British journal of anaesthesia
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The Model Hospital is an NHS online resource summarising performance data for, amongst other things, operating theatres categorised by NHS Trust and specialty. As an official source of information, it might be assumed that metrics, such as 'average late start time', 'average early finish time', and 'average late finish time', are calculated in a way to reflect performance in these domains, but this is not the case. These values are, respectively, only for those lists that start late, finish early, and finish late, with the number of lists in each category unreported. ⋯ The Model Hospital aggregates utilisations across lists in a mathematically invalid way, which leads to the assumption that small aliquots of unused time on lists can be combined to create larger time blocks, in which to complete more operations. We present alternative, more intuitive, and mathematically conventional methods to derive performance metrics using the same data. The results have implications for hospitals developing their own dashboards and international organisations seeking to create national databases for operating theatre performance.
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Editorial Comment
Postoperative nausea and vomiting: is the big little problem becoming a smaller little problem?
Postoperative nausea and vomiting (PONV) has been identified as a big (very frequently encountered) little (not linked to life-threatening outcomes) problem. Traditional drugs (dexamethasone, droperidol or similar drugs, serotonin receptor antagonists) each have significant but limited effect, leading to an increasing use of combination therapies. High-risk patients, often identified through use of risk scoring systems, remain with a significant residual risk despite combining up to three traditional drugs. ⋯ This disruptive strategy was supported by favourable initial results, absence of side-effects and lower acquisition costs of the added new drugs (aprepitant and palonosetron) because of their recent loss of patent protection. These results are provocative and hypothesis generating, but need confirmation and do not warrant immediate changes in clinical practice. The next steps will also necessitate wider implementation of protocols protecting patients from PONV and a search for additional drugs and techniques aimed at treating established PONV.
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Multicenter Study
Cardiometabolic disease and obesity patterns differentially predict acute kidney injury after total joint replacement: a retrospective analysis.
Acute kidney injury (AKI) is a frequent yet understudied postoperative total joint arthroplasty complication. This study aimed to describe cardiometabolic disease co-occurrence using latent class analysis, and associated postoperative AKI risk. ⋯ The risk of postoperative AKI varies widely between patients. The current study suggests that the co-occurrence of metabolic conditions (diabetes mellitus, hypertension), with or without obesity, is a more important risk factor for acute kidney injury than individual comorbid diseases.
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Diagnosis of perioperative anaphylaxis is difficult because of its non-specific and variable signs and symptoms. Therapeutic agents used to treat anaphylaxis and anaesthesiologist responses also vary depending on the case, which might affect outcomes; however, only a few studies have focused on these factors. ⋯ UMIN000035350.