Abstract:
BACKGROUND:Previously, our group successfully established one of the nation's first Perioperative Surgical Homes (PSHs) aimed at coordinating services to patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). As we now focus on extending the PSH to other service lines within the hospital, the long-term sustainability of this practice model is an important factor to consider moving forward. METHODS:We prospectively collected data from all patients who underwent elective primary TKA and THA at our institution between October 1, 2012, and September 30, 2014. Prospectively collected data included length of stay (LOS), 30-day readmission rate, postoperative pain scores, and complications. RESULTS:During the 2-year period, there were 328 primary joint arthroplasty patients. Overall, the median LOS was significantly shorter in the second year of the PSH initiative (P = 0.03). Stratified by procedure, the median LOS for patients undergoing THA was significantly shorter in the second year (P = 0.02), whereas the median LOS for patients undergoing TKA did not differ between the 2 time periods. In the second year of the PSH initiative, significantly more patients were discharged home than to a skilled nursing facility compared with year 1 of the PSH initiative (P = 0.02). Readmission rates within 30 days after surgery to our institution were 0.9% (0.0-4.4) in the first year of the PSH initiative and 3.3% (confidence interval, 1.3%-7.2%) in the second year of the PSH initiative (P = not significant). Pain scores did not change significantly from year 1 to year 2 (P = not significant). CONCLUSIONS:Data for the second year of implementation demonstrate similarly positive results in LOS, pain control, discharge destination, readmission, transfusion rates, and complications.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Cyriac J,Garson L,Schwarzkopf R,Ahn K,Rinehart J,Vakharia S,Cannesson M,Kain Zdoi
10.1213/ANE.0000000000001308subject
Has Abstractpub_date
2016-07-01 00:00:00pages
51-62issue
1eissn
0003-2999issn
1526-7598pii
00000539-201607000-00009journal_volume
123pub_type
杂志文章abstract::Spine surgery is associated with a wide range of surgical and anesthetic complications. Excessive cerebrospinal fluid leak can be a cause of cerebellar hemorrhage postoperatively. We report a 43-yr-old patient who had lumbar spine reexploration surgery complicated by a cerebrospinal fluid leak which led to cerebellar ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000143340.51813.6A
更新日期:2005-02-01 00:00:00
abstract:UNLABELLED:In this study, we tested the validity of the bispectral index (BIS) monitor during conscious and deep sedation of children by comparing it with the University of Michigan Sedation Scale (UMSS), a validated observational pediatric sedation scale. Eighty-six children <12 yr of age were enrolled in this observa...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000067402.02136.a2
更新日期:2003-07-01 00:00:00
abstract:UNLABELLED:We evaluated the blood-sparing effects of intraoperative moderate acute normovolemic hemodilution (ANH) combined with intraoperative tranexamic acid treatment and shed blood reinfusion in patients undergoing off-pump coronary artery bypass (OPCAB). One-hundred consecutive OPCAB patients (baseline hematocrit ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ane.0000113238.35409.fe
更新日期:2004-05-01 00:00:00
abstract::Elderly patients have a higher risk of developing adverse drug reactions during anesthesia, especially anesthesia affecting cardiovascular performance. In this prospective randomized study we compared quality of induction, hemodynamics, and recovery in elderly patients scheduled for hip fracture surgery and receiving ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ANE.0000149542.04833.55
更新日期:2005-05-01 00:00:00
abstract:BACKGROUND:The mechanism of the antinociceptive effects of nitrous oxide (N(2)O) has not been completely elucidated. On the other hand, numerous studies have indicated that mesolimbic dopaminergic neurons, which are thought to be involved in rewarding and reinforcement processes, play important roles in the supraspinal...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318172b15b
更新日期:2008-06-01 00:00:00
abstract::We compared in a prospective, randomized, double-blinded study the analgesic efficacy of three drugs in 120 ASA I and II patients scheduled to undergo ambulatory hand surgery with IV regional anesthesia. At discharge, oral analgesic tablets were prescribed as follows: tramadol 100 mg every 6 h, metamizol 1 g every 6 h...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200102000-00013
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:Patients with chronic pain frequently suffer affective disorders, particularly anxiety and depression. Although clinical research on the relationship between pain and depressive symptoms has been done, it is not clear whether pain causes depression or depression exaggerates pain. To investigate the relation ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000261514.19946.66
更新日期:2007-06-01 00:00:00
abstract::Spontaneous positive end-expiratory pressure (sPEEP) is a simple, low-cost method of providing low to moderate levels of PEEP as an alternative to continuous positive airway pressure (CPAP), whether used alone or with continuous positive pressure ventilation (CPPV) in intermittent mandatory ventilation (IMV). The ther...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1977-09-01 00:00:00
abstract::This article describes practices in patient blood management (PBM) in 4 countries on different continents that may provide insights for anesthesiologists and other physicians working in global settings. The article has its foundation in the proceedings of a session at the 2014 AABB annual meeting during which internat...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000001597
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The infusion of local anesthetic in the surgical wound is helpful in the multimodal management of postoperative pain. We hypothesized that local anesthetic wound infusion after cesarean delivery would provide better pain control than epidural morphine analgesia. METHODS:Healthy, term women scheduled for ele...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0b013e3182368e87
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:There have been numerous studies published on the ProSeal laryngeal mask airway (PLMA). However, few have investigated its utility in a large practice setting. We sought to gather comprehensive data about the characteristics, efficacy, and safety of its use by a representative group of anesthesiologists work...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318189ac84
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an impl...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000003861
更新日期:2019-08-01 00:00:00
abstract:UNLABELLED:Impaired in vivo immunity is often observed after major surgery and is multifactorial. We conducted a randomized clinical study to determine the independent effects of general anesthesia (GA) and of lumbar epidural anesthesia (LEA) on human immune function in the absence of surgical trauma. Nineteen healthy ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-200108000-00044
更新日期:2001-08-01 00:00:00
abstract::Antagonists of the serotonergic 5-hydroxytryptamine 3A receptor (5-HT(3A)R) and muscle nicotinic acetylcholine receptors (nAChR) are widely used in anesthesia practice. Both 5-HT(3A)R and nAChR are ligand-gated ion channels with known pharmacological overlap between some of their agonists and antagonists. We studied t...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000160531.65953.77
更新日期:2005-09-01 00:00:00
abstract::Several observational and objective methods are available to assess sedation depth; however, data regarding their accuracy in differentiating deep sedation are limited. In this study we compared 3 sedation tools in children from birth to 18 yr of age and determined their relative value in detecting deep levels of seda...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000184045.01780.73
更新日期:2006-02-01 00:00:00
abstract::The nasal route is preferred for fiberoptic intubation. Placing a lubricated endotracheal tube through the nostril can guide the fiberoptic scope towards the larynx. It would be helpful for optimal visualization of the vocal cord when the scope is passed through the endotracheal tube if the length of nares-vocal cord ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000149900.68354.33
更新日期:2005-05-01 00:00:00
abstract:UNLABELLED:Opioid-abstinence hyperalgesia (OAH) is a phenomenon characterized by thermal and mechanical hyperalgesia that occurs between intermittent doses of opioids or after the chronic administration of these drugs when administration is abruptly stopped. In these studies we attempted to determine whether the activa...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200210000-00035
更新日期:2002-10-01 00:00:00
abstract::Epidural anesthesia may be performed as a single injection or by staged doses. Thirty patients undergoing primary total hip replacement were randomly assigned to have epidural anesthesia using a single injection or a staged technique with 25 mL of 0.75% bupivacaine. Arterial plasma bupivacaine concentrations were sign...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199408000-00019
更新日期:1994-08-01 00:00:00
abstract:BACKGROUND:In children, postoperative respiratory rate (RR) monitoring by transthoracic impedance (TI), capnography, and manual counting has limitations. The rainbow acoustic monitor (RAM) measures continuous RR noninvasively by a different methodology. Our primary aim was to compare the degree of agreement and accurac...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000002062
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:In this study, we sought to determine whether a simplified ultrasound measurement of the largest transverse diameter, using a standard ultrasound machine, could be used to diagnose postoperative urinary retention (POUR). This method may replace expensive bladder volume measuring devices or a more complex ult...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/ANE.0000000000000595
更新日期:2015-05-01 00:00:00
abstract:UNLABELLED:Acute withdrawal syndromes, including agitation and a long weaning time, are common adverse effects after long-term sedation with midazolam. We performed this study to determine whether the sequential use of midazolam and propofol could reduce adverse effects as compared with midazolam alone. We studied 26 p...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ane.0000048714.01230.75
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:The diagnosis of myocardial infarction (MI) after noncardiac surgery has traditionally relied on using relatively insensitive contemporary cardiac troponin (cTn) assays. We hypothesized that using a recently introduced novel high-sensitivity cTnT (hscTnT) assay would increase the detection rate of perioperat...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000002240
更新日期:2017-11-01 00:00:00
abstract::Implanted electronic medical devices. or stimulators such as pacemakers and nerve stimulators have grown enormously in diversity and complexity over recent decades. The function and potential interaction of these devices with the perioperative environment is of increasing concern for anesthesiologists and surgeons. Be...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000001983
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Research information for children is often presented in a manner that is difficult to understand. We designed this study, therefore, to examine the effect of improved readability and processability of written study information on children's understanding. METHODS:One-hundred-ninety children aged 7-17 yr who...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000270326.44507.11
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Intrathecal neostigmine not only produces analgesia but also severe nausea. In contrast, epidural neostigmine enhances opioid and local anesthetic analgesia without causing nausea. Previous studies examined only single epidural neostigmine bolus administration and did not assess the efficacy of continuous ep...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e31819518e4
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:The primary objective of this study was to compare the characteristics of culture-positive and culture-negative status in septic patients. We also determined whether culture status is associated with mortality and whether unique variables are associated with mortality in culture-positive and culture-negative...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000004072
更新日期:2019-11-01 00:00:00
abstract::Successful procedural sedation represents a spectrum of patient- and clinician-related goals. The absence of a gold-standard measure of the efficacy of procedural sedation has led to a variety of outcomes being used in clinical trials, with the consequent lack of consistency among measures, making comparisons among tr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000000934
更新日期:2016-01-01 00:00:00
abstract::Intraoperative hypoxia occurred in two patients during the maintenance of the medical gas system. Engineers were purging oxygen pipelines with nitrogen to remove particulate debris but were unaware of a connection to operating room pipelines. This case illustrates the importance of communication between anesthesia pro...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200007000-00045
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromise in the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in th...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000002004
更新日期:2017-05-01 00:00:00
abstract:UNLABELLED:We examined how to program an operating room (OR) information system to assist the OR manager in deciding whether to move the last case of the day in one OR to another OR that is empty to decrease overtime labor costs. We first developed a statistical strategy to predict whether moving the case would decreas...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200010000-00029
更新日期:2000-10-01 00:00:00