Background Increased recognition of the dangers of opioid analgesia has led to significant focus on strategies for reducing use through multimodal analgesia, enhanced recovery protocols, and standardized guidelines for prescribing. Our institution implemented a standard protocol for prescribing analgesics at discharge after ventral hernia repair (VHR). We hypothesize that this strategy significantly reduces opioid use. Methods A standardized protocol for discharge prescribing was implemented in March 2018. Patients were prescribed ibuprofen, acetaminophen, and opioids based on milligram morphine equivalent (MME) use the 24 hours prior to discharge. We retrospectively reviewed prescriptions of opioids for two 6-month periods—July-December 2017 (PRE) and July-December 2018 (POST)—for comparison using EPIC report and the South Carolina Prescription Monitoring Program. Analysis performed included Mann-Kendall linear trend test and Student’s t-test for continuous variables. Results VHR was performed in 105 patients in the PRE and 75 patients in the POST group. Total MME prescribed decreased significantly from mean 322.7 + 261.3/median 225 (IQR 150-400) MME to 141.6 + 150.4/median 100 (50-184) MME ( P < .001). This represents a 57% reduction in mean opioid MME prescriptions. Acetaminophen prescribing increased from 10% to 65%, and ibuprofen from 7.6% to 61.3%. Refills were prescribed in 21 patients (20%) during the PRE period, which decreased to 10.7% during the POST group ( P = .141). Implementation of an evidence-based protocol significantly reduces opioid prescribing after VHR. Discussion A multimodal approach to postoperative pain management decreases the need for opioids. The additional implementation of an evidence-based prescribing protocol results in significant reduction of opioid use following VHR.
Parastomal hernias (PHs) cause significant morbidity in patients with permanent ostomies, and several laparoscopic and open repair techniques have been described. We report our experience with open retromuscular repair of PHs using permanent synthetic mesh. A prospectively maintained database was retrospectively reviewed to identify patients undergoing PH repair. Primary outcomes are surgical site occurrence, surgical site infection (SSI), and hernia recurrence. Variables were analyzed using Pearson's χ2 test or Fisher's exact test. Values of P < 0.05 were considered significant. Forty-six patients underwent retromuscular PH repair with permanent synthetic mesh. There were 26 patients with colostomies and 20 with ileostomies. All the patients were repaired using a keyhole retromuscular technique and direct passage of stoma through mesh. Transversus abdominis release was performed in 65.2 per cent of cases. Permanent synthetic polypropylene mesh was used in all cases. Surgical site occurrence occurred in 47.8 per cent of patients, SSI in 17.4 per cent, and hernia recurrence in 21.7 per cent. Resiting the stoma yielded the highest rate of SSI (40%) compared with leaving the stoma in situ (11.8%) or rematuring the stoma (0%; P = 0.011). Open keyhole retromuscular PH repair of PH with permanent synthetic mesh is safe, effective, and durable.
Bei 2812 Erstblutspendern wurden Eisenstoffwechselparameter im Blut untersucht. Das Serum-Ferritin war im Mittel bei den Frauen signifikant niedriger als bei den Männern (31 vs 86µg/l). 43% der Frauen und 6% der Manner wiesen initial ein erniedrigtes Serum-Ferritin als Zeichen von erschöpften Eisenreserven auf, was die immer noch hohe Prävalenz von Eisenmangel in Deutschland aufzeigt. Bei 60 Erst-spendern mit erhöhtem Serum-Eisen bzw. erhöhtem Serum-Ferritin wurde mit einem biomagnetometrischen Verfahren nichtinvasiv die Leber-Fe-Konzentration gemessen. Eine manifeste Eisenüberladung bei homozygoter hereditärer Hämochromatose wurde bei 7 von 2812 Probanden festgestellt. Dies bestätigt die hohe Prävalenz dieser Erbkrankheit von zirka 1:400 auch für den norddeutschen Raum.
tray. An audit was performed after the removal of instruments, and two instruments were added back to the vascular tray (2/131 [1.5%]) and none were added back to the aortic tray. A total of 780 instruments were removed from the 13 instances of the vascular tray and 475 from the 5 instances of the aortic tray for a total of 1275 instruments. The removal of the instruments yielded an estimated cost savings of $62,750 for repurchase and $97,444 in resterilization savings. Yearly, the removal of the instruments is projected to save 316.2 hours of personnel time in tray assembly at a cost of $5691.88. The table setup decreased from a mean of 7 minutes 44 seconds to 5 minutes 2 seconds (P < .0001) for the vascular tray and from 8 minutes 53 seconds to 4 minutes 56 seconds (P < .0001) for the aortic tray. Conclusions: Given increasing cost constraints in health care, sterile processing remains an untapped resource for cost improvement. Data analysis provides the ability to make sweeping decisions in tray management that otherwise cannot be performed reliably.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.