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Perioperative Care
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Perioperative Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Perioperative Care".

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 44165

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Richard H. Parrish II

E-Mail Website
Guest Editor
1. Director and Chief Pharmacist and Director, St. Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA 19134, USA
2. Clinical Associate Professor (affiliate), School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
Interests: pharmacy pediatrics; perioperative care; medication management; health informatics; clinical administration
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. John Kortbeek

E-Mail Website
Guest Editor
Departments of Surgery and Critical Care, University of Calgary, Calgary, AB, Canada
Interests: surgery and critical care

Special Issue Information

Dear Colleagues,

Perioperative care practices worldwide are in the midst of a sea change with the implementation of multidisciplinary processes that improve surgical outcomes through (1) better patient education, engagement, and participation, (2) enhanced pre-operative, intra-operative, and post-operative care bundles, and (3) interactive audit programs that provide feedback to the surgical team. These improved outcomes include reduction in the frequency and severity of complications and improved throughput that ultimately reduce operative stress. Practices in theatre as well as ward are becoming more collaborative and evidence-driven.

In this Special Issue, all professions involved in periprocedural areas are encouraged to “tell their stories” through practice-based research activities, descriptions of changes in resource utilization, and lessons learned in programmatic change management and implementation science. In addition, we welcome reports that demonstrate the impact of innovations in surgical procedures, application of new technologies and materials, and multidisciplinary collaboration in sustaining perioperative performance measures.

Dr. Richard H. Parrish II
Prof. Dr. John Kortbeek
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Perioperative care
  • Surgery
  • Operating room nursing
  • Anesthesiology
  • Clinical pharmacy
  • Allied health
  • Collaborative practice
  • Performance improvement

Published Papers (10 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 154 KiB  
Editorial
Peri-Operative Care
by John B. Kortbeek
Healthcare 2021, 9(7), 790; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9070790 - 23 Jun 2021
Viewed by 1102
Abstract
In the history of surgery, 1911 was a sentinel year [...] Full article
(This article belongs to the Special Issue Perioperative Care)

Research

Jump to: Editorial, Review, Other

11 pages, 261 KiB  
Article
Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic
by Jenna K. Lovely and David W. Larson
Healthcare 2021, 9(5), 549; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9050549 - 08 May 2021
Cited by 6 | Viewed by 2010
Abstract
This work aims to describe the implementation and subsequent learnings from the first decade after the full implementation of enhanced recovery pathway for colorectal surgery at a single institution. This paper will describe the diffusion efforts and plans through the Define, Measure, Analyze, [...] Read more.
This work aims to describe the implementation and subsequent learnings from the first decade after the full implementation of enhanced recovery pathway for colorectal surgery at a single institution. This paper will describe the diffusion efforts and plans through the Define, Measure, Analyze, Improve, Control (DMAIC) process of ongoing quality improvement and through research efforts. The information applies to all readers that provide surgical care within their organization as the fundamental principles of enhanced recovery for surgery are applicable regardless of the setting. Full article
(This article belongs to the Special Issue Perioperative Care)
10 pages, 1215 KiB  
Article
Remote Monitoring of Critically-Ill Post-Surgical Patients: Lessons from a Biosensor Implementation Trial
by Mariana Restrepo, Ann Marie Huffenberger, C William Hanson III, Michael Draugelis and Krzysztof Laudanski
Healthcare 2021, 9(3), 343; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9030343 - 18 Mar 2021
Cited by 3 | Viewed by 2014
Abstract
Biosensors represent one of the numerous promising technologies envisioned to extend healthcare delivery. In perioperative care, the healthcare delivery system can use biosensors to remotely supervise patients who would otherwise be admitted to a hospital. This novel technology has gained a foothold in [...] Read more.
Biosensors represent one of the numerous promising technologies envisioned to extend healthcare delivery. In perioperative care, the healthcare delivery system can use biosensors to remotely supervise patients who would otherwise be admitted to a hospital. This novel technology has gained a foothold in healthcare with significant acceleration due to the COVID-19 pandemic. However, few studies have attempted to narrate, or systematically analyze, the process of their implementation. We performed an observational study of biosensor implementation. The data accuracy provided by the commercially available biosensors was compared to those offered by standard clinical monitoring on patients admitted to the intensive care unit/perioperative unit. Surveys were also conducted to examine the acceptance of technology by patients and medical staff. We demonstrated a significant difference in vital signs between sensors and standard monitoring which was very dependent on the measured variables. Sensors seemed to integrate into the workflow relatively quickly, with almost no reported problems. The acceptance of the biosensors was high by patients and slightly less by nurses directly involved in the patients’ care. The staff forecast a broad implementation of biosensors in approximately three to five years, yet are eager to learn more about them. Reliability considerations proved particularly troublesome in our implementation trial. Careful evaluation of sensor readiness is most likely necessary prior to system-wide implementation by each hospital to assess for data accuracy and acceptance by the staff. Full article
(This article belongs to the Special Issue Perioperative Care)
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10 pages, 764 KiB  
Article
Evaluation of Pediatric Surgical Site Infections Associated with Colorectal Surgeries at an Academic Children’s Hospital
by Kimberly Pough, Rima Bhakta, Holly Maples, Michele Honeycutt and Vini Vijayan
Healthcare 2020, 8(2), 91; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8020091 - 09 Apr 2020
Cited by 9 | Viewed by 3247
Abstract
Appropriate use of antibiotic prophylaxis (AP) is a key measure for the prevention of surgical site infections (SSI) in colorectal surgeries; however, despite the presence of national and international guidelines, compliance with AP recommendations remains low. The purpose of this study is to [...] Read more.
Appropriate use of antibiotic prophylaxis (AP) is a key measure for the prevention of surgical site infections (SSI) in colorectal surgeries; however, despite the presence of national and international guidelines, compliance with AP recommendations remains low. The purpose of this study is to evaluate compliance with recommendations for the use of AP in children undergoing colorectal surgeries and to evaluate the effectiveness of antibiotics in the prevention of SSI. We collected demographic and clinical characteristics of patients who underwent colorectal surgeries, as well as microbiological and antimicrobial susceptibility data for patients who developed SSI. AP data were collected and compared with national guidelines. Antibiotic dosing and duration were most frequently in concordance with national guidelines, while antibiotic timing and selection had the lowest rates of compliance. Twelve of the 192 colorectal procedures evaluated resulted in SSI. Only 2 of the 12 children with SSI received appropriate AP for all four categories evaluated. Eight cases that resulted in SSI were due to organisms not covered by the recommended AP. We identified multiple areas for the improvement of AP in children undergoing colorectal surgery. A multidisciplinary approach to development of standardized protocols, educational interventions, and EHR-based algorithms may facilitate or improve appropriate AP use. Full article
(This article belongs to the Special Issue Perioperative Care)
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Review

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56 pages, 3630 KiB  
Review
Perioperative Pain Management and Opioid Stewardship: A Practical Guide
by Sara J. Hyland, Kara K. Brockhaus, William R. Vincent, Nicole Z. Spence, Michelle M. Lucki, Michael J. Howkins and Robert K. Cleary
Healthcare 2021, 9(3), 333; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9030333 - 16 Mar 2021
Cited by 68 | Viewed by 18151
Abstract
Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at [...] Read more.
Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum. Full article
(This article belongs to the Special Issue Perioperative Care)
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13 pages, 1285 KiB  
Review
A Meta-Analysis on Prophylactic Donor Heart Tricuspid Annuloplasty in Orthotopic Heart Transplantation: High Hopes from a Small Intervention
by Alberto Emanuel Bacusca, Andrei Tarus, Alexandru Burlacu, Mihail Enache and Grigore Tinica
Healthcare 2021, 9(3), 306; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9030306 - 10 Mar 2021
Cited by 5 | Viewed by 1528
Abstract
(1) Background: Tricuspid regurgitation (TR) is the most frequent valvulopathy in heart transplant recipients (HTX). We aimed to assess the influence of prophylactic donor heart tricuspid annuloplasty (TA) in orthotopic HTX (HTX-A), comparing the outcomes with those of HTX patients. (2) Methods: Electronic [...] Read more.
(1) Background: Tricuspid regurgitation (TR) is the most frequent valvulopathy in heart transplant recipients (HTX). We aimed to assess the influence of prophylactic donor heart tricuspid annuloplasty (TA) in orthotopic HTX (HTX-A), comparing the outcomes with those of HTX patients. (2) Methods: Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were as follows: the overall rate of postprocedural TR (immediate, one week, six months, and one year after the procedure), postoperative complications (permanent pacemaker implantation rate, bleeding), redo surgery for TR, and mortality. (3) Results: This meta-analysis included seven studies. Immediate postprocedural, one-week, six-month and one-year tricuspid insufficiency rates were significantly lower in the HTX-A group. There was no difference in permanent pacemaker implantation rate between the groups. The incidence of postoperative bleeding was similar in both arms. The rate of redo surgery for severe TR was reported only by two authors. In both publications, the total number of events was higher in the HTX cohort, meanwhile pooled effect analysis showed no difference among the intervention and control groups. Mortality at one year was similar in both arms. (4) Conclusion: Our study showed that donor heart TA reduces TR incidence in the first year after orthotopic heart transplantation without increasing the surgical complexity. This is a potentially important issue, given the demand for heart transplants and the need to optimize outcomes when this resource is scarce. Full article
(This article belongs to the Special Issue Perioperative Care)
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Other

2 pages, 160 KiB  
Book Review
Book Review: Cohn, S.L. (Ed.). Decision Making in Perioperative Medicine: Clinical Pearls. (New York: McGraw-Hill), 2021. ISBN: 978-1-260-46810-6
by Richard H. Parrish II
Healthcare 2021, 9(6), 687; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare9060687 - 07 Jun 2021
Viewed by 1411
Abstract
Cohn’s work fills a void in the perioperative care literature by providing a concise, comprehensive, practical, and authoritative guide to the medical management of common periprocedural issues and scenarios [...] Full article
(This article belongs to the Special Issue Perioperative Care)
6 pages, 1241 KiB  
Case Report
Suspected Malignant Hyperthermia and the Application of a Multidisciplinary Response
by Laura Ebbitt, Eric Johnson, Brooke Herndon, Kristina Karrick and Aric Johnson
Healthcare 2020, 8(3), 328; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8030328 - 09 Sep 2020
Cited by 2 | Viewed by 7048
Abstract
Purpose: Malignant hyperthermia (MH) is a critical and potentially life-threatening emergency associated with inhaled anesthetic and depolarizing neuromuscular blocker administration. This is a single center’s response to MH. Summary: When signs of MH are observed, a page for “anesthesia STAT-MH crisis” is called, [...] Read more.
Purpose: Malignant hyperthermia (MH) is a critical and potentially life-threatening emergency associated with inhaled anesthetic and depolarizing neuromuscular blocker administration. This is a single center’s response to MH. Summary: When signs of MH are observed, a page for “anesthesia STAT-MH crisis” is called, triggering a multidisciplinary response, including the deployment of a Malignant Hyperthermia Cart. The MH cart and the delegation of duties allows nurses, physicians and pharmacists to quickly understand their role in the stabilization, transition and recovery of a suspected MH patient. Conclusion: This case highlights the importance of multi-disciplinary involvement in these rare, but potentially fatal, cases. Full article
(This article belongs to the Special Issue Perioperative Care)
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5 pages, 1108 KiB  
Commentary
The Perioperative Surgical Home in Pediatrics: Improve Patient Outcomes, Decrease Cancellations, Improve HealthCare Spending and Allocation of Resources during the COVID-19 Pandemic
by Aysha Hasan, Remy Zimmerman, Kelly Gillock and Richard H Parrish II
Healthcare 2020, 8(3), 258; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8030258 - 07 Aug 2020
Cited by 4 | Viewed by 3560
Abstract
Cancellations or delays in surgical care for pediatric patients that present to the operating room create a great obstacle for both the physician and the patient. Perioperative outpatient management begins prior to the patient entering the hospital for the day of surgery, and [...] Read more.
Cancellations or delays in surgical care for pediatric patients that present to the operating room create a great obstacle for both the physician and the patient. Perioperative outpatient management begins prior to the patient entering the hospital for the day of surgery, and many organizations practice using the perioperative surgical home (PSH), incorporating enhanced recovery concepts. This paper describes changes in standard operating procedures caused by the COVID-19 pandemic, and proposes the expansion of PSH, as a means of improving perioperative quality of care in pediatric populations. Full article
(This article belongs to the Special Issue Perioperative Care)
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5 pages, 183 KiB  
Project Report
Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study
by Eric Johnson, Richard Parrish II, Gregg Nelson, Kevin Elias, Brian Kramer and Marian Gaviola
Healthcare 2020, 8(3), 252; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare8030252 - 03 Aug 2020
Cited by 6 | Viewed by 2532
Abstract
Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective [...] Read more.
Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described. Full article
(This article belongs to the Special Issue Perioperative Care)
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