Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewCognitive self-assessment scales in surgical settings: Acceptability and feasibility.
Pre-existing cognitive impairment is associated with poor surgical outcomes, long hospital stays, and increased morbidity and mortality. This necessitates the use of screening tools to evaluate preoperative cognitive status in elderly surgical patients. ⋯ Self-administered Gerocognitive Screening Examination (SAGE) was developed out of the need for a cognitive self-assessment scale in the clinic. At our institution, SAGE was given to 189 elderly surgical patients to evaluate baseline cognitive status, and preliminary results are promising that self-assessment scales are both feasible and acceptable in the surgical setting.
-
Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewThe patient's surgical journey and consequences of poor recovery.
Quality of recovery is a multidimensional construct that affects individual patients in different ways and during different time periods. The evaluation of quality of recovery requires patient-reported outcome measurement tools that are sensitive in detecting change with time and are preferably objective rather than subjective by nature. Current surgical outcomes are still predominantly focused on the avoidance of complications and reduced cost. ⋯ However, it is critical to maintain the high standards of surgical safety and cost containment as we move forward to address value-based care. An apparently successful surgery can result in poor recovery outcomes such as cognitive decline, persistent pain, reduced functional ability, loss of independence or inability to return to work. The special edition of Best Practice will focus on the multidimensional construct of quality of recovery, how to measure it and how it may apply in different populations.
-
Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewApproaches to the measurement of post-operative recovery.
Modern recovery assessment has progressed from that which addressed purely physiological restitution in the immediate post-operative period to that which is a multi-dimensional construct existing as a continuum and which follows a predictable trajectory. Recovery tools differ in their derivation, validation and scope of assessment. ⋯ Dichotomisation of recovery assessment mandates that a threshold be determined, above which recovery is deemed to have occurred. Ideally, recovery is assessed as a dichotomous outcome using the patient as their own pre-operative comparator, thus allowing recovery assessment at an individual patient, as well as group, level and overall as well as within each recovery domain.
-
Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewDefining quality of recovery - What is important to patients?
Postoperative recovery is a complex process with several interrelated domains. Traditionally, the absence of negative physiological symptoms like nausea and pain, along with avoidance of major postoperative complications, has been the standard set by clinicians and hospitals for a satisfactory postoperative recovery. ⋯ Although challenging to study, the development of a multimodal, patient-centered approach to evaluate the postsurgical period is critical for a truly comprehensive assessment of recovery quality. This review provides an overview of our current understanding of how patient factors like satisfaction can be impacted by the Anesthesia Care Team and how overall quality of recovery is related to perioperative patient experiences.