (p = .001), and CXR (p <.001). Cardiac abnormalities were commonly associated with patients of ≥ 40 years. Abnormal cardiac findings (CXR, ECG, Echo) were significantly (p<.05) increased with the presence of diabetes, hypertension, and cardiovascular comorbidities. Conclusions Preoperative testing revealed limited proportions of abnormal findings among patients with elective surgical procedures. Routine ordering of many preoperative investigations without specifications may not predict postoperative complications of the patients. Therefore, undertaking preoperative testing should be guided by targeted history, physical examination, clinical risk factors, and type of surgical procedure intended to be performed.

Malnutrition via GLIM Criteria in General Surgery Patients

Purpose: The purposes are to determine malnutrition in elective general surgery patients via GLIM criteria, compare GLIM criteria with NRS2002 and to determine the effect of malnutrition on Length of Stay (LoS). &#x0D; Materials and Methods: Malnutrition was detected with NRS2002 and GLIM. GLIM was evaluated in two different ways as 1-NRS2002 (first four questions) was used as a preliminary malnutrition screening tool for GLIM and 2-All patients were evaluated with GLIM without a preliminary assessment. Reduced muscle mass in GLIM, was assessed using different anthropometric measurements and cut-off points. In total, 10 different GLIM models were constituted. Data were collected within 48 hours of admission. Agreement between malnutrition tools was determined via Kappa. Logistic regression models were established to present the effect of malnutrition on long LoS. p

SP8.2.3 Serial CRP in post operative elective general surgery patients: analysis of usage and value

Abstract Aims The aim of this project is to investigate the current practice in measuring C-reactive protein (CRP) in the post-operative patients in elective general surgery, to determine the current trends in using it and its potential value in detecting post operative complications. Methods A retrospective analysis of a 100 consecutive patients admitted for elective general surgery between January and July 2021 was conducted. This included analysis of patient demographics and post-operative interventions including return to theatres and interventional radiology. The CRP levels of the patients who required interventions were compared against those who did not. Results 40 males; 60 females with a mean age of 61.1 years were included, 11% of these patients had post-operative interventions. This analysis showed CRP values were measured routinely post operatively for at least 5 days in 91% of patients. There was a rise in CRP in all patients in the early post-operative period (first three days). If CRP continued to rise after this, it was more associated with a need for post-operative interventions. Conclusions There is no diagnostic value for measuring CRP in the first three days of the post operative period, as it will always show a rise in that period. Continued rise after day 3 may indicate post operative complications. Setting up pre-determined blood tests profiles for elective surgical patients may help save time, effort and resources.

Reducing Surgical Site Infection by Prophylactic Negative Pressure Wound Therapy in a Cohort of General Surgery Patients

Background: Surgical site infection (SSI) is one of the leading complications in health care. Negative pressure wound therapy (NPWT) is meanwhile widely prophylactically used for preventing SSIs. For evaluating the results of the implantation of this technique, we used the Simon single-arm study design and examine whether NPWT has a prophylactic effect on reducing SSIs in a cohort of general surgery patients. Methods: This single-arm, two-stage study includes 81 elective general surgery patients and corresponds to the Simon’s design. The sample size calculation was based on a reduction in the superficial SSI rate from 12 to 4% (power 80%, significance level 5%) using a NPWT system. In compliance with Simon’s two-Stage design, the study required the recruitment of 34 patients in stage I and 47 patients in stage II. The two-stage design method would be discarded in case of a wound infection in 3 or more patients in stage I or 6 or more patients in stage II. Using the NPWT system in the operating room, a negative pressure wound dressing was applied post-operatively and removed after 7 days. According to the criteria of the Centres for Disease Control and Prevention (CDC), post-operative wound documentation followed on day 7 and 30. Results: In stage I, no SSI was apparent. In stage II, 3 patients had SSIs (CDC grade I). Conclusion: A prophylactic NPWT can significantly reduce the wound infection rate in elective general surgery.

828 Is Isolation Before Elective Surgery the Way Forward During The COVID-19 Pandemic?

IntroductionThe COVID-19 pandemic is here to last, and services must adapt to enable elective surgery to continue. Surgery involves high-risk aerosol generating procedures, potentially harmful to staff and patients. The current NICE guidance is for the patient to self-isolate for 72 hours prior to surgery. A question persists: Is 72-hour isolation the way forward in elective general surgery?MethodIn a DGH centre, using an anonymous questionnaire, we prospectively collected data on isolation for 36 elective general surgery patients during the 72h isolation period. The data was analysed to assess the concordance with isolation as well as patient's satisfaction with the process.Results75% of patients were concordant with 72 hours of isolation pre-operatively. This was an increase from 35% when compared to patients questioned during the 14 day isolation period. The main factors contributing to isolation breech were visitors to the house and the mode of transport used to attend hospital.ConclusionsThe protocol is now for a COVID swab 72 hours pre-operatively followed by isolation until the operation. Our results show that still significant breaches in isolation remain and patients welfare is adversely affected during that period. Further research and consideration is needed to optimise the COVID isolation protocol.

Quality Improvement to Address Surgical Burden of Disease at a Large Tertiary Public Hospital in Peru.

In resource-limited settings, there is a unique opportunity for using process improvement strategies to address the lack of access to surgical care. By implementing organizational changes in the surgical admission process, we aimed to decrease wait times, increase surgical volume, and improve patient satisfaction for elective general surgery procedures at a public tertiary hospital in Lima, Peru. During the first phase of the intervention, Plan-Do-Study-Act (PDSA) cycles were performed to ensure the surgery waitlist included up-to-date clinical information. In the second phase, Lean Six Sigma methodology was used to adapt the admission and scheduling process for elective general surgery patients. After six months, outcomes were compared to baseline data using Wilcoxon rank-sum test. At the conclusion of phase one, 87.0% (488/561) of patients on the new waitlist had all relevant clinical data documented, improved from 13.3% (2/15) for the pre-existing list. Time from admission to discharge for all surgeries improved from 5 to 4days (p<0.05) after the intervention. Median wait times from admission to operation for elective surgeries were unchanged at 4days (p=0.076) pre- and post-intervention. There was a trend toward increased weekly elective surgical volume from a median of 9 to 13 cases (p=0.24) and increased patient satisfaction rates for elective surgery from 80.5 to 83.8% (p=0.62), although these were not statistically significant. The process for scheduling and admitting elective surgical patients became more efficient after our intervention. Time from admission to discharge for all surgical patients improved significantly. Other measured outcomes improved, though not with statistical significance. Main challenges included gaining buy-in from all participants and disruptions in surgical services from bed shortages.

Deep Sleep and Beeps: Sleep Quality Improvement Project in General Surgery Patients

Poor sleep leads to poor health outcomes. Inpatient sleep disturbance has been studied primarily in the ICU. Minimal research exists on sleep in surgical populations. We recruited patients undergoing elective, inpatient general surgery procedures. Participants wore Fitbit trackers while inpatient to measure total sleep time (CDC recommendation is 7 or more hours per night). At discharge, patients completed the Richards-Campbell Sleep Questionnaire (RCSQ) to measure inpatient sleep quality. The RCSQ combines 5 domains into a cumulative score (0 to 100); a higher score means better sleep quality. Patients also completed the outpatient Pittsburgh Sleep Quality Index preoperatively and postoperatively. The primary end point was percentage of patients with total sleep score ≥ 50. Secondary outcomes included mean RCSQ domain scores, Fitbit total sleep time, and percentage with Pittsburgh Sleep Quality Index Score indicating poor sleep. We included 64 patients (mean ± SD age 55.0 ± 14.1 years). Mean ± SD RCSQ total sleep score was 49 ± 20.5 and 53.1% with total sleep score < 50. Mean ± SD RCSQ domain scores were Awakenings: 40.4 ± 22.8, Sleep Quality: 49.1 ± 27.9, Sleep Latency: 49.2 ± 25.3, Sleep Depth: 50.2 ± 26.5, Returning to Sleep: 55.9 ± 28.1, and Noise Disturbance: 59.1 ± 27.9. On night one, 25 devices (40%) had recorded sleep data due to enough sleep. Mean ± SD total sleep time on night 1 was 4.7 ± 2.8 hours. Mean total sleep time for nights 2, 3, and 4 remained fewer than 7 hours. Percentages for each night that achieved the CDC goal of 7 or more hours were as follows: night one 10.9%, night two 32.8%, night three 35.3%, and night four 27.6%. Per the Pittsburgh Sleep Quality Index, 88.1% of patients were poor sleepers preoperatively and 84.5% were poor sleepers at follow-up (p= 0.6). Elective general surgery patients experience a severe inpatient sleep disturbance, worse than in similarly studied ICU cohorts. This disturbance is driven primarily by nighttime awakenings.

Implementation of a very low calorie diet program into the pre-operative model of care for obese general elective surgery patients: Outcomes of a feasibility randomised control trial.

The present article aimed to evaluate the feasibility of implementing a very low calorie diet (VLCD) weight loss program into the pre-operative model of care for elective general surgery patients with obesity. A prospective, randomised control trial of adults with obesity awaiting elective general surgery was conducted at an outpatient clinic at a tertiary hospital. Patients were randomised to the intervention group, an 8-week VLCD program incorporating Optifast (Nestle Health, Germany) shakes, or to standard care (generic healthy eating information). Data were collected at baseline, week 8 and at 30 days post-surgery. The primary outcome of the study was feasibility, which was evaluated through demand, practicality, integration and acceptability measures. Forty-six participants (M 17: F 23, mean age 51.6 (13.1) years) with a mean body mass index ≥ 30 kg/m2 (40.5 kg/m2 (5.9)) were recruited. There was a higher mean weight loss in the intervention group (n = 23) compared to the control group (n = 14) (-6.5 vs +0.15 kg; P = <.001), with no excessive loss of muscle mass (MM), measured by bioelectrical impedance analysis. The reduction in waist circumference was greater for the intervention (n = 21) compared to control group (n = 5) (-6.11 vs +1.36 cm; P = .003). Quality of life increased significantly in the intervention group (P < .001). The pre-operative VLCD program produced clinically meaningful rapid weight loss pre-surgery and improved quality of life without an excessive loss of MM.

Comparison of intravenous dexmedetomidine and intravenous fentanyl to attenuate the hemodynamic stress response to tracheal extubation

Introduction: Endotracheal extubation can be associated with hypertension, tachycardia, arrhythmias, myocardial ischemia and raised intracranial pressures due to sympathetic stimulation. Aim: To compare the efficacy of dexmedetomidine, fentanyl and placebo in decreasing stress response to tracheal extubation in elective general surgery patients. Materials and Methods: 180 patients of either sex, ASA grade I -II normotensive, aged 18-65 years undergoing elective general surgeries of 60-180 minutes duration under general anaesthesia were randomized into 3 groups. Anaesthetic technique was standardized. Patients in Group N, F and D received an IV infusion of 100 ml of 0.9% normal saline, fentanyl 1?g/kg and dexmedetomidine 0.5?g/kg respectively 10 minutes before extubation for a period of 10 minutes. HR, SBP, DBP, MAP and SPO2 were recorded before, during and after extubation. Results: Statistically significant lesser increase in HR, SBP, DBP, MAP were noted after extubation in the dexmedetomidine group than the fentanyl group. Dexmedetomidine group had better extubation quality than the fentanyl group. Ramsay sedation and Aldrete scores were similar in all 3 groups. Hypotension and bradycardia were more with dexmedetomidine group than the fentanyl group but none required intervention. Conclusion: Dexmedetomidine 0.5?g/kg infusion administered 10 minutes before tracheal extubation was better compared to fentanyl 1?g/kg infusion in attenuating the hemodynamic stress response with comparable adverse effects. Hence, dexmedetomidine infusion can be a safer alternative to fentanyl infusion for attenuating extubation stress response. Keywords: Dexmedetomidine, Fentanyl, Extubation, Hemodynamic response.

An audit of patient satisfaction - What is the experience of elective general surgery patients being anaethetised in the operating theatre instead of the anaesthetic room?

An audit of patient satisfaction - What is the experience of elective general surgery patients being anaethetised in the operating theatre instead of the anaesthetic room?

English

INTRODUCTION: Anaesthesia has made major advances in recent years. Considerable efforts have been devoted to airway management by the anesthesiologist during the past 20 years. A large number of supraglottic airway devices have been introduced recently. The original purpose was to reduce the need for more invasive methods of airway management while offering a more reliable alternative to the facemask. The laryngeal mask airway (LMA) is one such innovative device designed for airway management. One of the principal aims of anaesthesia is to counter surgically induced stress. So the anesthesiologist should be able to use a method of delivering the anaesthetic that is by itself not stress inducing3. Since the LMA is placed directly over the posterior pharynx, it avoids tracheal stimulation and hence the systemic and ocular stress response associated with tracheal intubation. AIM OF THE STUDY: The aim of the study is to observe the usefulness of Midazolam and mini-dose of Succinyl choline to facilitate the insertion of laryngeal mask airway during Propofol anesthesia in elective general surgery patients based on the following parameters. 1. Conditions during insertion of laryngeal mask airway such as jaw relaxation, ease of insertion, number of attempts for insertion, airway trauma and total dose of Propofol. 2. Patient’s response to insertion of laryngeal mark airway such as gagging, coughing, head and limb movements, laryngospasm, etc. 3. Hemodynamic parameters like mean arterial pressure, heart rate and oxygen saturation. MATERIALS AND METHODS: After obtaining institutional ethical committee clearance and the patient consent, the study was carried out on 75 patients posted for elective surgical procedures lasting less than or equal to 45 min at Madras Medical College & GGH, Chennai. Patients belonging to the age group of 18 – 50 years of both the sexes were selected. Inclusion Criteria: 1. Elective short surgical procedures lasting less than or equal to 45 min Patients of ASA physical status I and II, 2. Aged between 18 – 50 years of both sexes. Exclusion Criteria: 1. Patients with full stomach ,pregnant patient, 2. Patients posted for emergency surgery, 3. Patients with oral, peri oral pathology such as tumours, abscess or grossly enlarged tonsils. OBSERVATIONS AND RESULTS: This study was conducted on 75 patients who were divided into 3 Groups of 25 patients each. Group A - Propofol Group, Group B - Propofol with midazolam Group, Group C - Propofol with succinyl choline Group. Demographic Profile: In group A and C, 48% of patients are males and rest 52% are females, while in group B 52% of patients are males and rest females. The mean age of patient is 30.52, 30.12 and 30.84 in groups A, B and C respectively. The mean weight is 51.8, 53 and 53.22 in groups A, B and C respectively. Patients in each group were statistically comparable in relation to sex, age and weight. SUMMARY: In this study, the conditions of LMA insertion, patient’s response to LMA insertion and the hemodynamic changes during and after LMA insertion in the following three groups of patients were observed. Group A - Inj. Propofol 2.5mg/kg only. Group B - Inj. Propofol 2.5 mg/kg + 0.04mg/kg midazolam. Group C- Inj. Propofol 2.5 mg/kg + 0.1 mg/kg succinyl choline. • The jaw relaxation was adequate in 100% of Group B patients compared to 32 % of patients in Group A and 64% in Group C. • Overall insertion conditions were excellent in 100% of patients in Group B compared to 32% in Group A and 44% in Group C. • LMA was inserted successfully in the first attempt in 100% of patients in Group A compared to 40% in Group A and 64% in Group C. • Airway trauma as evidenced by blood staining of LMA was found in 36% of patients in Group A and 32% in Group C while none of the patients in Group B had any airway trauma. • Post op myalgia was present in 40% of patients in Group C. • Patient movements were present in 48% of patients in Group A compared to 12% in Group C while no movement was present in any of the patient in Group B. • The total dose of Propofol required for successful insertion of LMA was 2.76mg/kg in Group A and 2.60 mg/kg in Group C, while it is the least 2.06mg/kg in Group B which is the cause of significant hemodynamic stability in patients of Group B CONCLUSION: To conclude, addition of Midazolam (0.04mg/kg) to the standard dose of propofol provides better LMA insertion conditions than the addition of mini-dose Succinyl Choline (0.1mg/kg).

Preoperative urinary tract infection increases postoperative morbidity

BackgroundPreoperative urinary tract infection (UTI) may be associated with surgical site infections secondary to hematogenous spread of bacteria. The association between preoperative UTI and postoperative complications has not been evaluated in general surgery populations. Materials and methodsPatients undergoing elective general surgery procedures from 2011 to 2013 were selected from the American College of Surgeons National Surgical Quality Improvement Program database. Patients with UTI present at the time of surgery (PATOS) were identified as cases. Patients without UTI PATOS were selected and matched 2:1 on age, American Society of Anesthesiologists class, and Current Procedural Terminology code with identified cases. Univariate and multivariate analyses compared postoperative outcomes between the two groups. ResultsA total of 434,802 patients were identified for inclusion in the study, with an overall preoperative UTI rate of 0.1% (n = 363). On univariate analysis, the UTI group had a significantly higher incidence of overall complications, infectious complications, and noninfectious complications. Multivariate analysis confirmed that patients with UTI had a higher risk of postoperative complications compared with those without preoperative UTI (odds ratio [OR] 1.551, 95% confidence interval [CI] 1.071-2.247). This relationship persisted for both infectious (OR 1.515, 95% CI 1.000-2.296) and noninfectious (OR 1.683, 95% CI 1.012-2.799) complications. ConclusionsWe demonstrated an increased rate of 30-d complications in elective general surgery patients with UTI PATOS. These findings suggest that diligent efforts to diagnose and treat UTI before surgery may result in improved outcomes. Furthermore, surgeons should consider postponing elective procedures to allow for the complete resolution of preoperative UTI.

Преоксигенация: можно ли сделать меру безопасности менее опасной?

While providing reserve time for dificult airway management, preoxygenation with pure oxygen increases the risk of pulmonary complications due to absorption atelectases. The authors explored when it could be appropriate to prevent atelectases by preoxygenation with decreased FiO₂. ASA I-II elective gynecological surgery patients were randomized among five groups (n = 22 each) with preoxygenation using FiO₂ 100, 70, 60, 60% + PEEP 5 mbar and 50%. Even FiO₂ 70% led to decrease. in safe apnea time (i.e. time interval to Sp²O₂ 95%) by two, while FiO₂ 50% - by more than three times. Furthermore, in five similar additional groups of women with same techniques ofpreoxygenation (n = 10 each) it was shown that for FiO₂ 5 70% very fast pattern of SpO2 fall after the first change ofpulseoxymeter figure (100% by 99%) is typical: interval to SpO2 90% was less than 1 min, while for FiO₂ 100% it lasts for 200 s. Since critical problem is "Cannot intubate, cannot ventilate", the authors tried to focus on the difficultfacemask ventilation prognosis. In the group of 71 elective general surgery patients (31 males, 40 females, ASA I-III) original prognostic model based on seven simple bedside tests (removable dentures, beard, snoring, Mallampati class 2-4, age > 50 y.o., BM > 30 kg/m², sternomental distance < 12 cm) demonstrated the reliability of difficult facemask ventilation negative prognosis of 97,5%. The authors suggest that only in patients with reliable prognosis of easy facemask ventilation prevention ofpulmonary complications by preoxygenation with FiO₂ 50-60% could be safely recommended.

Analytic morphomics corresponds to functional status in older patients

BackgroundOlder patients account for nearly half of the United States surgical volume, and age alone is insufficient to predict surgical fitness. Various metrics exist for risk stratification, but little work has been done to describe the association between measures. We aimed to determine whether analytic morphomics, a novel objective risk assessment tool, correlates with functional measures currently recommended in the preoperative evaluation of older patients. Materials and methodsWe retrospectively identified 184 elective general surgery patients aged >70 y with both a preoperative computed tomography scan and Vulnerable Elderly Surgical Pathways and outcomes Assessment within 90 d of surgery. We used analytic morphomics to calculate trunk muscle size (or total psoas area [TPA]) and univariate logistic regression to assess the relationship between TPA and domains of geriatric function mobility, basic and instrumental activities of daily living (ADLs), and cognitive ability. ResultsGreater TPA was inversely correlated with impaired mobility (odds ratio [OR] = 0.46, 95% confidence interval [CI] 0.25–0.85, P = 0.013). Greater TPA was associated with decreased odds of deficit in any basic ADLs (OR = 0.36 per standard deviation unit increase in TPA, 95% CI 0.15–0.87, P <0.03) and any instrumental ADLs (OR = 0.53, 95% CI 0.34–0.81; P <0.005). Finally, patients with larger TPA were less likely to have cognitive difficulty assessed by Mini-Cog scale (OR = 0.55, 95% CI 0.35–0.86, P <0.01). Controlling for age did not change results. ConclusionsOlder surgical candidates with greater trunk muscle size, or greater TPA, are less likely to have physical impairment, cognitive difficulty, or decreased ability to perform daily self-care. Further research linking these assessments to clinical outcomes is needed.

The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery

As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin <12 g/dL], haematinics and length of hospital stay) was analysed on 400 hundred patients undergoing elective laparoscopic bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, p<0.0001) respectively. In the elective general surgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis p<0.0001, ferritin <30 p<0.0001. Mean length of stay (days) was increased in the anaemic compared to in the non-anaemic group (2.7 vs. 1.9) and patients who were anaemic immediately post-operatively, also had an increased length of stay (2.7 vs. 1.9), p<0.05. Absolute iron deficiency was more common in patients undergoing bariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay.

LMA Unique Has Low Failure Rate in Elective Use

No large studies have examined the causes and complications of failure of the single-use Laryngeal Mask Airway Unique (uLMA). Researchers reviewed anesthesia records for 15,795 elective general surgery patients who received the uLMA at a single center in Michigan between 2006 and 2009. The primary outcome was uLMA …

Comparison of the effect of a single dose of erythromycin with pantoprazole on gastric content volume and acidity in elective general surgery patients

Introduction:Pulmonary aspiration of gastric contents remains one of the most feared complications of anesthesia. A gastric pH of 2.5 or less and a volume of 25 ml (0.4 ml/kg body weight) or more in average adult patients are considered critical factors for the development of pulmonary damage in adults.Materials and Methods:This study compared the efficacy of a single oral dose of erythromycin (a macrolide antibiotic) with oral pantoprazole (a proton pump inhibitor) on pre-operative gastric fluid volume and pH in a prospective, randomized, double-blind controlled fashion in 80 adult patients (of ASA physical status I and II) planned for elective surgery under general anesthesia. Patients were divided into two groups of 40 patients each. The pantoprazole group (Group I) received oral pantoprazole 40 mg and the erythromycin group (Group II) received oral erythromycin 250 mg at least 1 h prior to the induction of anesthesia. After tracheal intubation, gastric fluid was aspirated via a Salem Sump tube and its volume and pH were measured.Results:Although both erythromycin and pantoprazole decreased the gastric fluid volume to a similar extent, the decrease in gastric fluid acidity by pantoprazole was significantly greater than that by erythromycin. The proportion of patients at risk of pulmonary aspiration according to traditional criteria, i.e. pH ≤2.5 and volume ≥25ml, was lower in the pantoprazole group.Conclusion:Administration of pantoprazole was found to be more useful than a sub-therapeutic dose of erythromycin in decreasing both volume and acidity of gastric content.

Comparison of Hospital Performance in Emergency Versus Elective General Surgery Operations at 198 Hospitals

Surgical quality improvement has focused on elective general surgery (ELGS) outcomes despite the substantial risk associated with emergency general surgery (EMGS) procedures. Furthermore, any differences in the quality of care provided to EMGS versus ELGS patients are not well described. We compared risk factors and risk-adjusted outcomes associated with EMGS and ELGS procedures to assess whether hospitals have comparable outcomes across these procedures. Using American College of Surgeons National Surgical Quality Improvement Program data (2005 to 2008), regression models were constructed for 30-day overall morbidity, serious morbidity, and mortality among all patients, EMGS patients, and ELGS patients. Observed-to-expected (O/E) ratios were calculated from models based on EMGS or ELGS patients. Association of hospital performance after EMGS versus ELGS procedures was assessed by evaluating correlations of O/E ratios; agreement in outlier status (hospitals where O/E confidence intervals [CI] do not overlap 1.0) was evaluated with weighted kappa. Of 473,619 procedures, 67,445 (14.2%) patients underwent an EMGS procedure. EMGS patients were more likely to experience any morbidity (odds ratio [OR] 1.20; 95% CI 1.16 to 1.23), serious morbidity (OR 1.26; 95% CI 1.21 to 1.30), and mortality (OR 1.39; 95% CI 1.30 to 1.48). Correlation between O/E ratios for EMGS and ELGS were moderate to low (overall morbidity = 0.48, p < 0.0001; serious morbidity = 0.41, p < 0.0001, mortality = 0.18, p = 0.01). Outlier status was not consistent across EMGS and ELGS, with only slight agreement (overall morbidity = 0.18, p < 0.0001; serious morbidity = 0.16, p = 0.001, mortality = 0.19, p = 0.01). EMGS patients are at substantially greater risk than ELGS patients for adverse events. Hospitals do not appear to have highly consistent performance across EMGS and ELGS outcomes. Processes of care that afford improved outcomes to EMGS patients need to be identified and disseminated.

The impact of the pharmacist on an elective general surgery pre-admission clinic.

A traditional clinical pharmacy service for surgical patients involves a ward visit that identifies and responds to issues after prescribing has taken place. It was hypothesised that pharmacist involvement in a general surgery pre-admission clinic (PAC) would provide elective patients with significantly better pharmaceutical care than ward visits alone. 100 elective general surgery patients were recruited into 2 groups as part of a non-randomised controlled trial. The groups were comparable in terms of age, surgical procedure and use of medicines. The control group received standard ward visits. The intervention group had pharmaceutical assessment in a pre-admission clinic. This assessment incorporated pharmacist-led drug history taking and prescription transcription. Number, classification and clinical significance of pharmaceutical interventions. A pharmacist made 76 interventions in the PAC group and 79 interventions in the ward group. No prescribing errors and omissions were made in the PAC group. The clinical significance of PAC interventions was rated more highly than ward interventions on two scales. Involvement in the PAC increased the pharmacist's workload, but saved time for surgical and nursing staff. Surgical and nursing staff identified writing discharge prescriptions as the most valuable service provided by the PAC pharmacist. By ensuring safe prescribing in the PAC group, the pharmacist was able to become more involved in clinical issues. Pharmacist involvement in PACs presents a useful opportunity for expansion of pharmacy services. However, extra resources would be needed in order to provide these services fully.