Quality Of Perioperative Care Research Articles

Application of Specialized Group Management in the Quality Control of Perioperative Nursing

Objective: To explore the role of specialized group management in the quality control of perioperative nursing. Methods: 45 surgical nurses from our hospital were selected as the research subjects. Traditional operating room management was adopted from July 2019 to June 2020, and specialized group management was adopted from July 2020 to June 2021. The surgeon’s satisfaction, surgical nurses’ core professional competence, and surgical patients’ satisfaction were obtained through surveys and the results were analyzed. Results: Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation (P < 0.05). Besides, surgical nurses’ core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation (P < 0.05). Lastly, surgical patients’ satisfaction before the implementation of specialized group management was significantly lower than after its implementation (P < 0.05). Conclusion: Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.

Effect of insurance status on perioperative outcomes after robotic pancreaticoduodenectomy: a propensity-score matched analysis.

The influence of Medicaid or being uninsured is prevailingly thought to negatively impact a patient's socioeconomic and postoperative course, yet little has been published to support this claim specifically in reference to robotic pancreaticoduodenectomy. This study was undertaken to determine impact of health insurance type on perioperative outcomes in patients undergoing robotic pancreaticoduodenectomy. Following IRB approval, we prospectively followed 364 patients who underwent robotic pancreaticoduodenectomy. Patients were stratified by insurance status (i.e., Private, Medicare, and Medicaid/Uninsured); 100 patients were 2:2:1 propensity-score matched by age, BMI, ASA class, pathology, 8th edition AJCC staging, and tumor size. Perioperative variables were compared utilizing contingency testing and ANOVA. Statistical significance was accepted at a p-value ≤ 0.05 and data are presented as median (mean ± SD). The 100 patients undergoing propensity-score matching were 64 (65 ± 9.1) years old with a BMI of 27 (27 ± 4.9) kg/m2 and ASA class of 3 (3 ± 0.5). Operative duration was 421 (428 ± 105.9) minutes and estimated blood loss was 200 (385 ± 795.0) mL. There were 4 in-hospital deaths and 8 readmissions within 30days of discharge. Total hospital cost was $32,064 (38,014 ± 22,205.94).After matching, no differences were found in pre-, intra-, and short-term postoperative variables among patients with different insurances, including hospital cost and time to initiate adjuvant treatment, which was 8 (9 ± 7.9) weeks for patients with malignant disease. In our hepatopancreaticobiliary program, health insurance status did not impact perioperative outcomes or hospital costs. These findings highlight that financial coverage does not influence quality of perioperative care, reinforcing the equity of robotic surgery.

Developing the workforce to deliver perioperative medicine for older people undergoing surgery: a transdisciplinary education programme

Patients who are older, frail and medically complex are increasingly presenting for elective and emergency surgical interventions. Comprehensive Geriatric Assessment (CGA) and optimisation methodology improve morbidity and mortality in older surgical patients. However, there is a need to develop an extended and flexible workforce to provide patient-centred quality perioperative care and to simultaneously tackle the growing backlog of planned surgery following the Coronavirus 2019 (COVID-19) pandemic. At Guy's and St Thomas' NHS Foundation Trust, Perioperative Medicine for Older People (POPS) delivers a transdisciplinary education programme for foundation doctors, specialty registrars and advanced clinical practitioners to develop a blended team with shared capabilities and goals in perioperative care. This case study outlines the framework of how the education programme was developed and its evaluation, and the ongoing work of POPS to disseminate knowledge and promote national innovation and collaboration.

THU088 Perioperative Management Of Patients With Pituitary Tumors Undergoing Surgery: A Retrospective Review

Abstract Disclosure: J.T. Batch: None. H. Belal: None. G.Y. Gandhi: None. Background: Pituitary tumors account for 10% of brain neoplasms with transsphenoidal resection of these tumors responsible for 20% of all intracranial operations performed for primary brain tumors. Hypothesis: We suspected significant heterogeneity and lack of standardized protocols in the perioperative endocrine evaluation and management of patients undergoing resection of sellar masses. Methods: From June 2016 through November 2022, we identified 46 adult patients (23 females, mean age 52 years, age range 25 to 84 years) who underwent pituitary mass resection (44 transsphenoidal and two transcranial approaches) at our institution. We abstracted information about perioperative endocrine evaluation from their medical records. Results: The vast majority (32 patients) had nonfunctioning pituitary macroadenomas. Other indications for surgery included Cushing’s disease (3), prolactinomas (2), acromegaly (3), pituitary metastasis (1), gonadotroph adenomas (2), Rathke cleft cyst (2), and epidermoid cyst (1). Preoperative cortisol level was not measured in 8 patients. The decision to administer intraoperative corticosteroids was not consistently based on preoperative cortisol levels. 24 patients had cortisol levels <11 mcg/dL; 22 received intraoperative corticosteroids at anesthesia induction. 13 patients had cortisol levels ≥11 mcg/dL, and 11 received intraoperative steroids. Two patients had very large pituitary masses (over 4 cm), and one received intraoperative corticosteroids. Of the two patients with Cushing’s disease, one received intraoperative corticosteroids. Cortisol level was checked in 27 patients in the first four weeks after surgery; in the rest, it was measured between 2 months and three years after surgery. All five patients with confirmed adrenal insufficiency with cortisol levels <3 mcg/dL were treated with corticosteroids. 22 patients had cortisol levels in the equivocal zone (3 to 15 mcg/dL), and 16 were treated with corticosteroids. Nine patients ultimately did not have a follow-up in endocrinology. The long-term permanence of the diagnosis of diabetes insipidus could not be established due to a lack of uniform follow-up testing. Conclusions: Patients with pituitary gland tumors represent a heterogeneous yet commonly encountered neurosurgical population. Successful surgical management is critically dependent on the quality of perioperative care. Understanding preoperative evaluation, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to reduce morbidity and mortality. High-quality evidence guiding perioperative practices in this population is needed. We have used the information gathered in this study to create a multidisciplinary perioperative protocol with expertise from endocrinologists, neurosurgeons, neuro-ophthalmologists, and neuroradiologists. Presentation: Thursday, June 15, 2023

328 From delirium detection to correction: enhancing peri-operative care for older patients

Abstract Background Delirium is a common peri-operative complications in older adults. It is associated with poorer outcomes including functional decline, increased length of hospital stays, increased admissions to long term care and higher mortality. Therefore, this project aimed to assess the peri-operative care of older patients admitted under the surgical service in accordance with the standards set by the Collaborative for Peri-operative Optimisation of People (CPOP) and British Geriatrics Society (BGS) Peri-operative Care for People Living with Frailty undergoing Elective and Emergency Surgery Guidelines. Methods The study examined four key aspects of the guidelines: (1) surgical staff training on delirium; (2) proactive screening in for delirium in surgical patients; (3) proactively documenting delirium and implementing delirium guidelines; and (4) documentation of delirium diagnosis in discharge summaries. Results Data were collected from 72 surgical admissions over a fourteen-day period, of which 26 patients were aged >65. Results indicated suboptimal adherence to the guidelines, with only 4/26 older patients (15.4%) being screened for delirium. Three of 4 of these patients screened positive for delirium using the 4AT. No patients had delirium mentioned in their discharge summaries. Additionally, a survey of surgical non-consultant hospital doctors revealed that only 4/16 (25%) had received formal training on delirium. Conclusion In response to these findings, interventions were implemented, including teaching at surgical grand rounds, hospital-wide education for World Delirium Awareness Day, introduction of delirium care bundles, and an updated discharge summary template for surgical patients to include a delirium diagnosis. A reaudit is underway to evaluate the impact of these interventions on guideline adherence and the peri-operative care quality for older patients. These initial findings underscore the need for improved staff education and adherence to CPOP and BGS guidelines. The reaudit will provide valuable insights into the effectiveness of the implemented interventions in enhancing the perioperative care experience for the older patient cohort.

Reducing the Incidence of Postoperative Hypothermia in Patients Undergoing Robotic-Assisted Mitral Valve Surgery

Post-operation hypothermia tends to induce complications. Sixty percent of robotic-assisted mitral valve surgery patients experienced hypothermia while admitted to our intensive care unit (ICU), resulting in prolonged ICU stays and 57% (eight) of those patients with hypothermia also experiencing cardiac arrhythmia. The causes of hypothermia in our ICU included low temperature in the operating room, delayed initiation of blanket coverage after surgery, and lack of postoperative thermal blankets, insufficient cardiopulmonary bypass rewarming time, cold ICU beds, lack of in-service training for hypothermia, and lack of procedure auditing. This intervention was designed to reduce the incidence of hypothermia in ICU patients undergoing robotic-assisted mitral valve surgery upon ICU admission from 60% to 36% and the one-hour hypothermia rate from 43.3% to 26%. We implemented several measures including increasing the room temperature, pre-heating the ICU bed, achieving team consensus regarding prolonging the rewarming time after cardiopulmonary bypass, establishing a blanket warming area for postoperative patient use, and holding in-service training to enhance the awareness of the nurses were implemented. The incidence of hypothermia in ICU patients receiving robotic-assisted mitral valve surgery upon ICU admission decreased from 60% to 19.4%, while the one-hour hypothermia rate decreased from 43.3% to 19.4%. Using systemic interprofessional collaboration, combined thermal care can be achieved to significantly reduce the incidence of postoperative hypothermia in patients undergoing robotic-assisted mitral valve surgeries resulting in higher patient care quality and shorter ICU stays. We recommend applying this combined method to improve the quality of perioperative care for long-duration and major surgical procedures that involve large postoperative wounds and for patients who may require wider exposure during their operation.

Red Blood Cell Conservation and Use in the Cardiovascular Operating Rooms at Ben Taub General Hospital

A conservative hemoglobin transfusion threshold is noninferior to a liberal threshold in cardiac surgery. However, red blood cell (RBC) transfusion remains common during cardiac surgery. The authors' single-center, retrospective study aimed to decrease RBC transfusions for hemoglobin >7.5 g/dL in nonemergent cardiovascular surgeries utilizing cardiopulmonary bypass (CPB), by educating the anesthesiology and surgical staff on the benefits of a conservative threshold for transfusions, and incorporating the discussion and routine use of blood conservation methods for all nonemergent cardiac surgeries. This was a single-center, retrospective study that included all nonemergent coronary artery bypass grafting and single-valve cases utilizing CPB from January 2018 to December 2021 before and after the intervention in July 2019. The data involved a single community hospital. A total of 417 patients were included in the study. The authors adopted a conservative threshold for blood transfusion and implemented a collaborative multidisciplinary approach to blood conservation. Baseline patient characteristics were summarized, and the incidence of RBC transfusion before and after the intervention on July 26, 2019, were compared by Wilcoxon rank sum and chi-square tests. Multivariate logistic regression was used. The intervention was significantly associated with reduced RBC transfusion rate after adjusting for confounding variables (p < 0.05). The odds of receiving an RBC transfusion among patients after the intervention was 0.615 times the odds among patients before intervention (95% CI: 0.3913-0.9663). The authors' goal was to improve patient outcomes and the quality of perioperative care during cardiac surgery. By implementing a protocol and educating anesthesiologists, surgeons, and perfusionists, they successfully decreased the incidence of RBC transfusion above a hemoglobin of 7.5 g/dL.

Sociodemographic Disparities in Postoperative Nausea and Vomiting.

Postoperative nausea and vomiting (PONV) prophylaxis is consistently considered a key indicator of anesthesia care quality. PONV may disproportionately impact disadvantaged patients. The primary objectives of this study were to examine the associations between sociodemographic factors and the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. We conducted a retrospective analysis of all patients eligible for an institution-specific PONV prophylaxis protocol (2015-2017). Sociodemographic and PONV risk data were collected. Primary outcomes were PONV incidence and clinician adherence to PONV prophylaxis protocol. We used descriptive statistics to compare sociodemographics, procedural characteristics, and protocol adherence for patients with and without PONV. Multivariable logistic regression analysis followed by Tukey-Kramer correction for multiple comparisons was used to test for associations between patient sociodemographics, procedural characteristics, PONV risk, and (1) PONV incidence and (2) adherence to PONV prophylaxis protocol. Within the 8384 patient sample, Black patients had a 17% lower risk of PONV than White patients (adjusted odds ratio [aOR], 0.83; 95% confidence interval [CI], 0.73-0.95; P = .006). When there was adherence to the PONV prophylaxis protocol, Black patients were less likely to experience PONV compared to White patients (aOR, 0.81; 95% CI, 0.70-0.93; P = .003). When there was adherence to the protocol, patients with Medicaid were less likely to experience PONV compared to privately insured patients (aOR, 0.72; 95% CI, 0.64-1.04; P = .017). When the protocol was followed for high-risk patients, Hispanic patients were more likely to experience PONV than White patients (aOR, 2.96; 95% CI, 1.18-7.42; adjusted P = .022). Compared to White patients, protocol adherence was lower for Black patients with moderate (aOR, 0.76; 95% CI, 0.64-0.91; P = .003) and high risk (aOR, 0.57; 95% CI, 0.42-0.78; P = .0004). Racial and sociodemographic disparities exist in the incidence of PONV and clinician adherence to a PONV prophylaxis protocol. Awareness of such disparities in PONV prophylaxis could improve the quality of perioperative care.

Evaluation of Peri-Operative Management in Women with Deep Endometriosis Who are Candidates for Bowel Surgery: A Survey from the Italian Society of Gynecologic Endoscopy

Study ObjectiveThere is great consensus that the implementation of the enhanced recovery after surgery (ERAS) approach is beneficial for surgical patients, but there is a paucity of data concerning its application in women with deep endometriosis (DE) who are candidates for bowel surgery. The survey described herein was aimed at gathering detailed information on perioperative management of DE patients who were undergoing sigmoid/rectal (discoid or segmental) resection within the Italian Society of Gynecologic Endoscopy (SEGI) group. DesignBaseline survey. SettingNational survey conducted within the main Italian cooperative group in minimally invasive gynecologic surgery (SEGI). PatientsThe study did not involve patients. InterventionsA 63-item questionnaire covering ERAS items for gynecologic/elective colorectal surgery was sent to SEGI centers. Only questionnaires from centers that reported performing ≥10 sigmoid/rectal resections per year were considered for this analysis. Measurements and Main ResultsThirty-three of 38 (86.8%) of the questionnaires were analyzed. The rates of concordance with the ERAS guidelines were 40.4%, 64.4%, and 62.6% for preoperative, intraoperative, and postoperative items, respectively. The proportion of overall agreement was 56.6%. Preoperative diet, fasting and bowel preparation, correction of anemia, avoidance of peritoneal drains, postoperative feeding, and early mobilization were the most controversial items. Comparative analysis revealed that the referred rates of complete disease removal and conversion to open surgery were significantly different depending on case volume (p = .044 and p = .003, respectively) and gynecologist's/surgeon's experience (p = .042 and p = .022, respectively), with higher chances of obtaining a complete laparoscopic/robotic excision of endometriosis in centers that reported ≥30 DE surgeries performed per year and/or ≥90% of bowel resections performed by a gynecologist/general surgeon specifically dedicated to DE management. In contrast, the rates of concordance with the ERAS guidelines were not significantly different according to case volume (p = .081) or gynecologist's/surgeon's experience (p = .294). ConclusionThis is the first study on DE conducted on a national scale. The current survey results revealed suboptimal compliance with the ERAS recommendations and underline the need to improve the quality of perioperative care in DE patients undergoing sigmoid/rectal resection. This study is a first step toward building a consistent, structured reporting platform for the SEGI units and facilitating wide implementation and standardization of the ERAS protocol for DE patients in Italy.

Evaluation of effect of dexamethasone and bicarbonate as adjuvants to intracuff lignocaine on endotracheal tube tolerance during emergence and incidence of postoperative cough and sore throat

Background: Smooth uneventful extubation and prevention of postoperative complications such as cough and sore throat adds to the quality of perioperative care and patient outcome. This study was designed to compare tube tolerance and hemodynamics during extubation, as well as the incidence of postoperative cough and sore throat, in patients operated under general anesthesia of more than 2-h duration.Materials and Methods: This prospective double-blinded, randomized controlled study included 100 patients posted for elective surgical procedures with expected duration of more than 2 h, under general anesthesia. Patients were divided randomly into two equal groups, namely Group A and Group B. In Group A, endotracheal tube (ETT) cuff was filled with lignocaine with sodium bicarbonate as an adjuvant, while in Group B, dexamethasone was added as an adjuvant to intracuff lignocaine. ETT tolerance at the time of extubation was recorded and compared. Other parameters such as rate pressure product, volume of drug diffused through cuff, and incidence of postoperative cough and sore throat were also compared. Data analysis was done using unpaired t-test and Chi-square test as appropriate, where P < 0.05 was considered statistically significant.Results: Eighty-two percent of patients in Group A while 78% of patients in Group B were categorized as tube tolerant during extubation (P = 0.62). The incidence of postextubation sore throat at 1 h was 30% versus 16% (P = 0.09) while at 24 h was 20% versus 6% (P = 0.03) in Group A and Group B, respectively. The incidence of cough postextubation at 1 h was 6% versus 0 (P = 0.07) while at 24 h was 18% versus 4% (P = 0.02) in Group A and Group B, respectively. The volume of intracuff drug diffused during anesthesia was 0.71 ± 0.27 (mean ± standard deviation [SD]) ml in Group A and 0.5 ± 0.23 (mean ± SD) ml in Group B (P = 0.02). Majority of patients (>85%) in both the groups remained hemodynamic stable during emergence with no statistical difference between the groups.Conclusion: Both bicarbonate and dexamethasone as an adjuvant to 2% intracuff lignocaine offer smooth emergence in terms of tube tolerance and hemodynamic stability during extubation. However, dexamethasone when used as an adjuvant has a better effect on prevention of development of postoperative cough and sore throat.

Implementation of shared decision-making conversations in the preoperative evaluation clinic: Developing an educational curriculum and improving quality

BackgroundThe American College of Surgeons created the Geriatric Surgical Verification program to improve the quality of perioperative care for geriatric patients. The standards include the incorporation of shared decision-making with goals of care discussions as well as frailty and cognitive impairment assessments. As perioperative physicians, anesthesiologists can provide many of these discussions in the preoperative assessment clinic. Our project developed an educational curriculum for anesthesiology residents to train them to effectively conduct these conversations, eventually expanding these assessments to all providers in our perioperative clinic. We describe our team's implementation of shared decision-making conversations and frailty assessments into preoperative evaluation clinic workflow for patients greater than 65 years old MethodsUsing the six-step approach to curriculum development, we provided resources to improve anesthesiology residents’ communication skills and ability to use shared decision-making conversations to guide perioperative management.1 We also used Plan-Do-Study-Act cycles to streamline the assessments and expand its utilization for all providers seeing geriatric patients in the perioperative assessment clinic. We measured added time to clinic visit and volume of patients. We provided templates and literature with faculty support for residents. The documentation was further integrated with the preoperative assessment note. ResultsDuring the initial implementation period, 110 patients participated in shared decision-making conversation with residents, increasing visit time by an average of 7.29 minutes. This was a small enough increase that the template was expanded to all providers in the preoperative assessment clinic. Residents had only 1-5 prior goals of care discussions, and believed the curriculum provided greater opportunity and structure to improve their skills in this domain. ConclusionWe found this implementation to be successful with increased value in the preoperative evaluation clinic while also bolstering our shared decision-making educational curriculum for our anesthesiology residents. Since this study is a pilot, the impact and finalized intervention and curriculum are still being refined.

Attendance at anaesthetic or perioperative medicine preadmission clinic and the relationship with unplanned ICU and/or HDU admission Postoperatively

Quality perioperative care not only involves careful preoperative assessment but also identifying the appropriate level of postoperative care. For some patients this involves planned admission to ICU or High Dependency Unit (HDU) postoperatively. With the limited resources and existent bed pressures it is important this postoperative destination is identified in advance. In this study we aimed to assess whether attendance in specialist preadmission clinic, involving an assessment by either an anaesthetic consultant or perioperative medicine physician, was related to unplanned ICU/HDU admissions postoperatively.All patient surgeries conducted at St Vincent's Hospital Melbourne between July-December 2019 were retrospectively collected. Patients were excluded if they were emergency cases, hospital transfers or cardiac cases. Patients were grouped as either being seen in preadmission clinic by an anaesthetist/perioperative medicine physician or not and whether they were later admitted to ICU. Patients were counted as planned ICU admissions if there was a preoperative bed request or a noted plan for ICU ahead of surgery. Of 7712 surgeries conducted, 160 were admitted to ICU (2.07%). Of the ICU admissions, 73 were unplanned (0.9% of all surgeries) and 87 were planned (1.1%). Of the unplanned admissions, 19 were seen in preadmission clinic and 54 were not. This suggests that a preoperative review by a specialist anaesthetic consultant or perioperative medicine physician was associated with a reduction in unplanned ICU/HDU admission at our hospital.

Determination of the Relationship Between Perioperative Care Quality and Patient Satisfaction in Patients Undergoing Orthopedic Surgery

Determination of the Relationship Between Perioperative Care Quality and Patient Satisfaction in Patients Undergoing Orthopedic Surgery

Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study.

Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs). Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected: 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs. We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified: (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care. We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.

The Relationship Between Perioperative Care Quality and Postoperative Comfort Level in Patients With Hip Replacement Surgery

PurposeTo examine the relationship between perioperative care quality and postoperative comfort level of patients undergoing hip replacement surgery. DesignThis is a descriptive study. MethodsThis study was conducted with 90 patients between February and September 2021 in a training and research hospital in Turkey. Data were collected from Information Form, the Good Perioperative Nursing Care Scale (for Patients) (GPNCS), and the Post Hip Replacement Comfort Scale (PHRCS). FindingsThe mean age of the patients was 65.58 ± 15.10 years. The mean total scores of the patients in GPNCS and PHRCS were 134.61 ± 16.29 and 3.58 ± 0.40, respectively. In the correlation analysis, a statistically significant and positive weak relationship was determined between GPNCS and PHRCS, and as the quality of care during the surgery increases, the postoperative comfort levels increase (r = 0.253, P < .05). ConclusionsEnsuring the comfort of patients during the surgery as well as in the pre-, intra- and postoperative period is necessary and important for the quality of care. In addition, since the quality of the care during surgery is effective on the postoperative comfort levels of the patients, quality nursing care is required pre-, intra-, and postoperative periods.

Knowledge of enhanced recovery after surgery and influencing factors among abdominal surgical nurses: a multi-center cross-sectional study

Background: Enhanced recovery after surgery (ERAS) protocols are well established. Evidence describing nurses’ knowledge of ERAS is limited. Aim: To assess surgical nurses’ knowledge of ERAS and identify factors that correlate with knowledge level. Design: An anonymous cross-sectional survey via an online social platform was conducted in the abdominal surgical specialty of 40 hospitals in ten cities in China. Methods: Nurses of abdominal surgery in hospitals were enrolled in this study. A self-administered questionnaire that was reviewed by an expert panel was used to assess the knowledge of ERAS in nurses. A generalised linear regression analysis was used to assess factors associated with nurses’ knowledge regarding ERAS. Results: Overall survey participation was 91.8% (2230/2430). The mean score of ERAS-related knowledge among abdominal surgical nurses was 12.10 (SD = 3.79). ERAS knowledge differed according to gender, age, education level, professional title, years of working, specialised working years, ERAS training experience, surgical department, and type of hospital (p < 0.05). Conclusions: Chinese nurses employed in abdominal surgical services need to improve the knowledge about ERAS protocols. Standardised training is recommended to improve nurses’ ERAS-related knowledge, which can help nurses improve the quality of perioperative care and promote the recovery of patients.

Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy. This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time. The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

Prevention and Management of Postoperative Ileus: A Review of Current Practice.

Postoperative ileus (POI) has long been a challenging clinical problem for both patients and healthcare physicians alike. Although a standardized definition does not exist, it generally includes symptoms of intolerance to diet, lack of passing stool, abdominal distension, or flatus. Not only does prolonged POI increase patient discomfort and morbidity, but it is possibly the single most important factor that results in prolongation of the length of hospital stay with a significant deleterious effect on healthcare costs in surgical patients. Determining the exact pathogenesis of POI is difficult to achieve; however, it can be conceptually divided into patient-related and operative factors, which can further be broadly classified as neurogenic, inflammatory, hormonal, and pharmacological mechanisms.Different strategies have been introduced aimed at improving the quality of perioperative care by reducing perioperative morbidity and length of stay, which include Enhanced Recovery After Surgery (ERAS) protocols, minimally invasive surgical approaches, and the use of specific pharmaceutical therapies. Recent studies have shown that the ERAS pathway and laparoscopic approach are generally effective in reducing patient morbidity with early return of gut function. Out of many studies on pharmacological agents over the recent years, alvimopan has shown the most promising results. However, due to its potential complications and cost, its clinical use is limited. Therefore, this article aimed to review the pathophysiology of POI and explore recent advances in treatment modalities and prevention of postoperative ileus.

Nurse-run preanaesthesia assessment clinics: an initiative towards improving the quality of perioperative care at the ambulatory care centre

IntroductionNurse-run preanaesthesia assessment is well established in ambulatory surgery. However, in the Middle East the implementation of such a service is new and needed careful preparation. Aim of this audit...

Critères qualité de la résection chirurgicale et chirurgie d’épargne parenchymateuse: Quality criteria for lung cancer surgery and lung parenchymal preservation

The quality of surgical treatment for non-small cell lung cancer (NSCLC), is based on oncological recommendations and should guide our daily surgical practice and clinical research, at a time when alternative ablative techniques are emerging, as well as multimodal medical care, with or without surgery. Quality criteria to perform this type of surgery can be found at different levels: quality of the surgical indication confirmed by multidisciplinary team (MDT) meeting, quality of resection linked with the surgeon’s expertise, quality of perioperative care, quality of the pathologist’s analysis and quality of long-term follow-up. Only the centres certified for cancer thoracic surgery are authorised to perform this type of surgery. For a patient with localised resectable NSCLC, the recommended treatment remains complete anatomical surgical resection associated with radical lymphadenectomy. This surgical procedure allows optimal locoregional tumour control and precise pathological staging (pTNM), offering a prognostic value. It is essential to determine the adjuvant strategy. In the absence of respiratory failure, lobectomy remains the gold standard for resection. However, recent studies have shown that segmentectomy may become a favoured option for resection of smaller tumours (2 centimetres of less) without lymph node invasion (N0). In any extent of parenchymal resection, the lymphadenectomy has to be identical and follow international recommendations. The ultimate objective of this surgery is patients’ long-term survival, directly correlated with all quality criteria, particularly complete resection (R0).© 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.