Multimodal strategies to improve surgical outcome

Kehlet, Henrik; Wilmore, Douglas W.

doi:10.1016/s0002-9610(02)00866-8

Cited by 1,537 publications

(1,114 citation statements)

References 128 publications

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“…2 patients were not allowed to leave the hospital because of this, one of whom (a patient aged 77) ended up spending 2 nights in hospital. Orthostatic intolerance and nausea and vomiting are likely to be caused by either the pain management or the surgery (Kehlet and Wilmore 2002). The challenge remains to optimize perioperative care even further to prevent the occurrence of these side effects.…”

Section: Discussionmentioning

confidence: 99%

“…These protocols are based on principles of optimal clinical care and pain management in combination with a revision of organizational factors. This permits an optimized perioperative period in which patients can safely recover in a shorter period of time (Kehlet and Wilmore 2002, Husted et al 2012). As a result of these improved factors, LOS has gradually been reduced (Kehlet and Wilmore 2002, Husted et al 2012, den Hartog et al 2013, Khan et al 2014, Winther et al 2015).…”

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confidence: 99%

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Total hip arthroplasty in an outpatient setting in 27 selected patients

Hartog¹,

Mathijssen²,

Vehmeijer³

2015

Acta Orthopaedica

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Background and purpose — As a result of introduction of a fast-track program, length of hospital stay after total hip arthroplasty (THA) decreased in our hospital. We therefore wondered whether THA in an outpatient setting would be feasible. We report our experience with THA in an outpatient setting.Patients and methods — In this prospective cohort study, we included 27 patients who were selected to receive primary THA in an outpatient setting between April and July 2014. Different patient-reported outcome measures (PROMs) were recorded preoperatively and at 6 weeks and 3 months postoperatively. Furthermore, anchor questions on how patients functioned in daily living were scored at 6 weeks and 3 months postoperatively.Results — 3 of the 27 patients did not go home on the day of surgery because of nausea and/or dizziness. The remaining 24 patients all went home on the day of surgery. PROMs improved substantially in these patients. Moreover, anchor questions on how patients functioned in their daily living indicated that the patients were satisfied with the postoperative results. 1 re-admission occurred at 11 days after surgery because of seroma formation. There were no other complications or reoperations.Interpretation — At our hospital, with a fast-track protocol, outpatient THA was found to be feasible in selected patients with satisfying results up to 3 months postoperatively, without any outpatient procedure-specific complications or re-admissions.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Total hip arthroplasty in an outpatient setting in 27 selected patients

Hartog¹,

Mathijssen²,

Vehmeijer³

2015

Acta Orthopaedica

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“…It has been conclusively proven that the simultaneous application of all the individual components of FTS yield maximum advantage [1]. However, in countries like India, we find it difficult to implement a few components of the program.…”

Section: Discussionmentioning

confidence: 99%

“…Multi-modal interventions implemented in the peri-operative period have been known to enhance recovery [1]. It has been popularly called BFast-track surgery^(FTS), BEnhanced recovery after Surgery^or BMulti-modal rehabilitation after surgery^.…”

Section: Introductionmentioning

confidence: 99%

Fast-Tracking Colostomy Closures

Nanavati

Prabhakar

2015

Indian J Surg

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There have been very few studies on applying fasttrack principles to colostomy closures. We believe that outcome may be significantly improved with multimodal interventions in the peri-operative care of patients undergoing this procedure. A retrospective study was carried out comparing patients who had undergone colostomy closures by the fasttrack and traditional care protocols at our centre. We intended to analyse peri-operative period and recovery in colostomy closures to confirm that fast-track surgery principles improved outcomes. Twenty-six patients in the fast-track arm and 24 patients in the traditional care arm had undergone colostomy closures. Both groups were comparable in terms of their baseline parameters. Patients in the fast-track group were ambulatory and accepted oral feeding earlier. There was a significant reduction in the duration of stay (4.73±1.43 days vs. 7.21± 1.38 days, p=0.0000). We did not observe a rise in complications or 30-day re-admissions. Fast-track surgery can safely be applied to colostomy closures. It shows earlier ambulation and reduction in length of hospital stay.

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“…Fast-track surgery focuses on enhancing recovery and reducing morbidity by implementing existing and new evidence-based, best practices in surgery and anesthesia, including analgesia, reduction of surgical stress, fluid and blood management, nutrition, and ambulation [6][7][8].…”

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confidence: 99%

Ethical Tenets of Perioperative Care: “Finding My Surgical Way Home”

Hall

Goeddel

Vetter

2015

AMA Journal of Ethics

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In the course of their daily practice, anesthesiologists are confronted with a number of conventional ethical issues connected to situations ranging from informed consent to endof-life decision making [1]. The specialty of anesthesiology has recently evolved to include not only critical care and pain medicine but also perioperative medicine. The full spectrum of perioperative expertise is manifest in the perioperative surgical home (PSH), a new and innovative care model initially developed and now being widely advocated by the American Society of Anesthesiologists (ASA) in close collaboration with vital surgical, nursing, health care administrative, and payer stakeholders [2]. The PSH is a patient-centered, institutionled, interdisciplinary, team-based, coordinated, and-where possible-standardized care model that guides the patient from presurgical decision making to postdischarge care [3,4]. The PSH seeks to improve the surgery experience and outcomes and to add measurable value to the highest-cost segment of health care.The PSH holds significant potential to make health care more patient-centered [3]. Within its broad scope of responsibility, this innovative care model, if given the resources, can effectively address ethical issues in surgical patient care. In this paper, after describing the fundamentals of the PSH, we discuss two controversial and highly charged issues with significant ethical ramifications for anesthesiologists: patient-centered decision making and futility of care.An Overview of the Perioperative Surgical Home Multiple variants of the PSH will be implemented based upon institutional infrastructure, resources, and other factors [3][4][5]. Our prototypic PSH model at the University of Alabama at Birmingham (UAB) integrates the heretofore frequently fragmented preoperative, intraoperative, postoperative, and postdischarge phases of patient care [3]. It is based on the anesthesiologist's serving as the surgical patient's perioperativist-the primary physician who coordinates care with other team members to provide seamless continuity from preoperative evaluation to postoperative care. In the UAB PSH model, an anesthesiologist works in tandem with a nurse practitioner and a registered nurse (or social worker) case coordinator to provide, coordinate, and integrate pre-, intra-, and postoperative care. This team is readily available to address the patient's questions or concerns about his or her care and oversees the patient's transitional and rehabilitation plans on hospital discharge [3].The UAB PSH model also involves a multimodal approach, often referred to as "fast-track surgery," in which not only surgeons, anesthesiologists, and nurses but also pharmacists, physical/occupational therapists, nutritionists, and social workers are equal participants of

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Multimodal strategies to improve surgical outcome

Cited by 1,537 publications

References 128 publications

Total hip arthroplasty in an outpatient setting in 27 selected patients

Total hip arthroplasty in an outpatient setting in 27 selected patients

Fast-Tracking Colostomy Closures

Ethical Tenets of Perioperative Care: “Finding My Surgical Way Home”

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