Despite growing attention to patients,safety worldwide,no data were available on the impact of adverse respiratory events(AREs)on post-anesthesia care and post-operation care in China.This study evaluated the occurren...Despite growing attention to patients,safety worldwide,no data were available on the impact of adverse respiratory events(AREs)on post-anesthesia care and post-operation care in China.This study evaluated the occurrence of AREs,the impact of AREs on length of stay(LOS)in post-anesthesia care unit(PACU)and postoperative time in hospital,and PACU cost and in patient healthcare costs.A retrospective,matched-cohort study was conducted by prospectively collecting the data of 159 AREs in PACU during 2016-2017 in an university hospital in China.Records were reviewed by pre-trained,qualified nurses and/or anesthesiologists.The incidence and the impact of AREs were analyzed.The LOS in PACU and postoperative time in hospital and the costs in PACU and inpatient healthcare costs were also obtained.Results showed that there were 253 AREs involving 156 patients.Hypoxia(n=141,55.73%)and respiratory depression(n=70,27.67%)were the most common AREs.Measurement data including body mass index(BMI)(22.85±4.36 vs.22.32±3.83),duration of procedure(138.47±77.33 min vs.137.44±72.33 min),duration of anesthesia(176.35±82.66 min vs.174.61±78.08 min),LOS(16.53±10.65 days vs.16.57±9.56 days),inpatient healthcare costs($9465.57±9416.33 vs.$8166.51±5762.01),and postoperative LOS(11.26±8.77 days vs.11.9±8.30 days)showed no significant differences between ARE and matched groups(P<0.05).Duration(81.65±54.79 min vs.38.89±26.09 min)and costs($31.99±17.80 vs.$18.72±8.39)in PACU were significantly different in ARE group from those in matched group(P<0.001).Proportion of patients with prolonged stay in PACU was significantly higher in ARE group than in matched group(18.59%vs.1.28%),with an odds ratio(after matching)of 17.58(95%CI=4.11 to 75.10;P<0.001).The AREs that occurred during the immediate postoperative period in PACU increased the incidence rate of prolonged stay,delayed the PACU stay,and increased the costs in PACU,resulting in the need of higher levels of postoperative care than anticipated,but the postoperative LOS and inpatient healthcare costs were unchanged.展开更多
Background: Inadvertent postoperative hypothermia (IPH) is known to be associated with various adverse effects. The aim of this study was to evaluate the incidence, predictors and outcome of core inadvertent hypotherm...Background: Inadvertent postoperative hypothermia (IPH) is known to be associated with various adverse effects. The aim of this study was to evaluate the incidence, predictors and outcome of core inadvertent hypothermia on admission in the post-anesthesia care unit. Methods: Observational, prospective study in a Post-Anesthesia Care Unit. The study population consisted of adult patients after non-cardiac and non-neurologic surgery. Patients’ demographics, intraoperative and postoperative data were collected. Descriptive analysis of variables was used to summarize data and the Mann-Whitney U test, Fisher’s exact test or Chi-square test was used. Univariate and multivariate analyses were done with logistic binary regression with calculation of an Odds Ratio (OR) and its 95% Confidence Interval. Results: The incidence of IPH on admission was 32%. In univariate analysis: age, body mass index (BMI), high risk surgery, revised cardiac risk index (RCRI), type of anesthesia, use of forced-air warming, amount of intravenous crystalloids administrated, duration of anesthesia, duration of surgery and admission visual analogue scale (VAS) for pain > 3 were considered predictors of hypothermia. In multiple logistic regression analysis, age (OR 1.7, P = 0.045, for age > 65 years), RCRI (OR 3.18, P = 0.041, for RCRI > 2), duration of anesthesia (OR 1.52, P < 0.001) and admission VAS for pain (OR 2.05, P = 0.007) were considered independent predictors of IPH. Patients with IPH at PACU admission stay longer in the PACU. Conclusions: IPH was associated with a longer stay in the PACU. Age, comorbidities duration of anesthesia and pain at PACU admission were considered independent predictors for IPH.展开更多
在医患关系日益复杂、医患纠纷不断升级的今天,对医患关系的研究自然十分重要。然而传统的医患关系研究,在思辨和社会调查的方法之外,一直缺少医院田野(field in hospital)的维度。本文即为作者根据在重症监护室中的田野笔记(field not...在医患关系日益复杂、医患纠纷不断升级的今天,对医患关系的研究自然十分重要。然而传统的医患关系研究,在思辨和社会调查的方法之外,一直缺少医院田野(field in hospital)的维度。本文即为作者根据在重症监护室中的田野笔记(field notes)整理后形成的。通过集中描述发生在重症监护室中的主要活动,勾画出医生和病人家属的临床形象和实在困境。本文不仅可以为医患关系的研究者提供一个学术文本,同时也为大众展示了一个重要的"生活"文本。展开更多
Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The p...Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value<35.5°C)and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age,education,preoperative mild cognitive impairment,American Society of Anesthesiologists grade,duration of surgery,site of surgery,and pain intensity.Relative hypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyperthermia,but not absolute hyperthermia,was associated with a decreased risk of ED.Registration:Chinese Clinical Trial Registry(No.ChiCTR-OOC-17012734).展开更多
母乳喂养是为婴儿提供健康成长和发育所需营养的理想方式，是确保儿童健康和生存的最有效措施之一。婴幼儿喂养在生命最初2年尤为重要，在此阶段如能获得最佳营养，将有助于降低婴幼儿患病率和死亡率，减少日后罹患慢性疾病的风险，促...母乳喂养是为婴儿提供健康成长和发育所需营养的理想方式，是确保儿童健康和生存的最有效措施之一。婴幼儿喂养在生命最初2年尤为重要，在此阶段如能获得最佳营养，将有助于降低婴幼儿患病率和死亡率，减少日后罹患慢性疾病的风险，促使身心发育更加健康。但在全球范围内，6个月以内婴儿的纯母乳喂养率低于40%，在5岁以下儿童死亡中，有11.6%与母乳喂养不足有关[1,2]。美国疾病预防控制中心调查显示，因母乳喂养不理想所产生的母婴双方的医疗花费，每年达数十亿美元[3]。世界卫生组织（World Health Organization，WHO）预测，如每个新生儿出生后1 h内能够开始母乳喂养，并坚持最初6个月内纯母乳喂养，则每年可挽救约80万5岁以下儿童的生命[1]。展开更多
文摘Despite growing attention to patients,safety worldwide,no data were available on the impact of adverse respiratory events(AREs)on post-anesthesia care and post-operation care in China.This study evaluated the occurrence of AREs,the impact of AREs on length of stay(LOS)in post-anesthesia care unit(PACU)and postoperative time in hospital,and PACU cost and in patient healthcare costs.A retrospective,matched-cohort study was conducted by prospectively collecting the data of 159 AREs in PACU during 2016-2017 in an university hospital in China.Records were reviewed by pre-trained,qualified nurses and/or anesthesiologists.The incidence and the impact of AREs were analyzed.The LOS in PACU and postoperative time in hospital and the costs in PACU and inpatient healthcare costs were also obtained.Results showed that there were 253 AREs involving 156 patients.Hypoxia(n=141,55.73%)and respiratory depression(n=70,27.67%)were the most common AREs.Measurement data including body mass index(BMI)(22.85±4.36 vs.22.32±3.83),duration of procedure(138.47±77.33 min vs.137.44±72.33 min),duration of anesthesia(176.35±82.66 min vs.174.61±78.08 min),LOS(16.53±10.65 days vs.16.57±9.56 days),inpatient healthcare costs($9465.57±9416.33 vs.$8166.51±5762.01),and postoperative LOS(11.26±8.77 days vs.11.9±8.30 days)showed no significant differences between ARE and matched groups(P<0.05).Duration(81.65±54.79 min vs.38.89±26.09 min)and costs($31.99±17.80 vs.$18.72±8.39)in PACU were significantly different in ARE group from those in matched group(P<0.001).Proportion of patients with prolonged stay in PACU was significantly higher in ARE group than in matched group(18.59%vs.1.28%),with an odds ratio(after matching)of 17.58(95%CI=4.11 to 75.10;P<0.001).The AREs that occurred during the immediate postoperative period in PACU increased the incidence rate of prolonged stay,delayed the PACU stay,and increased the costs in PACU,resulting in the need of higher levels of postoperative care than anticipated,but the postoperative LOS and inpatient healthcare costs were unchanged.
文摘Background: Inadvertent postoperative hypothermia (IPH) is known to be associated with various adverse effects. The aim of this study was to evaluate the incidence, predictors and outcome of core inadvertent hypothermia on admission in the post-anesthesia care unit. Methods: Observational, prospective study in a Post-Anesthesia Care Unit. The study population consisted of adult patients after non-cardiac and non-neurologic surgery. Patients’ demographics, intraoperative and postoperative data were collected. Descriptive analysis of variables was used to summarize data and the Mann-Whitney U test, Fisher’s exact test or Chi-square test was used. Univariate and multivariate analyses were done with logistic binary regression with calculation of an Odds Ratio (OR) and its 95% Confidence Interval. Results: The incidence of IPH on admission was 32%. In univariate analysis: age, body mass index (BMI), high risk surgery, revised cardiac risk index (RCRI), type of anesthesia, use of forced-air warming, amount of intravenous crystalloids administrated, duration of anesthesia, duration of surgery and admission visual analogue scale (VAS) for pain > 3 were considered predictors of hypothermia. In multiple logistic regression analysis, age (OR 1.7, P = 0.045, for age > 65 years), RCRI (OR 3.18, P = 0.041, for RCRI > 2), duration of anesthesia (OR 1.52, P < 0.001) and admission VAS for pain (OR 2.05, P = 0.007) were considered independent predictors of IPH. Patients with IPH at PACU admission stay longer in the PACU. Conclusions: IPH was associated with a longer stay in the PACU. Age, comorbidities duration of anesthesia and pain at PACU admission were considered independent predictors for IPH.
文摘在医患关系日益复杂、医患纠纷不断升级的今天,对医患关系的研究自然十分重要。然而传统的医患关系研究,在思辨和社会调查的方法之外,一直缺少医院田野(field in hospital)的维度。本文即为作者根据在重症监护室中的田野笔记(field notes)整理后形成的。通过集中描述发生在重症监护室中的主要活动,勾画出医生和病人家属的临床形象和实在困境。本文不仅可以为医患关系的研究者提供一个学术文本,同时也为大众展示了一个重要的"生活"文本。
基金supported by a grant from the National Key Research and Development Program of China(No.2018YFC2001800)
文摘Background:Emergence delirium(ED)is a kind of delirium that occured in the immediate post-anesthesia period.Lower body temperature on post-anesthesia care unit(PACU)admission was an independent risk factor of ED.The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.Methods:This study was a secondary analysis of a prospective observational study.Taking baseline body temperature as a reference,intraoperative absolute and relative temperature changes were calculated.The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference.ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.Results:A total of 874 patients were analyzed with a mean age of 71.8±5.3 years.The incidence of ED was 38.4%(336/874).When taking 36.0°C,35.5°C,and 35.0°C as thresholds,the incidences of absolute hypothermia were 76.7%(670/874),38.4%(336/874),and 17.5%(153/874),respectively.In multivariable logistic regression analysis,absolute hypothermia(lowest value<35.5°C)and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age,education,preoperative mild cognitive impairment,American Society of Anesthesiologists grade,duration of surgery,site of surgery,and pain intensity.Relative hypothermia(decrement>1.0°C from baseline)and its cumulative duration were also associated with an increased risk of ED,respectively.When taking the relative increment>0.5°C as a threshold,the incidence of relative hyperthermia was 21.7%(190/874)and it was associated with a decreased risk of ED after adjusting above confounders.Conclusions:In the present study,we found that intraoperative hypothermia,defined as either absolute or relative hypothermia,was associated with an increased risk of ED in elderly patients after non-cardiac surgery.Relative hyperthermia,but not absolute hyperthermia,was associated with a decreased risk of ED.Registration:Chinese Clinical Trial Registry(No.ChiCTR-OOC-17012734).
文摘母乳喂养是为婴儿提供健康成长和发育所需营养的理想方式，是确保儿童健康和生存的最有效措施之一。婴幼儿喂养在生命最初2年尤为重要，在此阶段如能获得最佳营养，将有助于降低婴幼儿患病率和死亡率，减少日后罹患慢性疾病的风险，促使身心发育更加健康。但在全球范围内，6个月以内婴儿的纯母乳喂养率低于40%，在5岁以下儿童死亡中，有11.6%与母乳喂养不足有关[1,2]。美国疾病预防控制中心调查显示，因母乳喂养不理想所产生的母婴双方的医疗花费，每年达数十亿美元[3]。世界卫生组织（World Health Organization，WHO）预测，如每个新生儿出生后1 h内能够开始母乳喂养，并坚持最初6个月内纯母乳喂养，则每年可挽救约80万5岁以下儿童的生命[1]。
