Articles: operative.
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Anesthesia and analgesia · Oct 2018
Comparative StudyThe Association Between Timing of Routine Preoperative Blood Testing and a Composite of 30-Day Postoperative Morbidity and Mortality.
Laboratory testing is a common component of preanesthesia evaluation and is designed to identify medical abnormalities that might otherwise remain undetected. While blood testing might optimally be performed shortly before surgery, it is often done earlier for practical reasons. We tested the hypothesis that longer periods between preoperative laboratory testing and surgery are associated with increased odds of having a composite of 30-day morbidity and mortality. ⋯ In American Society of Anesthesiologists physical status I and II patients, risk of 30-day morbidity and mortality was not different with blood testing up to 2 months before surgery, suggesting that it is unnecessary to retest patients shortly before surgery.
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Anesthesia and analgesia · Oct 2018
Epidural Analgesia and Subcutaneous Heparin 3 Times Daily in Cancer Patients With Acute Postoperative Pain.
The use of epidural analgesia in conjunction with subcutaneous administration of unfractionated heparin 3 times per day could increase the risk of spinal epidural hematoma, but insufficient patient experience data exist to determine this. We retrospectively reviewed the incidence of spinal epidural hematoma in 3705 cases at our institution over a 7-year period of patients receiving acute postoperative epidural analgesia and heparin 3 times per day. No cases of spinal epidural hematoma were reported (95% CI, 0-0.0009952).
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More recent studies have focused on clinical outcomes of operative versus nonoperative treatment in patients with adult spinal deformity (ASD). However, scientific support for ASD surgery is weak. We compared outcomes of operative and nonoperative treatment of ASD with minimum 2-year follow-up in a meta-analysis. ⋯ Our meta-analysis showed that operative treatment has been demonstrated to significantly reduce disability and pain and to improve clinical outcomes compared with nonoperative treatment. Further large, multicenter, well-designed studies are necessary to substantiate our results.