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  • 1
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    Incidence, Prediction, and Causes of Unplanned 30-Day Hospital Admission After Ambulatory Procedures
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Anesthesia & Analgesia Vol. 131, No. 2 ( 2020-08), p. 497-507
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 131, No. 2 ( 2020-08), p. 497-507
    Abstract: Unanticipated hospital admission is regarded as a measure of adverse perioperative patient care. However, previously published studies for risk prediction after ambulatory procedures are sparse compared to those examining readmission after inpatient surgery. We aimed to evaluate the incidence and reasons for unplanned admission after ambulatory surgery and develop a prediction tool for preoperative risk assessment. METHODS: This retrospective cohort study included adult patients undergoing ambulatory, noncardiac procedures under anesthesia care at 2 tertiary care centers in Massachusetts, United States, between 2007 and 2017 as well as all hospitals and ambulatory surgery centers in New York State, United States, in 2014. The primary outcome was unplanned hospital admission within 30 days after discharge. We created a prediction tool (the PREdicting admission after Outpatient Procedures [PREOP] score) using stepwise backward regression analysis to predict unplanned hospital admission, based on criteria used by the Centers for Medicare & Medicaid Services, within 30 days after surgery in the Massachusetts hospital network registry. Model predictors included patient demographics, comorbidities, and procedural factors. We validated the score externally in the New York state registry. Reasons for unplanned admission were assessed. RESULTS: A total of 170,983 patients were included in the Massachusetts hospital network registry and 1,232,788 in the New York state registry. Among those, the observed rate of unplanned admission was 2.0% (3504) and 1.7% (20,622), respectively. The prediction model showed good discrimination in the training set with C-statistic of 0.77 (95% confidence interval [CI], 0.77–0.78) and satisfactory discrimination in the validation set with C-statistic of 0.71 (95% CI, 0.70–0.71). The risk of unplanned admission varied widely from 0.4% (95% CI, 0.3–0.4) among patients whose calculated PREOP scores were in the first percentile to 21.3% (95% CI, 20.0–22.5) among patients whose scores were in the 99th percentile. Predictions were well calibrated with an overall ratio of observed-to-expected events of 99.97% (95% CI, 96.3–103.6) in the training and 92.6% (95% CI, 88.8–96.4) in the external validation set. Unplanned admissions were most often related to malignancy, nonsurgical site infections, and surgical complications. CONCLUSIONS: We present an instrument for prediction of unplanned 30-day admission after ambulatory procedures under anesthesia care validated in a statewide cohort comprising academic and nonacademic hospitals as well as ambulatory surgery centers. The instrument may be useful in identifying patients at high risk for 30-day unplanned hospital admission and may be used for benchmarking hospitals, ambulatory surgery centers, and practitioners.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000004852
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2018275-2
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  • 2
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    Effect of Intraoperative Arterial Hypotension on the Risk of Perioperative Stroke After Noncardiac Surgery: A Retrospective Multicenter Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Anesthesia & Analgesia Vol. 133, No. 4 ( 2021-10), p. 1000-1008
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. 4 ( 2021-10), p. 1000-1008
    Abstract: Intraoperative cerebral blood flow is mainly determined by cerebral perfusion pressure and cerebral autoregulation of vasomotor tone. About 1% of patients undergoing noncardiac surgery develop ischemic stroke. We hypothesized that intraoperative hypotension within a range frequently observed in clinical practice is associated with an increased risk of perioperative ischemic stroke within 7 days after surgery. METHODS: Adult noncardiac surgical patients undergoing general anesthesia at Beth Israel Deaconess Medical Center and Massachusetts General Hospital between 2005 and 2017 were included in this retrospective cohort study. The primary exposure was intraoperative hypotension, defined as a decrease in mean arterial pressure (MAP) below 55 mm Hg, categorized into no intraoperative hypotension, short ( 〈 15 minutes, median [interquartile range {IQR}], 2 minutes [1–5 minutes] ) and prolonged (≥15 minutes, median [IQR], 21 minutes [17–31 minutes] ) durations. The primary outcome was a new diagnosis of early perioperative ischemic stroke within 7 days after surgery. In secondary analyses, we assessed the effect of a MAP decrease by 〉 30% from baseline on perioperative stroke. Analyses were adjusted for the preoperative STRoke After Surgery (STRAS) prediction score, work relative value units, and duration of surgery. RESULTS: Among 358,391 included patients, a total of 1553 (0.4%) experienced an early perioperative ischemic stroke. About 42% and 3% of patients had a MAP of below 55 mm Hg for a short and a prolonged duration, and 49% and 29% had a MAP decrease by 〉 30% from baseline for a short and a prolonged duration, respectively. In an adjusted analysis, neither a MAP 〈 55 mm Hg (short duration: adjusted odds ratio [OR adj ], 0.95; 95% confidence interval [CI] , 0.85–1.07; P = .417 and prolonged duration: OR adj , 1.18; 95% CI, 0.91–1.55; P = .220) nor a MAP decrease 〉 30% (short duration: OR adj , 0.97; 95% CI, 0.67–1.42; P = .883 and prolonged duration: OR adj , 1.30; 95% CI, 0.89–1.90; P = .176) was associated with early perioperative stroke. A high a priori stroke risk quantified based on preoperatively available risk factors (STRAS prediction score) was associated with longer intraoperative hypotension (adjusted incidence rate ratio, 1.04; 95% CI, 1.04–1.05; P 〈 .001 per 5 points of the STRAS prediction score). CONCLUSIONS: This study found no evidence to conclude that intraoperative hypotension within the range studied was associated with early perioperative stroke within 7 days after surgery. These findings emphasize the importance of perioperative cerebral blood flow autoregulation to prevent ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000005604
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2018275-2
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  • 3
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    Association Between Intraoperative Dexamethasone and Postoperative Mortality in Patients Undergoing Oncologic Surgery : A Multicentric Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Annals of Surgery Vol. 278, No. 1 ( 2023-07), p. e105-e114
    Details
    In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 278, No. 1 ( 2023-07), p. e105-e114
    Abstract: We examined the effects of dexamethasone on postoperative mortality, recurrence-free survival, and side effects in patients undergoing oncologic operations. Background: Dexamethasone prevents nausea and vomiting after anesthesia and may affect cancer proliferation. Methods: A total of 30,561 adult patients undergoing solid cancer resection between 2005 and 2020 were included. Multivariable logistic regression was applied to investigate the effect of dexamethasone on 1-year mortality and recurrence-free survival. Effect modification by the cancer’s potential for immunogenicity, defined as a recommendation for checkpoint inhibitor therapy based on the National Comprehensive Cancer Network guidelines, was investigated through interaction term analysis. Key safety endpoints were dexamethasone-associated risk of hyperglycemia 〉 180 mg/dL within 24 hours and surgical site infections within 30 days after surgery. Results: Dexamethasone was administered to 38.2% (11,666/30,561) of patients (6.5±2.3 mg). Overall, 3.2% (n=980/30,561) died and 15.4% (n=4718/30,561) experienced cancer recurrence within 1 year of the operation. Dexamethasone was associated with a −0.6% (95% confidence interval: −1.1, −0.2, P =0.007) 1-year mortality risk reduction [adjusted odds ratio (OR adj ): 0.79 (0.67, 0.94), P =0.009; hazard ratio=0.82 (0.69, 0.96), P =0.016] and higher odds of recurrence-free survival [OR adj : 1.28 (1.18, 1.39), P 〈 0.001]. This effect was only present in patients with solid cancers who were defined as not to respond to checkpoint inhibitor therapy [OR adj : 0.70 (0.57, 0.87), P =0.001 vs OR adj : 1.13 (0.85, 1.50), P =0.40]. A high ( 〉 0.09 mg/kg) dose of dexamethasone increased the risk of postoperative hyperglycemia [OR adj : 1.55 (1.32, 1.82), P 〈 0.001], but not for surgical site infections [OR adj : 0.84 (0.42, 1.71), P =0.63]. Conclusions: Dexamethasone is associated with decreased 1-year mortality and cancer recurrence in patients undergoing surgical resection of cancers that are not candidates for immune modulators. Dexamethasone increased the risk of postoperative hyperglycemia, however, no increase in surgical site infections was identified.
    Type of Medium: Online Resource
    ISSN: 0003-4932
    URL: Article
    DOI: 10.1097/SLA.0000000000005526
    RVK:
    XA 23900
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2002200-1
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  • 4
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    Use of etomidate in patients with heart failure undergoing noncardiac surgery
    Elsevier BV ; 2020
    In:  British Journal of Anaesthesia Vol. 125, No. 6 ( 2020-12), p. 943-952
    Details
    In: British Journal of Anaesthesia, Elsevier BV, Vol. 125, No. 6 ( 2020-12), p. 943-952
    Type of Medium: Online Resource
    ISSN: 0007-0912
    URL: Article
    DOI: 10.1016/j.bja.2020.06.059
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2011968-9
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  • 5
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    BOSTN Bundle Intervention for Perioperative Screening and Management of Patients With Suspected Obstructive Sleep Apnea: A Hospital Registry Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Anesthesia & Analgesia Vol. 130, No. 5 ( 2020-05), p. 1415-1424
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. 5 ( 2020-05), p. 1415-1424
    Abstract: We developed and implemented a perioperative guideline for obstructive sleep apnea (OSA), comprising a preoperative screening tool (BOSTN) and clinical management pathways. OSA was suspected with 2 or more of the following: body mass index ≥30 kg/m 2 , observed apnea, loud snoring, daytime tiredness, and neck circumference ≥16.5 inches in women or ≥ 17.5 inches in men. The primary objective of this study was to assess the association between high BOSTN scores and the requirement of invasive mechanical ventilation after surgery. METHODS: In this hospital registry study, 169,662 noncardiac surgical cases performed at Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, between May 2008 and September 2017 were analyzed. We assessed the association between a high BOSTN Score (score ≥2) and the primary outcome of requirement of invasive mechanical ventilation within 7 days after surgery using multivariable logistic regression adjusted for patient-specific factors and case-specific surgical and anesthesiological confounders. Patients with a BOSTN Score ≥2 were assumed to have a high likelihood of suffering from OSA. Key secondary outcome was postoperative desaturation, defined as a peripheral oxygen saturation measurement 〈 90% within 10 minutes of extubation. RESULTS: Invasive mechanical ventilation within 7 days of surgery was necessary in 3170 (2.3%) low-risk cases (BOSTN Score 〈 2) and 664 (2.1%) high-risk cases (BOSTN Score ≥2). A score ≥2 was associated with significantly lower odds of requiring postoperative invasive ventilation (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI] , 0.80–0.98; P = .017), but with an increased risk of postextubation desaturation (aOR, 1.34; 99.3% CI, 1.21–1.48; P 〈 .001). Patients with a score ≥2 were hospitalized for an average of 3.71 days after surgery, compared to 4.27 days with a score 〈 2 (adjusted incidence rate ratio [aIRR], 0.87; 99.3% CI, 0.84–0.91; P 〈 .001). CONCLUSIONS: Patients at high risk of OSA required postoperative mechanical ventilation less frequently, had higher odds of postoperative desaturation, and were hospitalized for shorter periods of time.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000004294
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2018275-2
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  • 6
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    Efficiency Gains in Tracer Identification for Nuclear Imaging: Can In Vivo LC-MS/MS Evaluation of Small Molecules Screen for Successful PET Tracers?
    American Chemical Society (ACS) ; 2014
    In:  ACS Chemical Neuroscience Vol. 5, No. 12 ( 2014-12-17), p. 1154-1163
    Details
    In: ACS Chemical Neuroscience, American Chemical Society (ACS), Vol. 5, No. 12 ( 2014-12-17), p. 1154-1163
    Type of Medium: Online Resource
    ISSN: 1948-7193 , 1948-7193
    URL: Article
    DOI: 10.1021/cn500073j
    Language: English
    Publisher: American Chemical Society (ACS)
    Publication Date: 2014
    detail.hit.zdb_id: 2528493-9
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  • 7
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    Association between propofol dose and 1-year mortality in patients with or without a diagnosis of solid cancer
    Elsevier BV ; 2020
    In:  British Journal of Anaesthesia Vol. 124, No. 3 ( 2020-03), p. 271-280
    Details
    In: British Journal of Anaesthesia, Elsevier BV, Vol. 124, No. 3 ( 2020-03), p. 271-280
    Type of Medium: Online Resource
    ISSN: 0007-0912
    URL: Article
    DOI: 10.1016/j.bja.2019.11.028
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2011968-9
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  • 8
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    Development and external validation of a prognostic model for ischaemic stroke after surgery
    Elsevier BV ; 2021
    In:  British Journal of Anaesthesia Vol. 127, No. 5 ( 2021-11), p. 713-721
    Details
    In: British Journal of Anaesthesia, Elsevier BV, Vol. 127, No. 5 ( 2021-11), p. 713-721
    Type of Medium: Online Resource
    ISSN: 0007-0912
    URL: Article
    DOI: 10.1016/j.bja.2021.05.035
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2011968-9
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  • 9
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    Discharge Prediction for Patients Undergoing Inpatient Surgery: Development and validation of the DEPENDENSE score
    Wiley ; 2021
    In:  Acta Anaesthesiologica Scandinavica Vol. 65, No. 5 ( 2021-05), p. 607-617
    Details
    In: Acta Anaesthesiologica Scandinavica, Wiley, Vol. 65, No. 5 ( 2021-05), p. 607-617
    Abstract: A substantial proportion of patients undergoing inpatient surgery each year is at risk for postoperative institutionalization and loss of independence. Reliable individualized preoperative prediction of adverse discharge can facilitate advanced care planning and shared decision making. Methods Using hospital registry data from previously home‐dwelling adults undergoing inpatient surgery, we retrospectively developed and externally validated a score predicting adverse discharge. Multivariable logistic regression analysis and bootstrapping were used to develop the score. Adverse discharge was defined as in‐hospital mortality or discharge to a skilled nursing facility. The model was subsequently externally validated in a cohort of patients from an independent hospital. Results In total, 106 164 patients in the development cohort and 92 962 patients in the validation cohort were included, of which 16 624 (15.7%) and 7717 (8.3%) patients experienced adverse discharge, respectively. The model was predictive of adverse discharge with an area under the receiver operating characteristic curve (AUC) of 0.87 (95% CI 0.87‐0.88) in the development cohort and an AUC of 0.86 (95% CI 0.86‐0.87) in the validation cohort. Conclusion Using preoperatively available data, we developed and validated a prediction instrument for adverse discharge following inpatient surgery. Reliable prediction of this patient centered outcome can facilitate individualized operative planning to maximize value of care.
    Type of Medium: Online Resource
    ISSN: 0001-5172 , 1399-6576
    URL: Issue
    URL: Article
    DOI: 10.1111/aas.v65.5
    DOI: 10.1111/aas.13778
    RVK:
    XA 11250
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2004319-3
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  • 10
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    Effects of Volatile Anesthetics on Postoperative Ischemic Stroke Incidence
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of the American Heart Association Vol. 10, No. 5 ( 2021-03-02)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 5 ( 2021-03-02)
    Abstract: Preclinical studies suggest that volatile anesthetics decrease infarct volume and improve the outcome of ischemic stroke. This study aims to determine their effect during noncardiac surgery on postoperative ischemic stroke incidence. Methods and Results This was a retrospective cohort study of surgical patients undergoing general anesthesia at 2 tertiary care centers in Boston, MA, between October 2005 and September 2017. Exclusion criteria comprised brain death, age 〈 18 years, cardiac surgery, and missing covariate data. The exposure was defined as median age‐adjusted minimum alveolar concentration of all intraoperative measurements of desflurane, sevoflurane, and isoflurane. The primary outcome was postoperative ischemic stroke within 30 days. Among 314 932 patients, 1957 (0.6%) experienced the primary outcome. Higher doses of volatile anesthetics had a protective effect on postoperative ischemic stroke incidence (adjusted odds ratio per 1 minimum alveolar concentration increase 0.49, 95% CI, 0.40–0.59, P 〈 0.001). In Cox proportional hazards regression, the effect was observed for 17 postoperative days (postoperative day 1: hazard ratio (HR), 0.56; 95% CI, 0.48–0.65; versus day 17: HR, 0.85; 95% CI, 0.74–0.99). Volatile anesthetics were also associated with lower stroke severity: Every 1‐unit increase in minimum alveolar concentration was associated with a 0.006‐unit decrease in the National Institutes of Health Stroke Scale (95% CI, −0.01 to −0.002, P =0.002). The effects were robust throughout various sensitivity analyses including adjustment for anesthesia providers as random effect. Conclusions Among patients undergoing noncardiac surgery, volatile anesthetics showed a dose‐dependent protective effect on the incidence and severity of early postoperative ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.120.018952
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2653953-6
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