Perioperative Patient Research Articles

Appropriateness and Comprehensiveness of Using ChatGPT for Perioperative Patient Education in Thoracic Surgery in Different Language Contexts: Survey Study.

ChatGPT, a dialogue-based artificial intelligence language model, has shown promise in assisting clinical workflows and patient-clinician communication. However, there is a lack of feasibility assessments regarding its use for perioperative patient education in thoracic surgery. This study aimed to assess the appropriateness and comprehensiveness of using ChatGPT for perioperative patient education in thoracic surgery in both English and Chinese contexts. This pilot study was conducted in February 2023. A total of 37 questions focused on perioperative patient education in thoracic surgery were created based on guidelines and clinical experience. Two sets of inquiries were made to ChatGPT for each question, one in English and the other in Chinese. The responses generated by ChatGPT were evaluated separately by experienced thoracic surgical clinicians for appropriateness and comprehensiveness based on a hypothetical draft response to a patient's question on the electronic information platform. For a response to be qualified, it required at least 80% of reviewers to deem it appropriate and 50% to deem it comprehensive. Statistical analyses were performed using the unpaired chi-square test or Fisher exact test, with a significance level set at P<.05. The set of 37 commonly asked questions covered topics such as disease information, diagnostic procedures, perioperative complications, treatment measures, disease prevention, and perioperative care considerations. In both the English and Chinese contexts, 34 (92%) out of 37 responses were qualified in terms of both appropriateness and comprehensiveness. The remaining 3 (8%) responses were unqualified in these 2 contexts. The unqualified responses primarily involved the diagnosis of disease symptoms and surgical-related complications symptoms. The reasons for determining the responses as unqualified were similar in both contexts. There was no statistically significant difference (34/37, 92% vs 34/37, 92%; P=.99) in the qualification rate between the 2 language sets. This pilot study demonstrates the potential feasibility of using ChatGPT for perioperative patient education in thoracic surgery in both English and Chinese contexts. ChatGPT is expected to enhance patient satisfaction, reduce anxiety, and improve compliance during the perioperative period. In the future, there will be remarkable potential application for using artificial intelligence, in conjunction with human review, for patient education and health consultation after patients have provided their informed consent.

Modern aspects of infusion therapy: review

The infusion therapy is a routine procedure of the nowadays perioperative period and critical patient treatment. But there are controversial questions about the quantity, quality, start and duration of infusion therapy, which are under discussion. Modern infusion therapy includes intravenous administration of crystalloid solutions and more rarely colloid solutions. The type, amount and rate of infusion fluid depends on the indication for infusion therapy and the specific requirements of the patient. Nowadays colloidal solutions have limited indications. Crystalloid solutions are used for infusion therapy of patients with hypovolemia or dehydration, correction of free water deficiency, correction of electrolyte disorders, replenishment of ongoing fluid losses and replacement for patients who unable to drink water orally. All patients should be monitored with combination of clinical parameters and laboratory tests. Therapeutic endpoints should be determined. The moment these endpoints are achieved fluid therapy should be appropriately de-escalated in order to avoid overhydration.

Safety and Complication Rate of Ring External Fixation in the Foot and Ankle

External fixation is a powerful tool for foot and ankle surgeons. Currently, there is no consensus on true complication rate. The purpose of this study was to report our institution's complication rate of ring external fixation performed by a single surgeon. We retrospectively evaluated electronic medical record of 224 patients with 238 circular frames between 2009 to 2021 at a single institution. We defined minor complications as a frame managed without early frame removal or return to operating room. Major complications were defined as early return to operative room or early removal defined by our institution as less than two months. We recorded over 1,642 Ilizarov wires and 278 half pins; 10% (n=163) of wires and 7% (n=19) of half pins had a complication. We recorded 44% (n=104) minor complications and 9% (n=22) major complications. Minor complications average (mean) onset was four weeks, 89% (n=93) involved wires, and 73% resolved without additional care. Major complications average (mean) onset was 3.7 weeks. Of these, 32% (n=7) went on to successful revision. This revealed a significant correlation between minor complications and history of osteomyelitis (p<0.05). While minor complications do appear high, we find this was due to wire irritation and local erythema which resolved without additional intervention. To better assess complications with external fixation we believe that wire irritation and pin site erythema should be recognized as an expected outcome. A better understanding of ring external fixation in foot and ankle surgery is vital to appropriate perioperative management and patient care. Clinical level of Evidence: IV, retrospective chart review.

Abnormal Postoperative PROMIS Scores are Associated With Patient Satisfaction in Adult Spinal Deformity and Degenerative Spine Patients.

Retrospective review. To evaluate (1) patient satisfaction after adult spine surgery; (2) associations between the number of abnormal PROMIS domain scores and postoperative satisfaction; and (3) associations between the normalization of a patient's worst preoperative PROMIS domain score and postoperative satisfaction. Although "legacy" patient-reported outcome measures correlate with patient satisfaction after adult spine surgery, it is unclear whether PROMIS scores do. We included 1119 patients treated operatively for degenerative spine disease (DSD) or adult spinal deformity (ASD) from 2014 to 2019 at our tertiary hospital who completed questionnaires preoperatively and at ≥1 postoperative time points up to two years. Postoperative satisfaction was measured in ASD patients using items 21 and 22 from the SRS 22-revised questionnaire and in DSD patients using the NASS Patient Satisfaction Index. The "Worst" preoperative PROMIS domain was that with the greatest clinically negative deviation from the mean. "Normalization" was a postoperative score within 1 SD of the general population mean. Multivariate logistic regression identified factors associated with satisfaction. Satisfaction was reported by 88% of DSD and 86% of ASD patients at initial postoperative follow-up; this proportion did not change during the first year after surgery. We observed an inverse relationship between postoperative satisfaction and the number of abnormal PROMIS domains at all postoperative time points beyond 6 weeks. Only among ASD patients was normalization of the worst preoperative PROMIS domain associated with greater odds of satisfaction at all time points up to one year. The proportion of DSD and ASD patients satisfied postoperatively did not change from six weeks to 1 year. Normalizing the worst preoperative PROMIS domain and minimizing the number of abnormal postoperative PROMIS scores may reduce the number of dissatisfied patients. PROMIS data can guide perioperative patient management to improve satisfaction. Level-3.

The Effect of Health Literacy on Preoperative Anxiety Levels in Patients Undergoing Elective Surgery.

This study aimed to determine preoperative anxiety levels, their associated factors, and the relationship between health literacy and preoperative anxiety in adult patients undergoing elective surgery. This descriptive cross-sectional study was conducted in a tertiary hospital between December 21, 2021, and June 20, 2022, and included 466 adult patients. Participants were administered the demographic data and basic health status form, Health Literacy Scale (HLS), and Beck Anxiety Inventory (BAI). Statistical significance was set at p < 0.05. The participants' mean BAI score was low to moderate (9.28±10.85). The total HLS score was 105.89±24.42. For the BAI, a negative correlation was found between the access to information sub-dimensions of the HLS and BAI (p=0.043, r=-0.094). In addition, a negative correlation was detected between patients' age and HLS and its sub-dimensions (p<0.001, respectively [r=-0.188, r=-0.193, r=-0.205, r=-0.161]), and a positive correlation was observed among the HLS sub-dimensions (p<0.001, respectively [r=0.873, r=0.057, r=0.966, r=0.915]). Higher HLS and sub-dimension averages were observed in single, high school, university graduates, and civil servant participants. In addition, higher BAI averages were detected in females, homemakers, urban residents, participants living only with their children, and those with additional diseases (respectively, p<0.001, p<0.001, p=0.007, p=0.0034, p<0.01). As the level of health literacy increased, preoperative anxiety levels decreased. Preoperative assessment and education are fundamental to perioperative patient care, particularly in the surgical setting.

Surgery and Anesthesia Preoperative "Virtual Huddle": A Pilot Trial to Enhance Communication across the Drape.

Effective communication between surgeons and anesthesiologists is critical for high-quality, safe, and efficient perioperative patient care. Despite widespread implementation of surgical safety checklists and time-outs, ineffective team communication remains a leading cause of patient safety events in the operating room. To promote effective communication, we conducted a pilot trial of a "virtual huddle" between anesthesiologists and surgeons. Attending anesthesiologists and surgeons at an academic medical center were recruited by email to participate in this feasibility trial. An electronic health record-based smartphone application was utilized to create secure group chats among trial participants the day before a surgery. Text notifications connected a surgeon/anesthesiologist pair in order to introduce colleagues, facilitate a preoperative virtual huddle, and enable open-ended, text message-based communication. A 5-point Likert scale-based survey with a free-text component was used to evaluate the utility of the virtual huddle and usability of the electronic platform. A total of 51 unique virtual huddles occurred between 16 surgeons and 12 anesthesiologists over 99 operations. All postintervention survey questions received a positive rating (range: 3.50/5.00-4.53/5.00) and the virtual huddle was considered to be easy to use (4.47/5.00), improve attending-to-attending communication (4.29/5.00), and improve patient care (4.22/5.00). There were no statistically significant differences in the ratings between surgery and anesthesia. In thematic analysis of qualitative survey results, Participants indicated the intervention was particularly useful in interdisciplinary relationship-building and reducing room turnover. The huddle was less useful for simple, routine cases or when participation was one sided. A preoperative virtual huddle may be a simple and effective intervention to improve communication and teamwork in the operating room. Further study and consideration of broader implementation is warranted.

Pre-Procedure Intervention of Subclinical Hypothyroidism: Case Report

Background: Subclinical hypothyroidism (SH) is a very common disorder in the general population. In patients with known hypothyroidism or hypothyroidism who have been undergoing treatment, a TSH test should be included in the preoperative assessment to determine the adequacy of treatment and to ensure that thyroid therapy is optimized before surgery. Case Presentation: A 39 years old woman complains about a weakness that has been 4 years interfering with activities. Shortness of breath if doing strenuous activities, walking long distances, and climbing stairs, and shortness of breath decreases after rest. Sore throat found since 1 week of hospitalization, and fever for 1 day. A lump in the neck is not found. Previously, the patient had been treated for 8 days in the Department of Cardiology and planned the installation of a temporary pacemaker due to bradycardia that persisted until cardiac arrest. Conclusion: Subclinical hypothyroid patients undergoing pre-procedure intervention are predisposed to anemia, electrophysiologic disturbances, and hypotension, all of which can precipitate cardiovascular collapse. The goal of therapy in the perioperative patient with thyroid dysfunction centers around the attempt to normalize hormone levels before surgical intervention whenever possible and, when that is not feasible, to use other measures that will maximize hemodynamic stability and prevent decompensation.

A Practical Approach to Predicting Surgical Site Infection Risk Among Patients Before Leaving the Operating Room.

A surgical site infection (SSI) prediction model that identifies at-risk patients before leaving the operating room can support efforts to improve patient safety. In this study, eight pre-operative and five perioperative patient- and procedure-specific characteristics were tested with two scoring algorithms: 1) count of positive factors (manual), and 2) logistic regression model (automated). Models were developed and validated using data from 3,440 general and oncologic surgical patients. In the automated algorithm, two pre-operative (procedure urgency, odds ratio [OR]: 1.7; and antibiotic administration >2 hours before incision, OR: 1.6) and three intraoperative risk factors (open surgery [OR: 3.7], high-risk procedure [OR: 3.5], and operative time OR: [2.6]) were associated with SSI risk. The manual score achieved an area under the curve (AUC) of 0.831 and the automated algorithm achieved AUC of 0.868. Open surgery had the greatest impact on prediction, followed by procedure risk, operative time, and procedure urgency. At 80% sensitivity, the manual and automated scores achieved a positive predictive value of 16.3% and 22.0%, respectively. Both the manual and automated SSI risk prediction algorithms accurately identified at-risk populations. Use of either model before the patient leaves the operating room can provide the clinical team with evidence-based guidance to consider proactive intervention to prevent SSIs.

RETRACTED: Discharge of postoperative patients with an opioid prescription is associated with increased persistent opioid use, healthcare expenditures and mortality: a retrospective cohort study

BackgroundThe risk factors for persistent opioid use after surgical discharge and the association between opioid prescription at discharge and postoperative emergency department visits, readmission, and mortality are unclear. MethodsThis population-based retrospective cohort study involved opioid-naive patients who underwent surgical procedures from January 1, 2000 to November 30, 2020. The data source was Hong Kong Hospital Authority Clinical Management System electronic health record. The primary outcome was the incidence of new persistent opioid use. Other study outcomes included 30-day emergency department visits, 30-day readmission, and 30-day all-cause mortality. Multivariable logistic regression models were used to estimate the association between opioid prescription at discharge and persistent opioid use, emergency department visits, readmission, and all-cause mortality. ResultsOver a median follow-up of 1 month with 36 104 person-years, 438 128 patients (opioid prescription: 32 932, no opioid prescription: 405 196) who underwent surgical procedures were analysed, of whom 15 112 (3.45%) had persistent opioid use after discharge. Prescribing opioids on discharge was associated with increased risks of developing persistent opioid use (odds ratio [OR]: 2.30, 95% confidence interval [CI]: 2.19–2.40, P<0.001), 30-day emergency department visits (OR: 1.28, 95% CI: 1.23–1.33, P<0.001), 30-day readmission (OR: 1.17, 95% CI: 1.13–1.20, P<0.001), and 30-day all-cause mortality (OR: 1.68, 95% CI: 1.53–1.86, P<0.001). ConclusionsIn this large cohort of patients undergoing surgery, an opioid prescription on discharge was associated with a higher chance of persistent opioid use and increased risks of postoperative emergency department visits, readmission, and mortality. Minimising opioid prescriptions on discharge could improve perioperative patient outcomes.

Mastering the Best Practices: A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery.

The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.

Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures.

This study adopted a cross-sectional study design. This study was designed to investigate the effects of bone cross-link bridging on fracture mechanism and surgical outcomes in vertebral fractures using the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB). The complex interplay of bone density and bone bridging in the elderly can complicate vertebral fractures, necessitating a better understanding of fracture mechanics. We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2-8), and maxVB (9-18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2-8) group had less A4 and more B1 and B2 fractures. The maxVB (9-18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2-8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9-18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9-18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.

Research Progress in Precision Nursing for Enhanced Recovery After Surgery

With the evolution and development of the concepts of medicine, research concerning precision medicine and precision nursing is constantly expanding and deepening, creating new challenges and opportunities for the nursing practice of enhanced recovery after surgery (ERAS). In this paper, we reviewed the current status of research on precision nursing for ERAS, giving an overview of the application status of precision nursing in ERAS from the perspectives of precision nursing assessment, precision symptom management, precision nutrition support, and precision health education and nursing follow-up. In addition, we analyzed the challenges and their solutions for further promotion and application of precision nursing in ERAS, including strengthening the basic professional knowledge and skills, building a nursing information platform, and actively applying new tools and technologies. In the future, clinical nursing staffs should further utilize the relevant concepts and methods of precision nursing to optimize and improve perioperative patient care strategies, ensure patient safety, enhance the quality of nursing care, improve patient outcomes, and promote a more important role played by precision nursing in ERAS.

Anesthesia management and outcomes of gynecologic oncology surgery

ABSTRACT Objectives This study assessed postoperative mortality, morbidity, and complications associated with anesthesia administration for gynecologic oncology abdominal surgery and investigated the risk factors for the development of these complications. Methods We conducted a retrospective cohort study analyzing the data of patients who underwent elective gynecologic oncology surgery between 2010 and 2017. The demographic data; comorbidities; preoperative anemia; Charlson Comorbidity Index; anesthesia management; complications; preoperative, intraoperative, and postoperative periods; mortality; and morbidity were investigated. The patients were classified as surviving or deceased. Subgroup analyses of patients with endometrial, ovarian, cervical, and other cancers were performed. Results We analyzed 416 patients; 325 survived and 91 were deceased. The postoperative chemotherapy rates (p < 0.001), and postoperative blood transfusion rates (p = 0.010) were significantly higher in the deceased group, while the preoperative albumin levels were significantly lower in the deceased group (p < 0.001). Infused colloid amount was higher in the deceased group of endometrial (p = 0.018) and ovarian cancers (p = 0.017). Conclusions Perioperative patient management for cancer surgery requires a multidisciplinary approach led by an anesthesiologist and surgeon. Any improvement in the duration of hospital stay, morbidity, or recovery rate depends on the success of the multidisciplinary team.

ChatGPT and Generative Artificial Intelligence in Mohs Surgery: A New Frontier of Innovation

The rapid and exponential progress in generative artificial intelligence (AI) technologies has inspired many to contemplate the potential applications of such tools within medicine. With regard to the Mohs surgical workflow, AI shows promise in assisting with perioperative planning, patient education, patient communication, and clinical documentation. AI has the potential to transform modern Mohs surgical practices, but at this time, critical human review of any AI-generated content remains necessary.

Impact of Emend on Perioperative Bariatric Surgery Antiemetic Utilization, Patient Satisfaction, and Costs.

Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of anesthesia and surgery, resulting in patient discomfort and dissatisfaction. Latest research has demonstrated the efficacy of NK-1 receptor antagonists in PONV management and its use in chemotherapy nausea prophylaxis. The authors of this article would like to provide evidence to support the use fosaprepitant, as monotherapy, in postoperative care, replacing a polypharmacological standard of care regimen. This was a retrospective chart review of 400 patients who received standard of care antiemetic regimen or received fosaprepitant (No-Fosaprepitant vs. Fosaprepitant groups, respectively). The primary outcome of this study is to evaluate the impact of fosaprepitant (administered intravenously) on perioperative antiemetic use, treatment cost, and patient satisfaction. Total PONV medication cost decreased with the replacement of standard of care regimen for fosaprepitant, from 46.47±20.54 United States Dollars in the no-Fosaprepitant group to 25.69±14.84 United States Dollars in the Fosaprepitant group. There was a significant reduction in antiemetic doses between groups; 0.37±0.745 versus 7.61±5.202 for ondansetron (P=0.001), 92±1.279 versus 2.21±2.399 for promethazine (P=0.001), 0.25±0.685 versus 1.41±0.577 for scopolamine patch (P=0.001), and 0.05±0.218 versus 1.14±0.398 for dexamethasone (P=0.001). Patient satisfaction, measured by a questionnaire, was a 11.6% higher in the Fosaprepitant group. Fosaprepitant is a relevant alternative in preventing and treating PONV in patients who underwent bariatric/metabolic surgical procedures.

Using PQIP to demonstrate the perioperative patient journey at the Royal Marsden Hospital

Using PQIP to demonstrate the perioperative patient journey at the Royal Marsden Hospital

Guidelines in Practice: Positioning the Patient.

Positioning the patient is an important perioperative task; the recently updated AORN "Guideline for positioning the patient" provides perioperative personnel with background information and evidence-based best practices for perioperative patient positioning and focuses on maintaining patient and staff member safety. The revised guideline includes recommendations for placing patients safely in a variety of positions and avoiding positioning injuries, such as postoperative vision loss. This article provides an overview of positioning recommendations for assessing patients' risk for injury, implementing safe positioning practices, placing patients in the Trendelenburg position, and preventing intraocular injuries. It also includes a patient-focused scenario on preventing adverse events associated with the Trendelenburg position that aligns with information discussed in the article. Perioperative nurses should review the guideline in its entirety and implement appropriate recommendations for positioning patients during procedures.

Potential safety concerns in use of ChatGPT for peri-operative patient communication.

BJU InternationalAccepted Articles Research Letter Potential safety concerns in use of ChatGPT for peri-operative patient communication Joshua YM Tung, Corresponding Author Joshua YM Tung [email protected] orcid.org/0000-0003-4991-9790 Department of Urology, Singapore General HospitalCorrespondence: e-mail: [email protected]Search for more papers by this authorDaniel YZ Lim, Daniel YZ Lim orcid.org/0000-0002-9715-6970 Health Services Research Unit, Singapore General HospitalSearch for more papers by this authorGerald GR Sng, Gerald GR Sng Department of Endocrinology, Singapore General HospitalSearch for more papers by this author Joshua YM Tung, Corresponding Author Joshua YM Tung [email protected] orcid.org/0000-0003-4991-9790 Department of Urology, Singapore General HospitalCorrespondence: e-mail: [email protected]Search for more papers by this authorDaniel YZ Lim, Daniel YZ Lim orcid.org/0000-0002-9715-6970 Health Services Research Unit, Singapore General HospitalSearch for more papers by this authorGerald GR Sng, Gerald GR Sng Department of Endocrinology, Singapore General HospitalSearch for more papers by this author First published: 11 May 2023 https://doi.org/10.1111/bju.16042 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/bju.16042. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

(502) Arista™ Hemostat Associated with Decreased Odds of Infection and Reoperation Following Inflatable Penile Prosthesis Surgery in a Diverse, Multiethnic Academic Center

Abstract Introduction Using hemostatic agents to manage intraoperative bleeding or assist in surgical closures is well established practice. Currently, several hemostatic agents such as Arista™, Surgiflo®, and Surgicel® are available for surgeon use when placing inflatable penile prosthesis (IPP). However, the effect of these agents on postoperative infection remains to be seen. Thus, we conducted a study to compare postoperative infection and reoperation rates of Arista™ to other hemostatic agents. Objective Primary objective was to determine if use of Arista™, when compared to other hemostatic agents, was associated with decreased rates of infection and reoperation in patients from a diverse, multiethnic population undergoing a primary IPP implantation. Methods A single institution retrospective study of patients who underwent IPP implantation between December 2015 and February 2022 from a single surgeon was conducted. Patients were sorted into groups based on use of intraoperative hemostatic agents. Demographic data, intra- and peri-operative patient characteristics, reoperation, and post-operative infection information was extracted from electronic medical records. Results A total of 434 patients undergoing primary IPP (95.4% Coloplast and 4.6% AMS devices) met inclusion criteria; of which, 158 (36.4%) received Arista™ and 276 (63.6%) received other hemostats such as Surgiflo®, and Surgicel®. There was no significant difference between age, race, preferred language, BMI, or smoking status between the Arista™ and other hemostat groups. Cardiovascular disease (CVD) and diabetes were prevalent in 76.7% and 56.3% of our sample, respectively. A vast majority (84%) of CVD patients had concomitant diabetes. Median Operative time was significantly shorter in the other hemostat group compared to the Arista™ group (62 minutes vs. 75, P &amp;lt;0.001). There was no significant difference in post-operative instances of urinary retention, emergency department visits, or readmission between the two hemostat groups. Multivariable model controlling for age and CVD (Table 1) revealed that Arista™ was associated with significantly decreased odds of postoperative infection and reoperation when compared to other hemostats (OR = 0.36; 95% CI (0.14 – 0.97), P=0.04). Conversely, active smoking were associated with significantly higher odds (OR = 3.92; 95% CI (1.39 – 11.04), P=0.01). Conclusions Our retrospective study indicates that use of Arista™, regardless of patient CVD status, may lead to decreased infections and subsequent reoperations. Prospective randomized control trials should be pursued to adequately assess the benefits of Arista™ compared to other hemostatic agents. Disclosure No

Error traps in Pediatric Patient Blood Management in the Perioperative Period.

Patient blood management is a patient-centered evidence-based approach to improve patient outcomes by harnessing the patient's own hematopoietic system to optimize blood health while promoting patient safety and empowerment. Perioperative patient blood management is a standard of care in adult medicine, yet it is not commonly accepted in pediatrics. Raising awareness may be the first step in improving perioperative care for the anemic and/or bleeding child. This article highlights five preventable perioperative blood conservation error traps for children. The goal is to provide practical clinical guidance to improve preoperative diagnosis and treatment of anemia, facilitate recognition and treatment of massive hemorrhage, reduce unnecessary allogeneic blood transfusions, and decrease associated complications of anemia and blood component transfusions utilizing a patient/family-centered informed consent and shared decision-making approach.