British journal of anaesthesia
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Intraoperative mortality is now rare. In contrast, 30-day postoperative mortality remains common, with most deaths occurring during the initial hospitalisation. The legacy of anaesthesiology will be determined by our success in dealing with postoperative mortality, which is currently the major problem in perioperative medicine. Carpe diem!
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Editorial Comment
Managing capacity for urgent surgery: staffing, staff scheduling in-house or on-call from home, and work assignments.
Parmar and colleagues developed and validated a graphical method for choosing the number of operating theatres to set aside for urgent surgical cases. We address appropriate usage of their new method for calculating anaesthesia staffing, including comparison with previously published techniques. Parmar and colleagues' method is based on all staff scheduled in-house, rather than some on-call from home. We review that this is not nearly as large a limitation as it may seem because of behavioural factors of staff assignment.
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Days alive and out of hospital (DAOH) is a composite, patient-centred outcome measure describing a patient's postoperative recovery, encompassing hospitalisation and mortality. DAOH is the number of days not in hospital over a defined postoperative period; patients who die have DAOH of zero. The Standardising Endpoints in Perioperative Medicine (StEP) group recommended DAOH as a perioperative outcome. However, DAOH has never been validated in patients undergoing emergency laparotomy. Here, we validate DAOH after emergency laparotomy and establish the optimal duration of observation. ⋯ DAOH is a valid, patient-centred outcome after emergency laparotomy. We recommend its use in clinical trials, quality assurance, and quality improvement, measured at 30 days as mortality heavily skews DAOH measured at 90 days and beyond.
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Review Meta Analysis
Analgesic use and associated adverse events in patients with chronic kidney disease: a systematic review and meta-analysis.
Treating pain in the context of chronic kidney disease (CKD) is challenging because of altered pharmacokinetics and pharmacodynamics, with an increased risk of toxicity and drug adverse events in this population. The aims of this systematic review and meta-analysis were to assess the prevalence of analgesic use and establish the risk of analgesics-related adverse events, in patients with CKD. ⋯ CRD42019156491 (PROSPERO).
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Multicenter Study Comparative Study Clinical Trial Observational Study
Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units.
Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. ⋯ ClinicalTrials.gov NCT04321265.