Browsing by Subject "Perioperative Care"
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Item From prehab to rehab: opportunities in geriatric perioperative medicine(2017-06-16) Dalton, Thomas O.Item Inpatient and perioperative management of hyperglycemia(2017-07-07) Meneghini, LuigiItem Investigating Resource Utilization in Elective Spine Patients with Affective Disorders: A Retrospective Analysis of a Cohort of 1199 Elective Spine Patients(2021-05-01T05:00:00.000Z) Christian, Zachary Kemon; Bagley, Carlos; Aoun, Salah; Dodds, JeffreyBACKGROUND: In elective spine surgery patients, affective disorders (ADs) are associated with increased preoperative opioid use to control pain, longer length of hospital stays, and increased postoperative readmission rates. When assessing healthcare resource utilization, how ADs influence perioperative electronic patient portal (EPP) communication with care providers has not been explored. It is also unclear how ADs influence in-patient and postoperative opioid consumption. OBJECTIVE: To investigate the resource utilization of patients with ADs in our population by analyzing the relationship between AD and both perioperative EPP communication, opioid use, and surgical outcomes. METHODS: The records of 1199 consecutive adult patients who underwent elective spinal surgery between January 2010 and August 2017 at a single institution were retrospectively reviewed for analysis. Primary outcomes included the number of perioperative EPP messages sent, perioperative narcotic use, rates of peri-operative complications, hospital length of stays, Emergency Department visits within 6 weeks, and readmissions within 30 after surgery. In the subanalysis, patients with patient-reported outcome measures for pain, anxiety, and depression within 30 days prior to surgery were used to assess whether preoperative narcotic use correlated with reported preoperative pain levels. RESULTS: Patients with an AD were more likely to take narcotics before surgery and to have active EPP accounts compared to controls. They were also more likely to send postoperative messages, and tended to send more messages. The AD group had higher rates of postoperative complications, ED visits, and readmissions postoperatively. The AD group also requirement more opioid in the inpatient setting and were more likely to refill prescriptions for opioid medications 3- and 12-months after surgery. In the subanalysis, the average rating of pain intensity was notably higher in the AD group; however, there was no statistically significant difference in rates of narcotic use between low- and high-pain cohorts. This was not the case for the control group. CONCLUSION: AD patients have increased EPP communication, perioperative opioid use, and postoperative complications. Addressing these concerns early and advocating for resources for this population may prevent more serious morbidity, reduce costs, address the opioid crisis, and improve patient care.Item [News](1977-10-17) Harrell, AnnItem The UT Southwestern Perioperative Optimization of Senior Health Program: Impact on Postoperative Delirium After Spine Surgery(2022-05) Pernik, Mark Nicholas; Bagley, Carlos; Aoun, Salah; Adogwa, OwoichoBACKGROUND: Delirium is a common complication in geriatric patients who often have multiple underlying risk factors after surgery or hospitalizations. Delirium is most effectively prevented prophylactically, as treatment of delirium may not shorten the duration or severity of delirium. Several investigations of pharmacological prophylaxis have shown minimal effect, whereas many non-pharmacological interventions have been shown to reduce the incidence of delirium. Multicomponent nonpharmacologic interventions can be effective in preventing delirium; however, implementation of preventative measures and programs are variable in perioperative care. OBJECTIVE: The aim of our study was to assess whether the Perioperative Optimization of Senior Health Program (POSH) reduced the incidence of postoperative delirium in geriatric patients undergoing elective spine surgery. METHODS: The POSH program is an interdisciplinary perioperative program involving geriatrics, surgery, and anesthesia. Preoperatively, patients enrolled in POSH (n=147) were referred for a geriatric assessment and optimization for surgery. Intraoperatively, patients underwent an individualized geriatric anesthesia protocol. Patients were co-managed postoperatively by the primary surgical team and the geriatrics consult service. POSH patients were retrospectively compared to a matched historical control group (n=177) treated with standard care. Outcomes included post-operative delirium, provider recognition of delirium, ICU and hospital LOS, initiation of walking postoperatively, and readmission. RESULTS: Patients enrolled in the POSH program were significantly older (75.5 vs. 71.5 years; p<0.001), had more comorbidities (8.0 vs. 6.6; p<0.001), and were more likely to undergo pelvic fixation (36.1% vs. 17.5%; p<0.001). The incidence of postoperative delirium was lower in POSH group compared to historical controls, although not statistically significant (11.6% vs. 19.2%; p=0.065). Delirium was significantly lower in patients who underwent complex spine surgery (≥4 levels of vertebral fusion; N=106) in the POSH group (11.7% vs. 28.9%, p=0.03). There was a 3-fold increase in the recognition of postoperative delirium by providers after program implementation, (76.5% vs. 23.5%; p=0.001). CONCLUSION: Interdisciplinary care for high-risk geriatric patients undergoing elective spine surgery may reduce the incidence of postoperative delirium and increase provider recognition of delirium. The benefit may be greater for those undergoing larger procedures.Item UTSW Perioperative Optimization of Senior Health: Initiatives to Reduce Delirium After Spine Surgery(2020-01-21) Deme, Palvasha Reddy; Bagley, Carlos A.; Wingfield, Sarah A.; Pernik, Mark Nicholas; Nguyen, Madelina L.; Ayala, Gabriela; Chorostecki, Jessica; Serias, Mae; Opute, Amaka; Hall, KristenINTRODUCTION: The UT Southwestern Perioperative Optimization of Senior Health (UTSW POSH) program is a multidisciplinary approach involving surgery, geriatrics, and anesthesia in an effort to reduce morbidity in high-risk elderly patients undergoing elective surgery. Modeled after the original POSH program developed at Duke University, one goal of the UTSW POSH program is to prevent delirium, an often-unrecognized source of adverse outcomes. In this two phase project, a validated chart review tool was used to determine delirium rates in UTSW POSH patients undergoing spine surgery. Concurrently, an initiative began to educate postoperative nurses about delirium risk assessment, recognition and management. As part of the initiative, nurses implemented a standardized screening tool (the 4 A's Test or 4AT) with the goal of increasing recognition of postoperative delirium in older adults undergoing spine surgery. METHODS: The records of 148 elderly patients who had undergone elective spine surgery were retrospectively reviewed. A chart review-based method was utilized to retrospectively identify delirium by applying CAM criteria. For intervention, nurses on the neurosurgical floor were asked to attend a 45-minute educational session conducted by a geriatric health care provider. Surveys regarding delirium knowledge were administered before and after each session. Three Registered Nurses became nurse champions to implement the 4AT and facilitate change in nursing workflow. Patient charts were audited using an EMR Reporting Tool to monitor rates of delirium screening. RESULTS: The incidence of delirium found in UTSW POSH patients through chart review was 11.6%. A greater proportion of nurses (76.07%) answered delirium knowledge questions correctly post-intervention as compared to pre-intervention (67.86%). The chi-square test showed the impact of nursing education was statistically significant (p = 0.0167, CI = 0.4763-0.9294). Daily delirium screening rates improved from 0% at baseline to 81.6% in a randomly selected 5-day period 7 weeks post-intervention. CONCLUSION: The incidence of delirium found in UTSW POSH patients was lower than most published rates, however there is still room for improvement. A delirium initiative utilizing nurse champions can be effective in educating nurses about delirium and initiating screening on a postoperative neurosurgical floor. Programs that provide multidisciplinary, specialized perioperative care for high-risk elderly patients may be effective in reducing the incidence of postoperative delirium.