Minimizing opioid consumption by eliminating patient‐controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol

Tirrell, Abigail R.; Hawa, Areeg A. Abu El; Bekeny, Jenna C.; Fan, Kenneth L.; Corral, Gabriel Del

doi:10.1111/andr.13095

Cited by 7 publications

(2 citation statements)

References 29 publications

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“…Almost all patients (n ¼ 52, 98.1%) were risk stratified by our institution's ERAS protocol in the study population, without differences in postoperative heparin administration (►Table 5). 30 Overall, there were no statistically significant differences in the incidence of complications between groups (p ¼ 0.121). The AP and non-AP groups had comparable rates of flap-related complications such as postoperative flap thrombosis (p ¼ 0.986), partial flap necrosis (p ¼ 0.534), and flap take-back (p ¼ 0.534), respectively.…”

Section: Postoperative Management and Short-term Outcomesmentioning

confidence: 85%

Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity Score–Matched Analysis

Berger

Huffman

Bovill

et al. 2023

J Reconstr Microsurg

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Objective: Free tissue transfer (FTT) provides a versatile method to achieve successful lower limb salvage. Thrombocytosis in patients undergoing lower extremity (LE) FTT is associated with increased risk of complications. The aims of this study were to assess the feasibility of performing LE FTT in patients with preoperative thrombocytosis, and whether antiplatelet (AP) therapy on the day of surgery (DOS) affects outcomes. Methods: A retrospective review of thrombocytotic patients who underwent LE FTT between 2011-2022 was performed. Patients were stratified into groups based on the receipt of AP therapy on the DOS. Patients were propensity score-matched for comorbidity burden and postoperative risk-stratification. Outcomes of interest included perioperative transfusion requirements, postoperative flap-related complications, rates of flap success, limb salvage and ambulatory status. Results: Of the 279 patients who underwent LE FTT, 65 (23.3%) were found to have preoperative thrombocytosis. Fifty-three patients remained following propensity score matching; of which, 32 (60.4%) received AP therapy on the DOS and 21 (39.6%) did not. Overall flap success rate was 96.2% (n=51). The likelihoods of thrombosis and hematoma development were similar between cohorts (p=0.949, p=0.574, respectively). Receipt of DOS AP therapy was associated an additional 2.77 units and 990.10 mL of transfused blood (p=0.020, p=0.018, respectively). At a mean follow-up of 20.7 months, overall limb salvage and ambulatory rates were 81.1% (n=43) and 79.2% (n=42), respectively, with no differences between cohorts. Conclusion: Preoperative thrombocytosis is not an absolute contraindication to LE FTT. DOS AP therapy may be protective in comorbid patients with elevated platelet counts, but must be weighed against possible short-term bleeding as suggested by significant increases in postoperative transfusion requirements.

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Section: Postoperative Management and Short-term Outcomesmentioning

confidence: 85%

Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity Score–Matched Analysis

Berger

Huffman

Bovill

et al. 2023

J Reconstr Microsurg

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show abstract

“…Opioid consumption and total hospital length of stay after GAS may be reduced by avoiding the use of intravenous patient-controlled analgesia. 88…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach

Sanchez

Khallouq

et al. 2023

Anesthesia &Amp; Analgesia

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Transgender and gender-diverse (TGD) people endure numerous physical and mental health disparities secondary to lifelong stigma and marginalization, which are often perpetuated in medical spaces. Despite such barriers, TGD people are seeking gender-affirming care (GAC) with increased frequency. GAC facilitates the transition from the sex assigned at birth to the affirmed gender identity and is comprised of hormone therapy (HT) and gender-affirming surgery (GAS). The anesthesia professional is uniquely poised to serve as an integral support for TGD patients within the perioperative space. To provide affirmative perioperative care to TGD patients, anesthesia professionals should understand and attend to the biological, psychological, and social dimensions of health that are relevant to this population. This review outlines the biological factors that impact the perioperative care of TGD patients, such as the management of estrogen and testosterone HT, safe use of sugammadex, interpretation of laboratory values in the context of HT, pregnancy testing, drug dosing, breast binding, altered airway and urethral anatomy after prior GAS, pain management, and other GAS considerations. Psychosocial factors are reviewed, including mental health disparities, health care provider mistrust, effective patient communication, and the interplay of these factors in the postanesthesia care unit. Finally, recommendations to improve TGD perioperative care are reviewed through an organizational approach with an emphasis on TGD-focused medical education. These factors are discussed through the lens of patient affirmation and advocacy with the intent to educate the anesthesia professional on the perioperative management of TGD patients.

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An enhanced recovery after surgery protocol for facial feminization surgery reduces perioperative opioid usage, pain, and hospital stay

Bedar¹,

Dejam²,

Caprini³

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Minimizing opioid consumption by eliminating patient‐controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol

Cited by 7 publications

References 29 publications

Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity Score–Matched Analysis

Free Tissue Transfer to the Lower Extremity in the Setting of Thrombocytosis and the Role of Antiplatelet Therapy: A Propensity Score–Matched Analysis

Perioperative Care of Transgender and Gender-Diverse Patients: A Biopsychosocial Approach

An enhanced recovery after surgery protocol for facial feminization surgery reduces perioperative opioid usage, pain, and hospital stay

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