Outpatient Surgery Research Articles

Outpatient Office-Based Surgical Procedures

Outpatient Office-Based Surgical Procedures

Disparities in the expansion of telemedicine in pediatric specialty care through the COVID-19 pandemic and beyond.

The COVID-19 pandemic resulted in the rapid expansion of telemedicine, including in specialties traditionally dependent on physical exams, such as pediatric surgery. Trends in its utilization as in-person visits resumed are not well understood, nor is its effect on mitigating disparities related to social determinants of health (SDOH). We hypothesize that telemedicine utilization increased after the pandemic and has remained higher compared to pre-pandemic levels. Additionally, we hypothesize that increased telemedicine use has contributed to lower no-show rates and more equitable access to care. A retrospective cohort analysis was conducted of all outpatient visits at a single outpatient pediatric surgery clinic at a quaternary academic center from 01/02/2018 to 10/26/2022. Clinical variables extracted included demographic data, no-show rate (patient did not attend scheduled appointment), and visit type (in person vs telemedicine). Geocoded census data was used to determine SDOH variables such as internet and computer access. A mixed effect logistic regression model was performed to identify which variables were associated with differences in telemedicine usage. 6339 encounters for 2735 patients were analyzed. Odds of presenting to a scheduled telemedicine visit compared to an in-person visit was 0.76 (CI 0.63-0.91, p-value < 0.01). The odds of selecting a telemedicine visit decreased by 34 % for Spanish speakers and 63 % for 'other' language speakers compared to English speakers (p-value < 0.01). The odds of choosing a telemedicine visit also decreased by 4 % for every one-unit increase in the probability of having access to the internet (p < 0.01). There was no significant difference in the odds of choosing a telemedicine visit for insurance status, age, distance, or probability of having access to a computer. Telemedicine continues to be utilized at higher rates compared to pre-pandemic levels, but does not reduce no-show rates, which may reflect limits in its clinical utility. It is used less frequently by non-English speakers, which may contribute to ongoing disparities in access to specialty pediatric care.

An Updated Overview of Anesthesia for Ambulatory Orthopaedic Surgery.

Outpatient orthopaedic surgery necessitates unique requirements from anesthesia to optimize institutional operations, patient safety, and outcomes. Anesthesia involvement spans the entirety of the patient's perioperative experience, which is split into three phases: preoperative, intraoperative, and postoperative. A thorough anesthesia-specific workup is crucial to patient selection and creation of an anesthetic plan. The anesthetic interventions intraoperatively are varied and selected specifically for each patient. Recovery from anesthesia is guided by evidence-based criteria, followed by discharge education and a final assessment from an anesthesia provider. The future of orthopaedic surgery continues to trend toward ambulatory surgery, and anesthesia is adapting appropriately.

What to Consider for Sports Medicine, Hand, Foot and Ankle, and Spine Procedures Performed in the ASC Setting.

This paper will review special considerations for orthopaedic ambulatory surgery specialties in sports medicine, hand, foot and ankle, and spine procedures. Orthopaedic ambulatory surgery has seen a rapid increase in the number of cases that are being migrated from the hospital to the outpatient surgical setting. This rapid increase warrants a heightened awareness for special considerations for outpatient surgical procedures that include both patient and procedure alike. As patients become more complicated, so do the procedures that are being performed in the ambulatory surgery setting. Without recognition of special considerations for ambulatory surgery center (ASC) patients, especially in sports medicine, hand, foot and ankle, and spine procedures specialties, there lies an inherent risk that has the potential to be mitigated. Patient selection needs to be carefully considered when procedures are selected for the ambulatory surgical setting, in addition to considerations that include a multidisciplinary approach to care. Orthopaedic nurses play a vital role in the treatment and care delivery in the ASC setting and for sports medicine, hand, foot and ankle, and spine procedures. Each aspect of the care continuum needs to be considered to avoid adverse outcomes and patient safety-related issues.

Ambulatory Surgery Ensemble: Predicting Adult and Pediatric Same-Day Surgery Cases Across Specialties.

To develop an ensemble model using case-posting data to predict which patients could be discharged on the day of surgery. Few models have predicted which surgeries are appropriate for day cases. Increasing the ratio of ambulatory surgeries can decrease costs and inpatient bed utilization while improving resource utilization. Adult and pediatric patients undergoing elective surgery with any surgical specialty in a multisite academic health system from January 2021 to December 2023 were included in this retrospective study. We used surgical case data available at the time of case posting and created 3 gradient-boosting decision tree classification models to predict case length (CL) less than 6 hours, postoperative length of stay (LOS) less than 6 hours, and home discharge disposition (DD). The models were used to develop an ambulatory surgery ensemble (ASE) model to predict same-day surgery (SDS) cases. The ASE achieved an area under the receiver operating characteristic curve of 0.95 and an average precision of 0.96. In total, 139,593 cases were included, 48,464 of which were in 2023 and were used for model validation. These methods identified that up to 20% of inpatient cases could be moved to SDS and identified which specialties, procedures, and surgeons had the most opportunity to transition cases. An ensemble model can predict CL, LOS, and DD for elective cases across multiple services and locations at the time of case posting. While limited in its inclusion of patient factors, this model can systematically facilitate clinical operations such as strategic planning, surgical block time, and case scheduling.

Improving Safe Thermoregulation Practices in an Urban Outpatient Surgery Center Through a Quality Improvement Initiative.

Improving Safe Thermoregulation Practices in an Urban Outpatient Surgery Center Through a Quality Improvement Initiative.

Identifying At-Risk Populations for Reoperations, Readmissions, and Interventions in MBSAQIP Using a Novel Inpatient Postoperative Care Metric.

Metabolic and bariatric surgery (MBS) is increasingly used for obesity and metabolic disease, with safety profiles showing it is among the safest major operations. The last 20 + years have noted significantly improved safety that has been accompanied by decreasing length of stay and select populations electing for outpatient surgery, leading to continued decreases in cost. Regardless, readmissions and complications still occur, requiring inpatient postoperative care (IP-POC). The current study aimed to identify and characterize at-risk populations for MBS-related IP-POC. The 2015-2021 MBSAQIP (n = 1,346,468 records) was used to extract 973,520 primary cases of laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, duodenal switch, and associated IP-POC. Conversions, pediatric cases, and < 30-day follow-up were excluded. IP-POC severity scores were calculated by summing readmissions (1 point), interventions (5 points), and reoperations (15 points). Risk factors associated with IP-POC were identified using zero-inflated Poisson models. GERD, COPD, smoking, and type of MBS procedure were significantly associated with increased IP-POC incidence and severity. Male sex was associated with increased severity but a lower likelihood of IP-POC, while Black and Hispanic race predicted increased IP-POC likelihood but not severity. ROC curve analysis identified IP-POC score thresholds of ≥ 6 and ≥ 10 as significantly associated with MACE (OR 2.4) and 30-day mortality (OR 4.7). The weighted IP-POC model demonstrated associations between preoperative characteristics and increased IP-POC likelihood and severity. These findings add to the current understanding of MBS patient care dynamics, and can be used to improve patient counseling, refine postoperative protocols, and optimize resource allocation.

Continuous vital sign monitoring with Biobeat® wearable devices for post-ambulatory surgery patients: a pilot feasibility study.

Improvement in anesthesia and surgical practices has enabled more patients, including those undergoing higher-risk surgeries, to be treated in outpatient settings. This shift creates a need for reliable postoperative monitoring at home. Wearable devices like the Biobeat® offer continuous, real-time monitoring of vital signs have remained largely untested for home use in this context.A prospective, single-center observational study was conducted at the Centre hospitalier de l'Université de Montréal (CHUM) from February to August 2023. Fifty eligible patients underwent continuous monitoring with the Biobeat® device for five days post-surgery, with data transmitted to CHUM's telehealth service. Feasibility was assessed by the percentage of patients without data loss during consecutive 2-hour intervals.Of the 50 patients enrolled, 49 completed the study, but all experienced some level of data loss. While 39.6% of patients maintained connectivity without complete data loss for 6-8-hour intervals, challenges included device discomfort, Bluetooth disconnection, and connectivity issues. Thirteen patients removed the device early due to discomfort or technical issues. Of the 3 patients who experienced post-operative complications, no data was available within 24h prior to the episodes. Continuous vital signs monitoring is feasible for high-risk outpatient surgery patients; however, significant improvements are required in device reliability and data accessibility. Further studies are needed to refine the technology and develop reliable protocols for postoperative monitoring in the home setting.

Impact of COVID-19 Pandemic on Hand Surgery Volume in Japan.

Objectives: The impact of the COVID-19 pandemic on hand surgery in Japan has not been fully elucidated. This study investigated changes in the volume of hand surgery practiced during the pandemic. Methods: We used the National Database Open Data Japan (NDB-ODJ), a comprehensive repository of healthcare data administered by the government, to investigate changes in the volume of hand surgery services delivered during the COVID-19 pandemic. The type and number of upper extremity surgical procedures was examined during each month of the pandemic to identify associations. Results: During the first wave in the spring of 2020, scheduled surgeries decreased by 44% compared to pre-pandemic levels, with arthroplasties, osteotomies, and polydactyly surgeries experiencing the largest reductions. Trauma surgeries remained relatively stable, and some procedures like tendon repair and replantation even increased. While overall surgical volumes recovered in the second half of the pandemic, certain procedures, including finger pinning and tendon repair, remained below pre-pandemic levels. Interestingly, surgeries for Dupuytren contracture and amputation increased compared with the pre-pandemic period. Many scheduled and emergency procedures shifted to outpatient surgeries during the pandemic, and the proportion of inpatient surgeries decreased. In particular, the proportion of outpatient surgeries increased significantly in open reduction and internal fixation for wrist and forearm fractures, as well as in amputation surgeries. Conclusions: The COVID-19 pandemic had a minimal impact on the volume of hand surgery conducted in Japan, with a decrease in elective surgeries only during the first wave in the spring of 2020. Notably, the pandemic triggered a shift from inpatient to outpatient surgery for many procedures.

Disparities in Postoperative Pain Management: A Scoping Review of Prescription Practices and Social Determinants of Health.

Background: Opioid analgesic therapy has been traditionally used for pain management; however, the variability in patient characteristics, complexity in evaluating pain, availability of treatment within facilities, and U.S. physicians overprescribing opioids have contributed to the current opioid epidemic. Despite large research efforts investigating the patterns of postsurgical pain management and influencing factors, it remains unclear how these overall trends vary across the varying sizes and available resources of academic hospitals, community hospitals, and outpatient surgery centers. The primary aim of this scoping review was to examine the patterns of contemporary postoperative pain management across healthcare settings, including academic medical centers, community hospitals, and outpatient surgery centers. Specifically, this study investigates how prescription practices for opioids, NSAIDs, and acetaminophen are influenced by patient demographics, including sex, race, gender, insurance status, and other social determinants of health (SDoH), to inform equitable and patient-centered pain management strategies. Methods: This study utilized The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and was used as a reference checklist. The Arksey and O'Malley methodological framework was used to guide the review process. To ensure comprehensive coverage, searches were conducted across three major databases: PubMed, Embase, and Cochrane Library. Results: A total of 43 eligible studies were retained for analysis. The highest reported Healthy People 2030 category was Social and community context (n = 39), while the highest reported category of SDoH was age (n = 36). A total of 34 articles listed sex and age as SDoH. Additional SDoH examined were race/ethnicity (n = 17), insurance (n = 7), employment (n = 1), education (n = 4), and income (n = 1). This review suggests that there are significant gaps in the implementation of institution-specific, patient-centered, and equitable pain management strategies, particularly in academic hospitals, which our findings show have the highest rates of opioid and NSAID prescriptions (n = 26) compared to outpatient surgical centers (n = 8). Findings from our review of the literature demonstrated that while academic hospitals often adopt enhanced recovery protocols aimed at reducing opioid dependence, these protocols can fail to address the diverse needs of at-risk populations, such as those with chronic substance use, low socioeconomic status, or racial and ethnic minorities. Conclusions: Findings from this review are expected to have implications for informing both organizational-specific and nationwide policy recommendations, potentially leading to more personalized and equitable pain management strategies across different healthcare settings. These include guidelines for clinicians on addressing various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care.

A Comparison of Inpatient Versus Ambulatory Lumbar Surgical Care Utilization Among Minority Patients.

Retrospective cohort study. Identify and compare racial/ethnic disparities in ambulatory versus inpatient surgical care utilization for single-level lumbar spine surgery. The proportion of spine surgeries performed in the ambulatory setting has dramatically increased over the past 2 decades. However, few studies have investigated whether this shift has resulted in racial/ethnic disparities in surgical care utilization, particularly for outpatient lumbar spine surgery, compared with the inpatient setting. Utilizing the 2019 National Inpatient Sample and Nationwide Ambulatory Surgical Sample discharge, we included patients who had undergone a single-level lumbar discectomy, laminectomy, and/or fusion, were of Black, White, or Hispanic race/ethnicity, were covered under Medicare, Medicaid, or private insurance, and were aged 18 years or above. The primary outcome was the rate ratio (RR) of patients from the aforementioned 3 racial/ethnic groups undergoing lumbar surgical care, in the ambulatory and inpatient settings. US Bureau of Labor Statistics data were utilized to offset the model for population-based variations in sociodemographic factors utilizing nested coefficients. Among 397,173 cases, 220,250 (55.5%) were inpatient, and 176,923 (44.5%) were ambulatory. Compared with White patients, Black (RR: 0.54, 95% CI: 0.53-0.55) and Hispanic (RR: 0.61, 95% CI: 0.60-0.62) patients had lower utilization rates of ambulatory surgical care. More pronounced patterns were observed for Black (RR: 0.44 95% CI: 0.44-0.45) and Hispanic (RR: 0.55, 95% CI: 0.54-0.56) inpatient surgical utilization; all P < 0.001. Racial/ethic disparities in single-level lumbar surgical care utilization exist in both the ambulatory and the inpatient setting. Level 3.

Telehealth-An Environmentally Friendly Way to Take Care of Patients with Inflammatory Bowel Disease.

Background and Objectives: On 11 March 2020, our hospital adapted to the COVID-19 pandemic by becoming a temporary COVID-19 facility, leading to the suspension or delegation of non-COVID-19 services. Among the international IBD community, there were significant concerns regarding the neglect of immunocompromised IBD patients and their increased vulnerability to COVID-19. To address these challenges, the COVID-19 ECCO Taskforce recommended the implementation of telehealth. Following this recommendation, our hospital's IT department integrated audiovisual hardware and software solutions to facilitate virtual consultations. This approach enabled patients and their local physicians to receive formal reports comparable to those issued during standard in-person care. Materials and Methods: We retrospectively analyzed data from patients diagnosed with Crohn's disease and ulcerative colitis who participated in telemedicine consultations. Average distances and time saved were calculated using Google Maps, while carbon emissions and carbon footprint reductions were determined. Results: Between 11 August 2021 and 15 June 2023, 107 telehealth consultations were completed. Patients benefited from reduced travel distances, with an average saving of 168.28 km per consultation and a total reduction of 18,006 km. Travel time savings averaged 2 h and 22 min per consultation, amounting to a total of 252 h saved. The reduction in carbon emissions was calculated at 3.26 tons, equivalent to the annual absorption capacity of 109 fully grown trees, considering that an individual tree absorbs approximately 21.77 kg of CO2 annually. These findings underscore telemedicine's role in reducing environmental impact while enhancing patient convenience. Conclusions: The adoption of telehealth successfully optimized outpatient clinic operations, maintaining high-quality patient outcomes while contributing to environmental sustainability.

Feasibility, Outcomes, and Odds of Same-Day Surgery in Laparoscopic Elective Repair of Type IV Hiatal Hernia with Intrathoracic Stomach.

Feasibility, Outcomes, and Odds of Same-Day Surgery in Laparoscopic Elective Repair of Type IV Hiatal Hernia with Intrathoracic Stomach.

Optimizing Pharmacotherapy During Implementation of Enhanced Recovery After Surgery (ERAS) in Ambulatory Urologic Oncology Surgery: Narrative Review.

Adapting Enhanced Recovery After Surgery (ERAS) protocols to the ambulatory surgery setting is an ongoing need. While all surgical procedures necessitate the need for recovery protocols, urologists looking to perform outpatient surgical oncology procedures must be cognizant of the restrictive discharge criteria for an ambulatory procedure. Furthermore, a surgery being performed in the ambulatory setting should not imply that the procedure is without the risk of morbidity. With this in mind, ERAS protocols are paramount to ensuring optimal surgical outcomes. The individual components of such protocols encompass the perioperative period in its entirety. They include patient education, the stabilization of chronic medical conditions, perioperative nutrition, frailty mitigation, and the management of various postoperative sequalae. This review paper evaluates and summarizes the essential role of pharmacotherapy in ERAS protocols for ambulatory urologic oncology surgery.

Outpatient Transurethral Resections of Bladder Tumors: Insights from the Largest Cohort to Date

Introduction: Outpatient transurethral resection of bladder tumors (TURBT) is not widespread, involving only 5% of patients. Our aim was to assess the feasibility of TURBT in an outpatient setting and to evaluate factors possibly associated with conversion to inpatient care. Methods: All consecutive outpatient-TURBT performed between January 2016 and December 2022 in one academic center was retrospectively analyzed. Outpatient success was defined as the absence of conversion to conventional hospitalization as well as the absence of unscheduled care within 30 postoperative days. The quality of the resection was assessed by the presence of detrusor muscle in the surgical specimen. Results: A total of 500 consecutive outpatient-TURBT were included in 376 patients. Outpatient-TURBT was performed for primary tumor diagnosis in 187 (37%) cases, second look in 66 (13%) cases and tumor relapse in 216 (43%) cases. Muscle was present in 86% of cases. Perioperative inpatient conversions occurred in 40 cases (8%). Once converted, patients stayed a median of 2 days IQR (1;3). Seventy-seven post-TURBT unscheduled care were observed (15%) with 40 emergency room visits (8%) and/or 22 rehospitalizations (4%), occurring on a median postoperative day 3 IQR (1; 4). Overall complication rate was 11% (51 cases of grade 1 and 2 complications [10%] and 6 cases of grade 3 complications [1%]). Multivariate predictors of outpatient-TURBT failure were specimen weight ≥1 g (OR = 4.35, 95% CI: 1.60–13.3, p = 0.007), surgery duration (OR = 1.03, 95% CI: 1.06–1.71), p = 0.002) and antiplatelet treatment (OR = 2.86, 95% CI: 0.864–9.17, p = 0.077). Conclusion: Outpatient TURBT appears to be acceptable with an 8% conversion rate, as well as safe, with an 11% complication rate. Quality of the resection was not affected by the outpatient setting. Tumor weight ≥1 g, surgery duration and absence of antiplatelet treatment were significant multivariate predictors of outpatient surgery failure.

Who undergoes cytoreductive nephrectomy now? An analysis of perioperative risk characteristics in contemporary patients.

493 Background: Cytoreductive nephrectomy (CN) has traditionally been the first step in managing metastatic renal cell carcinoma (mRCC). However, the role of routine upfront cytoreductive nephrectomy in mRCC was questioned by the 2018 publications of CARMENA and SURTIME. That same year, Checkmate 214 highlighted the superior effectiveness of immune checkpoint inhibition as first-line systemic therapy in mRCC compared to sunitinib. IMDC risk assessment is widely used in mRCC decision-making. Data from the ACS-NSQIP, a validated method for assessing surgical risk, is commonly used to predict perioperative mortality and morbidity. We sought to understand how the risk characteristics of patients undergoing CN have changed since the reporting of CARMENA, SURTIME, and Checkmate 214 in 2018. Methods: This study used ACS-NSQIP data sets from 2015-2022. It included patients undergoing nephrectomy for mRCC with disseminated cancer, excluding those from 2018. Baseline characteristics and perioperative outcomes were compared using chi-square tests, t-tests, or logistic regression as appropriate. Data was available to approximate 3 of the 6 IMDC criteria (anemia, thrombocytosis, and performance status). Results: Of 82268 nephrectomies performed from 2015-2022, 2191 CN were appropriate for inclusion. The proportion of CN as a share of all nephrectomies in NSQIP has decreased since 2018 (Table, p&lt;0.05). Similarly, the proportion of patients undergoing CN with at least 1, 2, or 3 IMDC criteria has also dropped (Table, p&lt;0.05). The median NSQIP-predicted mortality and morbidity have significantly declined (Table, p&lt;0.05). Assessment of 18 baseline characteristics revealed that no single factor could fully account for the observed risk differences. Since 2018, the median length of stay has reduced from 4 to 3 days, and the proportion of outpatient surgeries has risen from 2.6% to 6% (p&lt;0.05). Despite variations in baseline risk, no significant differences were observed in mortality, major complications, operative characteristics, or readmission rates. Conclusions: Since 2018, patients undergoing CN have had lower IMDC and NSQIP risk profiles, and the overall number of CN procedures has declined. These shifts should be taken into account when interpreting historical data on CN. Further research is needed to assess whether this more selective approach to CN has resulted in improved outcomes since 2018. Characteristics of patients undergoing CN (all p&lt;0.05). Characteristic Pre-2018 (n=1165) Post-2018 (n=1026) Cytoreductive nephrectomy / total nephrectomies in NSQIP during period 1165/32071 = 3.6% 1026/50197 = 2.0% Minimum IMDC Criteria* 0 50.0% 54.5% 1 39.1% 37.7% 2 10.2% 7.8% 3 0.7% 0% Predicted Mortality Median 1.5% 1.2% 90 th percentile 5.6% 4.8% Predicted Morbidity Median 10.3% 9.9% 90 th percentile 14.0% 12.3% *Only anemia, thrombocytosis, and performance status could be assessed.

Outpatient Revision TKA Does Not Increase Incidence of Repeat Revision or Medical and Surgical Complications Compared With Inpatient Revision TKA.

The incidence of revision TKA is escalating. The safety and efficacy of performing revision TKA in an outpatient setting is important given this increased demand. (1) Are patients who undergo revision TKA in an outpatient setting more likely to undergo a repeat revision within 1 year compared with patients undergoing revision TKA in an inpatient setting? (2) Are patients who undergo outpatient revision TKA more likely to have increased hospital readmissions, manipulation under anesthesia (MUA), and medical complications compared with patients undergoing revision TKA in an inpatient setting? Patients who underwent single-component revision TKA in either an outpatient or inpatient setting were identified in the PearlDiver Mariner database using Current Procedural Terminology codes or ICD-9 and ICD-10 diagnosis codes. The PearlDiver database is a for-fee insurance patient records database that contains > 165 million individual patient records from 2010 to 2022 and allows patients to be tracked over time. Groups were propensity score-matched to minimize the risk of selection bias that patients with greater comorbidities would be treated in an inpatient setting. Propensity matching was performed using a 1:4 ratio by age, gender, and Elixhauser Comorbidity Index (ECI). After propensity matching, a total of 30,924 patients who underwent single-component revision TKA were included in the inpatient group and 7731 patients were included in the outpatient group. Outcome measures included rates of repeat revision at 1 year, hospital readmission at 90 days, and complications including deep vein thrombosis, pulmonary embolus, blood transfusion, wound complications, periprosthetic joint infection, and MUA at 90 days. Chi-square analyses were used to compare categorical variables, and independent samples t-tests were used to compare continuous variables. Because any observed differences favoring outpatient revision TKA were likely due to selection bias with no biologically plausible explanation for outpatient surgery resulting in fewer medical or surgical complications, the findings were interpreted as a noninferiority analysis, indicating that outpatient revision TKA is not inferior to inpatient revision TKA even if the data indicated a potential advantage for outpatient revision TKA over inpatient revision TKA. The 1-year incidence of repeat revision was no higher in the outpatient group than the inpatient group (5% [359 of 7731] versus 5% [1606 of 30,924]; p = 0.05). The incidence of 90-day hospital readmission was no higher in the outpatient revision TKA group compared with the inpatient revision TKA group (8% [643 of 7731] versus 15% [4561 of 30,924]; p < 0.001). The incidence of all medical and surgical complications investigated was no higher in the outpatient revision TKA group compared with the inpatient revision TKA group. In this study, outpatient revision TKA did not have a higher incidence of repeat revision, hospital readmission, and medical or surgical complications compared with performing revision TKA in an inpatient setting. However, we do not suggest that revision TKA in the outpatient setting is appropriate for all patients or that it is safer than in the inpatient setting, as there was some unmeasured confounding despite propensity matching in this large data set. Our findings suggest that with careful patient selection, complication and revision rates can be comparable to those seen with inpatient revision surgery while also freeing up inpatient resources for patients who would benefit from them. When determining the appropriate setting for revision TKA, it is crucial to consider the patient's overall health and medical comorbidities. Future studies should explore patient selection criteria and outcomes including patient satisfaction, pain scores, and cost savings of outpatient versus inpatient revision TKA to refine best practices and guide clinical decision-making. Level III, therapeutic study.

Effectiveness of Intraoperative Ketorolac in Outpatient Breast Surgery: A Double-blinded Prospective Randomized Controlled Trial.

The use of nonnarcotic analgesics, such as ketorolac, has been shown to reduce postoperative pain and opioid consumption. This double-blinded randomized trial is designed to assess the efficacy of intraoperative ketorolac in reducing postoperative narcotic use in outpatient breast reconstruction and reduction procedures. This study is a prospective double-blinded randomized controlled trial. Adult patients, 18-64 years of age, undergoing breast surgery were randomized to receive 15 mg of ketorolac, 30 mg of ketorolac, or a placebo dose of saline. Patients' opioid requirements in the postoperative anesthesia care unit and postoperative opioid utilization and pain scores were collected through a daily survey. Postoperative hematomas were assessed before discharge and at subsequent follow-up visits for a period of 14 days. Of the 63 patients included in the study, 31 patients underwent delayed reconstruction following mastectomy and 35 patients underwent breast reduction surgery. Patients who received 30 mg of ketorolac had the fastest pain resolution (P < 0.05). The rate of opioid discontinuance was the fastest overall in patients who received 15 mg of ketorolac (rate = -0.072) when compared with the 30-mg ketorolac group (rate = -0.071) and the placebo group (rate = -0.065). Total opioid usage in the postoperative anesthesia care unit was not statistically different across the 3 groups. Only 1 patient developed a hematoma in the 15-mg ketorolac group. This study demonstrates that a single dose of intraoperative ketorolac was associated with reduced opioid usage and postoperative pain. However, due to the study size, the difference in hematoma rate was not statistically significant.

Risk Factors for Venous Thromboembolism (VTE) Following Anterior Cruciate Ligament (ACL) Reconstruction: A Systematic Review and Meta-Analysis.

Risk Factors for Venous Thromboembolism (VTE) Following Anterior Cruciate Ligament (ACL) Reconstruction: A Systematic Review and Meta-Analysis.

Implementation of Continuous Capnography Protocol in a Postanesthesia Care Unit for Adult Patients at High-risk of Postoperative Respiratory Depression

Implementation of Continuous Capnography Protocol in a Postanesthesia Care Unit for Adult Patients at High-risk of Postoperative Respiratory Depression