Cleveland Clinic Akron General的动态

We're so glad to share the most recent contribution to the Clin-STAR Corner series, 'Practice-changing advances at the interface of surgery and geriatrics.' Read the full article here:?https://bit.ly/42gsnyG

I’m excited to share our latest publication: “Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?” Summary: Amongst geriatric hip fracture patients with a limited life expectancy, both surgery and palliative non-operative management (P-NOM) may yield similar quality of life outcomes. However, evidence on when to abstain from surgery is lacking. We performed a conjoint analysis and structured expert judgement to quantify the impact of patient characteristics on surgeons’ decisions to recommend P-NOM, and to elicit their risk perceptions. We found that surgeons’ inclinations to prefer P-NOM over surgery increased with the 30-day mortality risk they prognosticated for patients on average. However, mortality prognoses were heterogeneous across surgeons and generally showcased a low statistical accuracy. Furthermore, we observed substantial practice variation in P-NOM recommendations. Therefore, more decision support for considering P-NOM is necessary. I'd like to thank my co-authors Karin Groothuis-Oudshoorn, Annemieke Witteveen and Han Hegeman from HTSR, ZGT and the Biomedical Signals and Systems group for their contributions!

Same day surgery after Hip or Knee Replacement surgery? Very interesting article by colleagues from Jackson Memorial Hospital in Miami. Is same day surgery a reasonable goal ? In my view it is possible in appropriately chosen patients and depends also on the infrastructure available for follow up and the family setting . In summary, advances in surgical techniques, anesthesia, pain management and pressure to reduce costs has made these surgeries less invasive allowing for a much shorter hospital stay. Surprised to see that so little was said about the importance muscular strength for a rapid recovery. #hipreplacement #kneereplacement #qualitycontrol #Orthopaedicsurgery #Cliniquelasource

No surprise that patients with multiple co-morbidities face higher re-admission rates following knee replacements (TKA). Without adjustments to DRG reimbursements by CMS, hospitals may opt to halt elective joint replacements, affecting high-risk patients. In 2018, I shared clinic data at the OMA advocating for perioperative prehabilitation programs to reduce re-admissions, hospital stays, and post-op narcotic use. Regrettably, seven years later, few hospitals offer a comprehensive approach for at-risk TKA patients. #orthopedics #DRG #JNJ #OMA #Obesitymedicine

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery https://lnkd.in/gWQYe-sg #anesthesia #anesthesiology #prospective #study #acute #pain #acutepain #hospital #opioid #consumption #cardiac #surgery #cardiacsurgery

"Surgery and anaesthesia exert comparatively greater adverse effects on the elderly than on the younger brain, manifest by the higher prevalence of postoperative delirium and cognitive dysfunction. Postoperative delirium and cognitive dysfunction delay rehabilitation, and are associated with increases in morbidity and mortality among elderly surgical patients." --Study from the National Library of Medicine, Should general anaesthesia be avoided in the elderly? Delirium is a lesser known but debilitating side effect for seniors after surgery. At Solo-Dex, we offer a better solution. With our Precision Acute Pain Services?? patients get a targeted, regional anesthesia approach without the delirium side effects that gives you clarity rather than cloudiness. To learn more go to solo-dex.com. https://lnkd.in/ghsGMcUQ

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery https://lnkd.in/gViDH2jU #anesthesia #anesthesiology #prospective #study #acute #pain #acutepain #hospital #opioid #consumption #cardiac #surgery #cardiacsurgery

In this American Medical Association article, Susana Vacas, MD, PhD, a neuroanesthesiologist at Massachusetts General Hospital and Harvard Medical School, discusses the concerns doctors and surgeons have today regarding post operative delirium in elderly patients. "Patients with perioperative neurocognitive disorders have a 7% higher risk of death in the first year after surgery," Reading statistics like this can be very disheartening especially if you or your family member is a senior who is considering surgery. At Solo-Dex, we offer a solution that gives you and your family members peace of mind. With our Precision Acute Pain Service?? patients get a sustained, targeted anesthesia approach without the debilitating symptoms that can lead to severe issues after surgery. Make the safer, smarter choice. Choose Solo-Dex today. Learn more at solo-dex.com.

Interesting evaluation and proof of concept by a team of anesthesiologists in Harborview Medical Center in Seattle, Washington. Title: Process, successes and challenges of building an inpatient preoperative evaluation team for patients requiring urgent surgery. Objective:? Introduce and evaluate the Rapid OR Decision Evaluation and Optimization (RODEO) service aimed at improving preoperative care for patients requiring urgent surgery. Location:? Harborview Medical Center, Seattle, Washington, a Level 1 Trauma Center. Methodology: The RODEO service was staffed by Advanced Practice Providers (APPs) with telephone support from attending physicians. Initially targeted orthopedic trauma patients before expanding to other surgical areas. Tasks included evaluating chronic conditions, managing medications, ordering tests, and ensuring clear communication among care teams. Results: Assessed 730 patients, with a focus on medically complex individuals. Significantly reduced OR delays and cancellations due to incomplete workups from 19% to 0% and from 50% to 0%, respectively. Conclusion:? The implementation of a specialized preoperative team like RODEO is not only feasible but also effective in reducing OR delays and cancellations for urgent surgical inpatients. #anesthesiology #preoperative #surgery Limitations:? The study acknowledges that RODEO was designed for a specific setting and its implementation coincided with the COVID-19 pandemic, suggesting further research is needed to assess its impact on postoperative outcomes.

Nearly one in eight seniors (12%) who undergo surgery are readmitted to the hospital within 30 days of their procedure, researchers report Feb. 28 in the journal?JAMA Network Open. Further, more than a quarter (28%) landed back in the hospital within half a year, results showed. The risk was even higher for patients who were frail or suffering from dementia. Imperium Health can assist with cohorting thee high risk patients and educating physicians and beneficiaries on high quality care coordination to prevent re-admissions or complications from surgery. #surgey #senoirs #cms #valuebasedcare https://lnkd.in/gadyXJk3