UNASSIGNED: To demonstrate that electronic health record (EHR) data can be used in an automated approach to evaluate cataract surgery outcomes.
UNASSIGNED: Retrospective analysis.
UNASSIGNED: Resident and faculty surgeons.
UNASSIGNED: Electronic health record data were collected from cataract surgeries performed at the Johns Hopkins Wilmer Eye Institute, and cases were categorized into resident or attending as primary surgeon. Preoperative and postoperative visual acuity (VA) and unplanned return to operating room were extracted from the EHR.
UNASSIGNED: Postoperative VA and reoperation rate within 90 days.
UNASSIGNED: This study analyzed 14 537 cataract surgery cases over 32 months. Data were extracted from the EHR using an automated approach to assess surgical outcomes for resident and attending surgeons. Of 337 resident surgeries with both preoperative and postoperative VA data, 248 cases (74%) had better postoperative VA, and 170 cases (51%) had more than 2 lines improvement. There was no statistical difference in the proportion of cases with better postoperative VA or more than 2 lines improvement between resident and attending cases. Attending surgeons had a statistically greater proportion of cases with postoperative VA better than 20/40, but this finding has to be considered in the context that, on average, resident cases started out with poorer baseline VA.A multivariable regression model of VA outcomes vs. resident/attending status that controlled for preoperative VA, patient age, American Society of Anesthesiologists (ASA) score, and estimated income found that resident status, preoperative VA, patient age, ASA score, and estimated income were all significant predictors of VA. The rate of unplanned return to the operating room within 90 days of cataract surgery was not statistically different between resident (1.8%) and attending (1.2%) surgeons.
UNASSIGNED: This study demonstrates that EHR data can be used to evaluate and monitor surgical outcomes in an ongoing way. Analysis of EHR-extracted cataract outcome data showed that preoperative VA, ASA classification, and attending/resident status were important in predicting postoperative VA outcomes. These findings suggest that the utilization of EHR data could enable continuous assessment of surgical outcomes and inform interventions to improve resident training. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

UNASSIGNED: Enhanced recovery after surgery (ERAS) with a pre-emptive pain management program has been shown to decrease opioid prescriptions after thoracic surgery. We sought to determine which patient or procedural factors were associated with the need for prescription opioid medications after thoracic surgical procedures.
UNASSIGNED: We performed a retrospective analysis of a postoperative pain survey at the time of follow-up in combination with procedural and patient characteristic data. We then performed univariate and multivariate logistic regression to determine factors associated with prescription opioids use.
UNASSIGNED: Two hundred twenty-eight patients completed questionnaires at a median of 37 days after surgery. Most patients received minimally invasive surgery (n = 213, 93%) with the 2 most common types of operations being foregut (n = 92, 40%) and pulmonary resection (n = 80, 35%). Thirty-nine percent of patients (n = 89) were taking chronic pain medications preoperatively, with 15% on chronic opioids medication (n = 33). After surgery, 166 patients (72%) did not take opioids at home. Multivariate analysis showed any chronic opioid medications before surgery (odds ratio, 28.8; 95% confidence interval, 9.13-90.8, P < .001) were associated with opioid use postoperatively. In contrast, increase in age was associated with a decrease in opioid use (odds ratio, 0.96; 95% confidence interval, 0.93-0.99, P = .01).
UNASSIGNED: ERAS with pre-emptive pain management was associated with patients avoiding opioid prescriptions during recovery. The patient factor of preoperative opioid pain medication(s) and younger age is a significant factor for the patient needing opioids at home after surgery instead of procedural factors. Patient characteristics should be considered when tailoring the patient\'s pain management after thoracic surgical procedures.

UNASSIGNED: Tourniquet-induced ischemia and reperfusion (I/R) has been related to postoperative muscle atrophy through mechanisms involving protein synthesis/breakdown, cellular metabolism, mitochondrial dysfunction, and apoptosis. Ischemic preconditioning (IPC) could protect skeletal muscle against I/R injury. This study aims to determine the underlying mechanisms of IPC and its effect on muscle strength after total knee arthroplasty (TKA).
UNASSIGNED: Twenty-four TKA patients were randomized to receive either sham IPC or IPC (3 cycles of 5-min ischemia followed by 5-min reperfusion). Vastus medialis muscle biopsies were collected at 30 ​min after tourniquet (TQ) inflation and the onset of reperfusion. Western blot analysis was performed in muscle protein for 4-HNE, SOD2, TNF-ɑ, IL-6, p-Drp1ser616, Drp1, Mfn1, Mfn2, Opa1, PGC-1ɑ, ETC complex I-V, cytochrome c, cleaved caspase-3, and caspase-3. Clinical outcomes including isokinetic muscle strength and quality of life were evaluated pre- and postoperatively.
UNASSIGNED: IPC significantly increased Mfn2 (2.0 ​± ​0.2 vs 1.2 ​± ​0.1, p ​= ​0.001) and Opa1 (2.9 ​± ​0.3 vs 1.9 ​± ​0.2, p ​= ​0.005) proteins expression at the onset of reperfusion, compared to the ischemic phase. There were no differences in 4-HNE, SOD2, TNF-ɑ, IL-6, p-Drp1ser616/Drp1, Mfn1, PGC-1ɑ, ETC complex I-V, cytochrome c, and cleaved caspase-3/caspase-3 expression between the ischemic and reperfusion periods, or between the groups. Clinically, postoperative peak torque for knee extension significantly reduced in the sham IPC group (-16.6 [-29.5, -3.6] N.m, p ​= ​0.020), while that in the IPC group was preserved (-4.7 [-25.3, 16.0] N.m, p ​= ​0.617).
UNASSIGNED: In TKA with TQ application, IPC preserved postoperative quadriceps strength and prevented TQ-induced I/R injury partly by enhancing mitochondrial fusion proteins in the skeletal muscle.
UNASSIGNED: Mitochondrial fusion is a potential underlying mechanism of IPC in preventing skeletal muscle I/R injury. IPC applied before TQ-induced I/R preserved postoperative quadriceps muscle strength after TKA.

UNASSIGNED: To determine how postsurgical remote patient monitoring (RPM) influences readmissions and emergency visits within 30 days of discharge after operation and to understand patient and surgeon perspectives on postsurgical RPM.
UNASSIGNED: This study was conducted at a US tertiary academic medical center between April 1, 2021, and December 31, 2021. This mixed-methods evaluation included a randomized controlled trial evaluation of RPM after operation and a qualitative assessment of patients\' and surgeons\' perceptions of RPM\'s acceptability, feasibility, and effectiveness.
UNASSIGNED: A total of 292 patients participated in the RPM trial, and 147 were assigned to the RPM intervention. Despite a good balance between the groups, results indicated no difference in primary or secondary outcomes between the intervention and control groups. The qualitative component included 11 patients and 9 surgeons. The overarching theme for patients was that the program brought them peace of mind. Other main themes included technological issues and perceived benefits of the RPM platform. The major themes for surgeons included identifying the best patients to receive postsurgical RPM, actionable data collection and use, and improvements in data collection needed.
UNASSIGNED: Although quantitative results indicate no difference between the groups, postsurgical RPM appears well-accepted from the patient\'s perspective. However, technological issues could eliminate the benefits. Hospitals seeking to implement similar programs should carefully evaluate which populations to use the program in and seek to collect actionable data.

UNASSIGNED: There are numerous strategies to combat postoperative analgesia and expedite recovery after total knee arthroplasty (TKA). The purpose of this study was to determine opioid consumption, length of stay, and functional outcomes after robotic versus standard TKA in the setting of various regional pain modalities.
UNASSIGNED: A consecutive series of patients treated with unilateral primary robotic or standard TKA from January 2018-February 2021 were retrospectively identified. Regional pain modalities included peri-articular injection (PAI), adductor canal block (ACB), and infiltration between popliteal artery and capsule of knee (IPACK). Patient demographics, operative/perioperative variables, and postoperative function were recorded. Daily opiate consumption was calculated as morphine milligram equivalents (MME). Multivariate regression was performed to control for age, sex, and race.
UNASSIGNED: After review, 283 patients (177 Females; 106 Males) were included. Robotic TKA patients received IPACK + ACB (36), while standard TKA patients received either ACB (45), IPACK + ACB (167), or PAI (35). Daily inpatient opioid consumption in the standard IPACK + ACB (p = 0.02) and robotic IPACK + ACB groups (p = 0.0001) was significantly lower compared to standard ACB. When combined with IPACK block, robotic procedures synergistically lowered opiate consumption (p = 0.004) compared to standard procedures and led to earlier discharge (p = 0.003). The robotic IPACK + ACB cohort also demonstrated improved early ambulation compared to standard ACB, (p = 0.05), whereas the same benefit was not seen for patients who received IPACK during standard TKA.
UNASSIGNED: The utilization of IPACK block decreases inpatient postoperative opioid requirements following TKA. Robotic TKA and IPACK block appeared to have a synergistic effect on opioid consumption and postoperative recovery.

UNASSIGNED: Unplanned extubation is the removal of an endotracheal tube accidently during procedural activities or by the action of the patient. It is one of the commonly reported complications among mechanically ventilated patients in the intensive care unit. This study aimed to assess the magnitude and associated factors of unplanned extubation in intensive care units at referral hospitals in Addis Ababa, Ethiopia, 2021.
UNASSIGNED: Institutional based prospective observational study was conducted on 317 intubated patients in the intensive care unit at referral hospitals of Addis Ababa, Ethiopia, from January 8, 2021-May 9, 2021. Data were collected using a structured questionnaire. Descriptive statics were expressed in percentages and presented with tables and figures. Both Bivariable and multivariable logistic analysis was done to identify factors associated with unplanned extubation in intensive care unit. P < 0.05 with 95% CI was set as Statistical significance.
UNASSIGNED: The prevalence of unplanned extubation in this study was 19.74%. Being male (AOR = 3.132, 95%CI: 1.276-7.69), duration of intubation <5days (AOR = 2.475, 95% CI: 1.039-5.894), managed by junior resident (AOR = 5.25, 95% CI: 2.125-12.969), being physically restrained (AOR = 4.356, 95%CI: 1.786-10.624), night shift (AOR = 3.282, 95%CI:1.451-7.424)and agitation (AOR = 4.934,95%CI:1.934-12.586) were significantly contribute to the occurrence of unplanned extubation.
UNASSIGNED: and recommendation: This study showed that the prevalence of unplanned extubation was high in the intensive care unit. We suggest to intensive care unit staff to give special attention to early intubated patients, especially male individuals and the stakeholders of hospitals should rearrange the time of shift and physician schedules in the intensive care unit.

The COVID-19 pandemic has dramatically affected societies and healthcare systems around the globe. The perioperative care continuum has also been under significant strain due to the pandemic-tasked with simultaneously addressing surgical strains and backlogs, infection prevention strategies, and emerging data regarding significantly higher perioperative risk for COVID-19 patients and survivors. Many uncertainties persist regarding the perioperative risk, assessment, and management of COVID-19 survivors-and the energy to catch up on surgical backlogs must be tempered with strategies to continue to mitigate COVID-19 related perioperative risk. Here, we review the available data for COVID-19-related perioperative risk, discuss areas of persistent uncertainty, and empower the perioperative teams to pursue evidence-based strategies for high quality, patient-centered, team-based care as we enter the third year of the COVID-19 pandemic.

UNASSIGNED: Many studies have investigated a comparison of the potency and safety of PCV versus VCV modes in spinal surgery in prone position. However, controversy about the maximal benefits of which ventilation modes remains. The main purpose of this meta-analysis was to investigate which one is the optimal ventilation for surgery patients undergoing spine surgery in prone position between the two ventilation modes as PCV and VCV.
UNASSIGNED: We conducted a comprehensive search of PubMed, Embase, Web of Science, the Cochrane Library, and Google Scholar for potentially eligible articles. The continuous outcomes were analyzed using the mean difference and the associated 95% confidence interval. Meta-analysis was performed using Review Manager 5.4 software.
UNASSIGNED: Our meta-analysis included 8 RCTs involving a total of 454 patients between 2012 and 2020. The results demonstrated that IOB, Ppeak and CVP for VCV are significantly superior to PCV in spinal surgery in prone position. And PCV had higher Cdyn and PaO2/FiO2 than VCV. But there was no significant difference between PCV and VCV in terms of POB, Hb, HCT, HR and MAP.
UNASSIGNED: The PCV mode displayed a more satisfying effect than VCV mode. Compared to VCV mode in same preset of tidal volume, the patients with PCV mode in prone position demonstrated less IOB, lower Ppeak and CVP, and higher PaO2/FiO2 in spinal surgery. However, there is no obvious difference between PCV and VCV in terms of hemodynamics variables (HR and MAP).

UNASSIGNED: Patient satisfaction is a relative and complex concept, that mainly depends on the balance between patient\'s expected and perceived quality of care. Measuring patient satisfaction is important to assess the continuous quality and improvement in anesthesia services, highly affected by anesthetist patient interaction, perioperative anesthetic management and postoperative follow up. The aim of this study was to assess perioperative adult surgical patient satisfaction and its predictors following surgery and anesthesia services in three general Hospitals in a low income country.
UNASSIGNED: Multicenter prospective cross-sectional study was conducted in all general hospitals found in North Shewa Amhara Regional State hospitals from February to April 2021. After obtaining ethical approval from the institutional review board, 411 willing patients have participated in this study. Data was collected by chart review and face-to-face questions after 24 h of the postoperative period. The level of patient satisfaction was measured via a 5-point Likert scale. Descriptive statistics were presented in frequency and percentage. Both bivariate and multivariate logistic regression models were fit to identify the variables, which had an association with the outcome variable. P-values<0.2 for bivariate and <0.05 for multivariate and adjusted odds ratio were used to consider statistically significant. This study is registered with research unique identifying number of \"researchregistry7502\".
UNASSIGNED: Among 411 participants with a response rate of 96.9%; 61.8% were females and 54.7% had surgery under spinal anesthesia. The overall patient satisfaction was 64%. History of anesthesia exposure, premedication, spinal anesthesia and postoperative pain were predictive factors for patient satisfaction after perioperative anesthesia service with AOR (95% CI) P value of 2.311(1.244-4.294)0.008, 2.213(1.277-3.835) 0.005, 2.707(1.458-5.029) 0.002 and 2.430(1.452-4.065) <0.001 respectively.
UNASSIGNED: In general the overall patient satisfaction towards perioperative anesthesia service was low in contrast to many previous studies. Factors that cause dissatisfaction should be prevented or better treated and every stakeholder should be trained and participated.

BACKGROUND: Depression one of the world\'s prevalent mental illnesses is a leading cause of major public health problems globally and its frequency has been increasing, particularly in low and middle-income countries. Little is known about the magnitude and contributing factors of preoperative depression among elective surgical inpatients in the country and in the study area as well. The aim of the current study was to assess the magnitude and factors associated with preoperative depression among elective surgical inpatients.
METHODS: A cross-sectional study was conducted from May 01, 2021 to June 30, 2021 among preoperative surgical inpatients at University of Gondar comprehensive specialized hospital. Non probability sampling was used. A nine-item questionnaire screening tool was used to assess depression. We computed the bi-variable and multivariable binary logistic regression analyses. Crude and adjusted odds ratio with 95% confidence interval were used.
RESULTS: The magnitude of depression was 28.3%. In the multivariable logistic regression analysis female (AOR = 2.27, 95% CI: 1.15, 4.5), being widowed (AOR = 3.271, 95% CI: 1.25, 8.56), divorced (AOR = 3.41, 95% CI: 1.13, 10.26), length of hospital stay of 7-14 days (AOR = 2.7, 95%CI: 1, 7.2) and more than 14 days (AOR = 3.19, 95% CI: 1.3, 7.8), having co-existing diseases (AOR = 2.78, 95%CI: 1.28, 6.02), current history of pain (AOR = 3.12, 95%CI: 1.6, 5.7), admission to orthopedics (AOR = 3.28, 95%CI: 1.55, 6.95) and gynecology ward (AOR = 2.43, 95% CI: 1.03, 5.7) and poor social support AOR = 2.24, 95% CI: 1.1, 4.6) were significantly associated with depression.
CONCLUSIONS: The magnitude of pre-operation depression was 28.3%. Female, Widowed, being divorced, length of hospital stays, coexisting chronic illness, current history of pain, admission at orthopedic and gynecology wards and poor social support were factors significantly associated with depression. We recommend strengthening the linkage of the psychiatric department with preoperative patients to provide psychotherapy behavioral modification.