Search results for "Perioperative Care"
Periop cardiovascular guideline updated, calls for avoiding overscreening
The American College of Cardiology, American Heart Association, and other societies released new recommendations on evaluating and managing cardiovascular risk in patients undergoing noncardiac surgery.
https://acphospitalist.acponline.org/archives/2024/10/02/periop-cardiovascular-guideline-updated-calls-for-avoiding-overscreening.htm
2 Oct 2024
Safe to either continue or discontinue RAS inhibitors perioperatively, study finds
No differences in all-cause mortality or major postoperative complications were seen among patients whose renin-angiotensin system (RAS) inhibitors were continued or discontinued prior to major noncardiac surgery, though patients who continued the medications had a higher risk of hypotension during surgery, a trial in France found.
https://acphospitalist.acponline.org/archives/2024/09/11/safe-to-either-continue-or-discontinue-ras-inhibitors-perioperatively-study-finds.htm
11 Sep 2024
New appropriate use criteria offer framework for preop cardiac testing
The American College of Cardiology and other cardiology societies released a framework to guide the use of imaging in cardiovascular evaluation of patients undergoing nonemergent, noncardiac surgery.
https://acphospitalist.acponline.org/archives/2024/08/28/new-appropriate-use-criteria-offer-framework-for-preop-cardiac-testing.htm
28 Aug 2024
Postop afib that lasts 48 hours or longer associated with later recurrence
Cardiac surgery patients who had atrial fibrillation within four weeks of surgery had a 23% risk of recurrence at 12 months or later, which rose to 38% if the initial episode lasted at least 48 hours, a retrospective study found.
https://acphospitalist.acponline.org/archives/2024/07/31/postop-afib-that-lasts-48-hours-or-longer-associated-with-later-recurrence.htm
31 Jul 2024
Two common assessment methods highlight link between frailty and postoperative delirium
An analysis of elective surgery patients ages 70 years or older found that those assessed as frail by the frailty index or frailty phenotype had double the risk of postoperative delirium versus those who weren't frail.
https://acphospitalist.acponline.org/archives/2023/11/22/two-common-assessment-methods-highlight-link-between-frailty-and-postoperative-delirium.htm
22 Nov 2023
Adding vancomycin to cefazolin didn't reduce infections among arthroplasty patients
Cefazolin plus vancomycin did not lead to lower surgical-site infection rates compared with cefazolin plus placebo in patients getting knee, hip, or shoulder replacement surgery, a randomized trial in Australia found.
https://acphospitalist.acponline.org/archives/2023/10/25/free/adding-vancomycin-to-cefazolin-didnt-reduce-infections-among-arthroplasty-patients.htm
25 Oct 2023
Use of preoperative cardiac testing varies problematically, can be changed, review finds
Patients who were older or had more comorbidities were more likely to get preoperative cardiac testing, but so were those seen by a preoperative clinic or a cardiologist rather than in primary care, according to a systematic review.
https://acphospitalist.acponline.org/archives/2023/09/27/use-of-preoperative-cardiac-testing-varies-problematically-can-be-changed-review-finds.htm
27 Sep 2023
Haloperidol, atypical antipsychotics carry similar risks for older patients after surgery
Low to moderate doses of haloperidol, olanzapine, quetiapine, or risperidone didn't differ in risk of inpatient mortality, arrhythmia, pneumonia, and stroke or transient ischemic attack, according to a retrospective study of postoperative patients ages 65 years and older.
https://acphospitalist.acponline.org/archives/2023/09/06/haloperidol-atypical-antipsychotics-carry-similar-risks-for-older-patients-after-surgery.htm
6 Sep 2023
Recommendations on preventing surgical-site infections updated
The latest recommendations from the Society for Healthcare Epidemiology of America lowered the recommended postoperative target glucose level from less than 180 mg/dL to between 110 and 150 mg/dL, among other changes.
https://acphospitalist.acponline.org/archives/2023/05/10/recommendations-on-preventing-surgical-site-infections-updated.htm
10 May 2023
Withholding antihypertensives around surgery didn't affect vascular complication rate
Patients who didn't take their hypertension medications before and for two days after surgery had a lower incidence of intraoperative hypotension, but no difference in hypotension after surgery compared to those who continued medications.
https://acphospitalist.acponline.org/archives/2023/04/26/withholding-antihypertensives-around-surgery-didnt-affect-vascular-complication-rate.htm
26 Apr 2023
Postoperative mortality risk low by one month after COVID-19, study finds
An analysis of surgeries in England since COVID-19 vaccines were widely available found that surgery within two weeks of a positive SARS-CoV-2 test carried a 1.1% mortality rate, which declined to 0.3% by four weeks after infection.
https://acphospitalist.acponline.org/archives/2023/04/05/free/postoperative-mortality-risk-low-by-one-month-after-covid-19-study-finds.htm
5 Apr 2023
Frailty screening intervention linked to reduced mortality in year after elective surgery
A best practice alert identified patients with frailty and prompted surgeons to document a frailty-informed shared decision-making process and/or refer for additional evaluation by a multidisciplinary presurgery clinic or a primary care physician.
https://acphospitalist.acponline.org/archives/2023/03/01/frailty-screening-intervention-linked-to-reduced-mortality-in-year-after-elective-surgery.htm
1 Mar 2023
Antimicrobial prophylaxis guidelines often not followed after elective surgery
A retrospective cohort study of 521,091 inpatient surgeries at 825 U.S. hospitals found that vancomycin was the most frequently misused agent and its use was associated with increased rates of acute kidney injury.
https://acphospitalist.acponline.org/archives/2023/02/22/antimicrobial-prophylaxis-guidelines-often-not-followed-after-elective-surgery.htm
22 Feb 2023
Restrictive postop opioid protocols associated with changes in opioid prescribing, chronic use
Opioids prescribed after surgery and rates of conversion to long-term therapy decreased after a protocol limiting postop opioid prescriptions to three days or fewer was implemented at a tertiary care cancer center.
https://acphospitalist.acponline.org/archives/2023/01/11/restrictive-postop-opioid-protocols-associated-with-changes-in-opioid-prescribing-chronic-use.htm
11 Jan 2023
Guidelines recommend universal screening for cannabinoids prior to surgery
New recommendations from the American Society of Regional Anesthesia and Pain Medicine aim to help clinicians make safe, evidence-based decisions regarding the perioperative management of patients who consume cannabis.
https://acphospitalist.acponline.org/archives/2023/01/11/free/guidelines-recommend-universal-screening-for-cannabinoids-prior-to-surgery.htm
11 Jan 2023
ESKD patients more likely to survive procedures when dialysis done closer to surgery
The 90-day mortality rate after a surgical procedure was 5.2% in Medicare patients with end-stage kidney disease (ESKD) who last underwent dialysis three days prior to surgery, compared to 4.7% with dialysis two days prior and 4.2% with it one day prior, a retrospective study found.
https://acphospitalist.acponline.org/archives/2022/11/09/eskd-patients-more-likely-to-survive-procedures-when-dialysis-done-closer-to-surgery.htm
9 Nov 2022
Nearly 1 in 7 community-living Medicare patients died within year after major surgery
Mortality rates after major surgery were 28% among patients who were frail and 33% among those with dementia, a prospective longitudinal cohort study of Medicare fee-for-service beneficiaries found.
https://acphospitalist.acponline.org/archives/2022/10/26/nearly-1-in-7-community-living-medicare-patients-died-within-year-after-major-surgery.htm
26 Oct 2022
Gabapentin associated with delirium, pneumonia in older postop patients
A propensity-matched study found that patients ages 65 years and older who received gabapentin after surgery had a 3.4% risk of delirium and 1.3% risk of pneumonia, compared to 2.6% and 1.2%, respectively, in patients not taking the drug. Risk of in-hospital death was similar between groups.
https://acphospitalist.acponline.org/archives/2022/09/28/gabapentin-associated-with-delirium-pneumonia-in-older-postop-patients.htm
28 Sep 2022
New guideline released on periop management of antithrombotic therapy
The American College of Chest Physicians issued 44 recommendations, covering use of vitamin K antagonists, heparin bridging, direct oral anticoagulants, and antiplatelet drugs in patients undergoing surgeries or procedures.
https://acphospitalist.acponline.org/archives/2022/08/17/free/new-guideline-released-on-periop-management-of-antithrombotic-therapy.htm
17 Aug 2022
Postop atrial fibrillation carries same stroke risk as other new-onset atrial fibrillation
Patients who first developed atrial fibrillation within 30 days of surgery were less likely to be prescribed an anticoagulant, despite similar risks of stroke and transient ischemic attack as other patients with atrial fibrillation, a study found.
https://acphospitalist.acponline.org/archives/2022/07/27/postop-atrial-fibrillation-carries-same-stroke-risk-as-other-new-onset-atrial-fibrillation.htm
27 Jul 2022