Is perioperative home the future of surgical patient care?

Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.

Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study

BACKGROUND Acute kidney injury(AKI)is one of the most common acute pancreatitis(AP)-associated complications that has a significant effect on AP,but the factors affecting the AP patients’survival rate remains unclear.AIM To assess the influences of AKI on the survival rate in AP patients.METHODS A total of 139 AP patients were included in this retrospective study.Patients were divided into AKI group(n=72)and non-AKI group(n=67)according to the occurrence of AKI.Data were collected from medical records of hospitalized patients.Then,these data were compared between the two groups and further analysis was performed.RESULTS AKI is more likely to occur in male AP patients(P=0.009).AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score,higher Sequential Organ Failure Assessment score,lower Glasgow Coma Scale score,and higher demand for mechanical ventilation,infusion of vasopressors,and renal replacement therapy than AP patients in non-AKI group(P<0.01,P<0.01,P=0.01,P=0.001,P<0.01,P<0.01,respectively).Significant differences were noted in dose of norepinephrine and adrenaline,duration of mechanical ventilation,maximum and mean values of intra-peritoneal pressure(IPP),maximum and mean values of procalcitonin,maximum and mean serum levels of creatinine,minimum platelet count,and length of hospitalization.Among AP patients with AKI,the survival rate of surgical intensive care unit and in-hospital were only 23%and 21%of the corresponding rates in AP patients without AKI,respectively.The factors that influenced the AP patients’survival rate included body mass index(BMI),mean values of IPP,minimum platelet count,and hospital day,of which mean values of IPP showed the greatest impact.CONCLUSION AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI,which necessitates further attention to AP patients with AKI in surgical intensive care unit.

Force application of laparoscopic surgeons under the impact of heavy personal protective equipment during COVID-19 pandemic

Objective:Surgeons are required to wear heavy personal protective equipment while delivering care to patients during the COVID-19 pandemic.We examined the impact of wearing double gloves on surgeons’performance in laparoscopic surgery.Methods:Eleven surgeons-in-training at the Surgical Simulation Research Lab of the University of Alberta were recruited to perform laparoscopic cutting tasks in simulation while wearing none,one pair,and two pairs of surgical gloves.Forces applied to laparoscopic instruments were measured.Results:Wearing gloves prolonged task times(one pair of gloves:301.6±61.7 s;two pairs of gloves:295.8±65.3 s)compared with no gloves(241.7±46.9 s;p=0.043).Wearing double gloves increased cutting errors(20.4±5.1 mm^(2))compared with wearing one pair of gloves(16.9±5.5 mm^(2))and no gloves(14.4±4.6 mm^(2);p=0.030).Wearing gloves reduced the peak force(one pair of gloves:2.4±0.7 N;two pairs of gloves:2.7±0.6 N;no gloves:3.4±1.4 N;p=0.049),and the total force(one pair of gloves:10.1±2.8 N;two pairs of gloves:10.3±2.6 N;no glove:12.6±1.9 N;p=0.048)delivered onto lapa-roscopic scissors compared with wearing no glove.Conclusion:The combined effects of wearing heavy gloves and using tools reduced the touching sensation,which limited the surgeons’confidence in performing surgical tasks.Increasing practice in simulation is suggested to allow surgeons to overcome difficulties brought by personal protective equipment.

Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery

BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.

Advantage of surgical intensive care unit(SICU)predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital

Purpose It is a challenge for the primary hospitals to manage multiple trauma patients.In this article,we explored the advantage of establishing a surgical intensive care unit(SICU)predominant by cardiothoracic surgeons in the early management of multiple trauma.Methods This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups,based on time period and treat modes:group A(retrospective observation group)where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B(study group)where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018.Clinical data including demographics,injury severity score(ISS),causes of injury,time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected.Data were analyzed by SPSS 20.0 software.Categorical variables were presented as number and/or frequency and continuous variables as mean±SD.Results Altogether 406 patients were included in this study,including 217 patients in group A and 189 patients in group B.General data between the two groups revealed no significant difference:mean age(years)(35.51±12.97 vs.33.62±13.61,p=0.631),gender distribution(mean/female,130/87 vs.116/73,p=0.589)and ISS(15.92±7.95 vs.16.16±6.89,p=0.698).Fall from height were the dominant mechanism of injury,with 135 cases in group A(71.4%)and 121 cases in group B(55.8%),followed by traffic accidents.Injury mechanism showed no significant differences between two groups(p=1.256).Introduction of the SICU significantly improved the care of trauma patients,regarding speed and mortality.Time intervals between reception and entering SICU or operating room was(108.23±6.72)min and(45.67±7.96)min in group A and B,respectively(p=0.001).Mortality three days after injuries was 13.89%and 5.53%in group A and B,respectively(p=0.005).Conclusion Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

Nursing of 9 cases of double-hole thoracoscopic aortic valve replacement surgery

Background Objective To summarize the nursing experience of 9 cases of double-hole thoracoscopic aortic valve replacement.Methods From February 2021 to February 2022,9 patientsdiagnosed with severe aortic valve disease were enrolled,including 6 males and 3 females,with an average age(50.89±5.3)years,all of whom used double-hole thoracoscopic aortic valve replacement.Implement targeted surgical nursing plans,strengthen condition monitoring,surgical nursing cooperation,and take effective nursing interventions to urgently respond to intraoperative complications.Results Among the 9 patients,7 patients underwent mechanical valve replacement and 2 patients underwent biovalve replacement,of which 2 patients underwent aortic root enlargement surgery at the same time,and none of the patients underwent intraoperative emergency transfer orthothoracotomy.The extracorporeal bypass time was(137.56±27.99)min,the aortic occlusion time was(95.33±17.96)min,and the surgical survival rate was 100%;All patients had well-placed aortic valves,and 2 had mild(<2 cm2)perivalvular leakage.The postoperative recovery time was short,the ventilation time was 6.13(4.43,19.99)h,of which 8 patients were extubated within24 hours,and the ICU length of stay was(2.68±1.3)days,and no deaths and complications occurred.Conclusion For patients with simple aortic valve disease,double-hole thoracoscopic aortic valve replacement is a safe and effective surgical treatment with good early clinical results.Implement a scientifically based nursing plan during surgery to effectively prevent complications,promote early recovery,and improve the quality of nursing.