Category Archives: Perioperative care

What patient education interventions are used in the preoperative care of patients?

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A search of Joanna Briggs Institute and PubMed identified the following references.
The PubMed search included terms for these concepts: preoperative period, pain, psychology, adults, patient education.

From Joanna Briggs:

Cabilan C, et al.  Prehabilitation for surgical patients: a systematic review protocol. 2013.
This is protocol for a systematic review, but in the background information, it references several papers on presurgical interventions specifically concerning the outcome of pain.

Stern C.  Knowledge retention from preoperative patient information.  2005 (updated 2010).
This systematic review references several studies investigating usefulness of preoperative education on outcomes such as pain.

From PubMed:
(“Preoperative care”[mesh] OR “preoperative period”[mesh]) AND pain AND (psychology OR anxiety OR fear) AND adults AND patient education

This search may include references cited in the Joanna Briggs reviews.  It also includes a systematic review on outcomes of preoperative patient education in surgical setting:
Ronco M, et al.  Patient education outcomes in surgery: a systematic review from 2004 to 2010.  Int J Evid Based Healthc. 2012 Dec;10(4):309-23.

What is the evidence on effect of hyperglycemia on post-surgical complications?

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A search of Joanna Briggs Institute EBP retrieved this evidence summary:
Surgical Site Infection: Post-anesthesia and Post Operative Management. 2015.

It references a systematic review: Blondet JJ, Beilman GJ. Glycemic control and prevention of perioperative infection. Curr Opin Crit Care. 2007;13(4):421-427.
This review references studies documenting effect of perioperative hyperglycemia on post-surgical infection and mortality.

Additional references
PubMed: hyperglycemi* AND (postoperative OR post-operative OR perioperative) AND (complications OR mortality OR morbidity
Retrieves many references.  It is more efficient to begin with the systematic reviews from this search:
hyperglycemi* AND (postoperative OR post-operative OR perioperative) AND (complications OR mortality OR morbidity))systematic[sb]
Some of these reviews will evaluate effect of controling blood glucose in the postoperative period, but they should also address the literature documenting the problem.

What is some research related to ambulation of patients as it relates to preventing post op ileus?

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Delaney, C P Clinical perspective on postoperative ileus and the effect of opiates. Neurogastroenterology and motility 2004 vol:16 Suppl 2 pg:61 -66

Zutshi, Massarat Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. The American journal of surgery 2005 vol:189 iss:3 pg:268 -272

Delaney, Conor Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Diseases of the colon & rectum 2003 vol:46 iss:7 pg:851 -859

van Bree, Sjoerd H W New therapeutic strategies for postoperative ileus. Nature reviews. Gastroenterology & hepatology 2012 vol:9 iss:11 pg:675 -683

Thompson, Melissa Management of postoperative ileus. Orthopedics 2012 vol:35 iss:3 pg:213 -217

Lubawski, James Postoperative ileus: strategies for reduction. Therapeutics and Clinical Risk Management 2008 vol:4 iss:5 pg:913 -917

Reviewed JKN 4/14

Is a transradial band effective and safe for achieving hemostasis after transradial catheterization?

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Search in PubMed for catheterization AND band AND radial artery identified:

  • Catheter Cardiovasc Interv. 2010 Nov 1;76(5):660-7. RCT; 790 patients randomized to TR band or Radistop hemostatic compression device after catheterization; compared patient tolerance of device, local vascular complications, and time to achieve hemostasis
  • Catheter Cardiovasc Interv. 2012 Jan 1;79(1):78-81. doi: 10.1002/ccd.22963. Comparative study; 200 patients received TR band for 6 hours after procedure and 200 patients received TR band for 2 hours after procedure. Compared rates of 24 hour and 30 day radial artery occlusion and bleeding events.
  • J Interv Cardiol. 2009 Dec;22(6):571-5. Before and after study; 100 patients undergoing transradial catherization received TR band for 60 minutes and were compared to outcomes of 25 patients who had received band for 2 hours. Evaluated complications.
  • J Invasive Cardiol. 2009 Mar;21(3):101-4. Comparative study; 250 consecutive patients received HemoBand and 250 consecutive patients received TR band. Compared rates of radial artery occlusion at various time intervals.

What is postoperative systemic inflammatory response syndrome (SIRS) and what are the symptoms?

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Bottom line:  SIRS is a response by the body to some kind of infectious or noninfectious insult.  The response includes a profound systemic inflammation that can lead to septic shock and multiple organ failure.  Surgey can elicit this systemic inflammation by exposing patient to tissue damage and to possible infection.  Signs of SIRS include changes in heart rate, respiratory rate, blood pressure, temperature regulation, and immune cell activation.

Details:
Chapter 4. Fever and hypothermia.  In: Textbook of Critical Care, 6th ed., 2011.
Chapter 8. Inflammation, Infection, & Antimicrobial Therapy.  In:  Current Diagnosis & Treatment: Surgery [AccessSurgery]
These two chapters provide a brief explanation of SIRS.  Chapter 4 also includes algorithm for looking for source of infection.

Sepsis in adults.  In: DynaMed.  Summarizes diagnostic criteria and treatment options.  Patient is considered to have SIRS if he/she exhibits more than one of these criteria from the 2001 Society of Critical Care Medicine (SCCM)/The European Society of Intensive Care Medicine (ESICM)/American College of Chest Physicians (ACCP)/American Thoracic Society (ATS)/Surgical Infection Society (SIS) International Sepsis Definitions Conference:

  • Body temperature higher than 38°C or lower than 36°C
  • Heart rate higher than 90/min
  • Hyperventilation evidenced by respiratory rate higher than 20/min or PaCO2lower than 32 mmHg
  • White blood cell count higher than 12,000 cells/ μl or lower than 4,000/ μl

Intensive Care Med 2003 Apr;29(4):530

Chapter 68.  Multiple organ failure.  In:  Trauma [AccessSurgery] explains SIRS in the context of noninfectious causes.

How do postsurgical outcomes compare for general v. local anesthesia for implantation and testing of implantable cardioverter defibrillators (ICD)?

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A search of PubMed for “Defibrillators, Implantable”[MAJR] AND (local anesthesia OR sedation) AND (outcome OR complications OR safety OR satisfaction) identified several studies.

Studies comparing local anesthesia/sedation v. general anesthesia

Can we implant cardioverter defibrillator under minimal sedation?
Marquié C, Duchemin A, Klug D, Lamblin N, Mizon F, Cordova H, Boulo M, Lacroix D, Pol A, Kacet S.
Europace. 2007 Jul;9(7):545-50.
Measured patient-reported level of pain.

Electrophysiologist-implanted transvenous cardioverter defibrillators using local versus general anesthesia.
Manolis AS, Maounis T, Vassilikos V, Chiladakis J, Cokkinos DV.
Pacing Clin Electrophysiol. 2000 Jan;23(1):96-105.
Measured rate of post-surgical complications

Local anaesthesia versus general anaesthesia for cardioverter-defibrillator implantation.
Stix G, Anvari A, Podesser B, Pernerstorfer T, Mayer C, Laufer G, Schmidinger H.
Wien Klin Wochenschr. 1999 May 21;111(10):406-9.
Measured rate of post-surgical complications

Intravenous sedation for placement of automatic implantable cardioverter-defibrillators.
Pinosky ML, Reeves ST, Fishman RL, Alpert CC, Dorman BH, Kratz JM.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):764-6.
Measured length of stay and rate of post-surgical complications

Studies describing outcomes for procedures performed under locatl anesthetic/sedation

Safety and acceptability of implantation of internal cardioverter-defibrillators under local anesthetic and conscious sedation.
Fox DJ, Davidson NC, Royle M, Bennett DH, Clarke B, Garratt CJ, Hall MC, Zaidi AM, Patterson K, Fitzpatrick AP.
Pacing Clin Electrophysiol. 2007 Aug;30(8):992-7. Erratum in: Pacing Clin Electrophysiol. 2007 Nov;30(11):1423

Additional descriptive studies

Reviewed JKN 4/14

Is hemoglogin A1c associated with wound healing in the orthopedic population?

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Bottom line:  For patients undergoing orthopedic procedures, there is some evidence suggesting an association between perioperative HbA1c levels and complications involvoing the surgical site.

PubMed search:  (orthopedic procedures OR orthopedic surgery) AND (hemoglobin A1c OR hba1c)
The following references from the search results provided data on HbA1c in patients undergoing orthopedic procedures.

Jamsen (2010):  prospective cohort study of 1565 elective knee surgeries for which preoperative plasma glucose was recorded. Patients followed 20 months.  Mean HbA1c

Younger (2009):  Case-control study matching 21 patients with failed transmetatarsal amputation (TMA) with 21 successful TMAs.  HbA1c was the factor most closely associated with success of the TMA.

Marchant (2009):  Retrospective study of >1 million patients undergoing joint replacement surgery 1988-2005 as recorded in the Nationwide Inpatient Sample.  Patients with controlled diabetes mellitus (determined by combination of patient-measured blood glucose and HbA1c) had increased risk of  wound infection (adjusted odds ratio = 2.28 compared to patients with controlled diabetes mellitus.

Lamloum (2009):  Retrospective study of 318 consecutive diabetic patients undergoing surgery at an orthopedic hospital.   Table 3 compares rates of surgical site infections (SSI) for patients with HbA1c < 7.0 compared to rate for patients with HbA1c ≥ 7.0.  High HbA1c was associated with higher rate of SSI

Reviewed by John Nemeth 4/14