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11. Hospital-level variability in regional nerve block administration by race for total knee arthroplasty.

Author

Dixit, Anjali A., Kim, Christine Y., Mariano, Edward R., Krishnamoorthy, Vijay, Tetsu Ohnuma, Raghunathan, Karthik, Bryan, William E., Bartels, Karsten, and Sun, Eric C.

Abstract

This research report explores the potential racial disparity in the use of regional nerve blocks for total knee arthroplasty (TKA) in hospitals. The study found that hospitals with a higher proportion of Black patients undergoing TKA were less likely to administer nerve blocks. This difference persisted even after accounting for patient characteristics. The findings suggest that there may be a racial disparity in access to nerve blockade for pain management during TKA. However, it is important to note that the study has limitations and may not apply to the entire US population. [Extracted from the article]

Published
2024
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14. Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis

Author

Memtsoudis, Stavros G., Cozowicz, Crispiana, Bekeris, Janis, Bekere, Dace, Liu, Jiabin, Soffin, Ellen M., Mariano, Edward R., Johnson, Rebecca L., Hargett, Mary J., Lee, Bradley H., Wendel, Pamela, Brouillette, Mark, Go, George, Kim, Sang J., Baaklini, Lila, Wetmore, Douglas, Hong, Genewoo, Goto, Rie, Jivanelli, Bridget, Argyra, Eriphyli, Barrington, Michael J., Borgeat, Alain, De Andres, Jose, Elkassabany, Nabil M., Gautier, Philippe E., Gerner, Peter, Gonzalez Della Valle, Alejandro, Goytizolo, Enrique, Kessler, Paul, Kopp, Sandra L., Lavand’Homme, Patricia, MacLean, Catherine H., Mantilla, Carlos B., MacIsaac, Daniel, McLawhorn, Alexander, Neal, Joseph M., Parks, Michael, Parvizi, Javad, Pichler, Lukas, Poeran, Jashvant, Poultsides, Lazaros A., Sites, Brian D., Stundner, Otto, Sun, Eric C., Viscusi, Eugene R., Votta-Velis, Effrossyni G., Wu, Christopher L., Ya Deau, Jacques T., and Sharrock, Nigel E.

Published
2019
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20. A matched case-control comparison of hospital costs and outcomes for knee replacement patients admitted postoperatively to acute care versus rehabilitation

Author

Tse, Brian K., Walters, Tessa L., Howard, Steven K., Kim, T. Edward, Memtsoudis, Stavros G., Sun, Eric C., and Kou, Alex

Subjects
Hospitals -- Management, Health care costs -- Comparative analysis -- Analysis -- Economic aspects, Rehabilitation -- Health aspects -- Usage, Knee replacement arthroplasty -- Comparative analysis -- Economic aspects -- Patient outcomes, Company business management, Health
Abstract

For select total knee arthroplasty (TKA) patients, we have established an alternative pathway to bypass the acute care surgical ward and directly admit patients from the post-anesthesia care unit to on-campus rehabilitation. We retrospectively examined whether this 'fast track' pathway decreased costs and improved patient outcomes. After reviewing records of consecutive primary unilateral TKA patients over a 15-month period, each patient admitted to rehabilitation was matched with a control admitted to the acute care ward. The primary outcome was estimated total hospitalization cost (length of stay in days multiplied by the average cost per day). Secondary outcomes were length of stay, in-hospital pain scores, opioid use, maximum ambulatory distance and 30-day readmission, morbidity, and mortality. Of the 262 TKA patients during the study period, 14 were admitted to rehabilitation and were matched to 14 patients admitted to acute care. Estimated total hospitalization cost [median (10th-90th percentiles)] was US$30,755 (US$23,066-38,444) for ward patients compared to US$17,620 (US$13,215-33,918) for rehabilitation patients (P = 0.006). This difference [mean (95% CI)] was US$10,143 (US$2174-18,112). There were no other differences. For facilities similar to ours, direct postoperative admission of select TKA patients to subacute rehabilitation may be less costly than acute care and may not negatively affect outcomes., Author(s): Brian K. Tse [sup.1] , Tessa L. Walters [sup.1] [sup.2] , Steven K. Howard [sup.1] [sup.2] , T. Edward Kim [sup.1] [sup.2] , Stavros G. Memtsoudis [sup.3] [sup.4] , [...]

Published
2017
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22. Meeting Report: First Cardiovascular Outcomes Research in Perioperative Medicine Conference

Author

Bartels, Karsten, primary, Howard-Quijano, Kimberly, additional, Prin, Meghan, additional, Shaefi, Shahzad, additional, Steppan, Jochen, additional, Sun, Eric C., additional, Williams, Brittney, additional, Fox, Amanda A., additional, Namuyonga, Judith, additional, Shaw, Andrew D., additional, Vavilala, Monica S., additional, and Sessler, Daniel I., additional

Published
2022
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27. In Response

Author

Sun, Eric C., Bateman, Brian T., Memtsoudis, Stavros G., Neuman, Mark D., Mariano, Edward R., and Baker, Laurence C.

Published
2018
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37. Preoperative GLP-1 Receptor Agonists and Risk of Postoperative Respiratory Complications—Reply.

Author

Dixit, Anjali A., Bateman, Brian T., and Sun, Eric C.

Subjects
SURGICAL complications, GLUCAGON-like peptide-1 agonists, ELECTIVE surgery, GLUCAGON-like peptide-1 receptor, RESPIRATORY aspiration
Abstract

A recent analysis published in the Journal of the American Medical Association found no association between the use of GLP-1 receptor agonists (GLP-1 RAs) before surgery and postoperative respiratory complications in patients who underwent emergency surgery. The study focused on emergency surgery patients because they were likely unable to withhold their GLP-1 RA medications before the procedure and were expected to have a higher risk of pulmonary aspiration. The study concluded that the routine full-stomach precautions taken by anesthesiologists during emergency surgeries were safe and effective for patients taking GLP-1 RAs, suggesting that these precautions would also be safe for patients undergoing elective surgery. The study also addressed concerns about the sensitivity of claims-based codes to detect postoperative respiratory complications and clarified the difference between "guidelines" and "guidance" in relation to GLP-1 RA medication withholding times. [Extracted from the article]

Published
2024
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38. Preoperative GLP-1 Receptor Agonist Use and Risk of Postoperative Respiratory Complications.

Author

Dixit, Anjali A., Bateman, Brian T., Hawn, Mary T., Odden, Michelle C., and Sun, Eric C.

Subjects
GLUCAGON-like peptide-1 agonists, GLUCAGON-like peptide 1, PEPTIDE receptors
Abstract

This cohort study evaluates the risk of postoperative respiratory complications among patients with diabetes undergoing surgery who had vs those who had not a prescription fill for glucagon-like peptide 1 receptor agonists. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

Author

Memtsoudis, Stavros G, primary, Cozowicz, Crispiana, additional, Bekeris, Janis, additional, Bekere, Dace, additional, Liu, Jiabin, additional, Soffin, Ellen M, additional, Mariano, Edward R, additional, Johnson, Rebecca L, additional, Go, George, additional, Hargett, Mary J, additional, Lee, Bradley H, additional, Wendel, Pamela, additional, Brouillette, Mark, additional, Kim, Sang Jo, additional, Baaklini, Lila, additional, Wetmore, Douglas S, additional, Hong, Genewoo, additional, Goto, Rie, additional, Jivanelli, Bridget, additional, Athanassoglou, Vassilis, additional, Argyra, Eriphili, additional, Barrington, Michael John, additional, Borgeat, Alain, additional, De Andres, Jose, additional, El-Boghdadly, Kariem, additional, Elkassabany, Nabil M, additional, Gautier, Philippe, additional, Gerner, Peter, additional, Gonzalez Della Valle, Alejandro, additional, Goytizolo, Enrique, additional, Guo, Zhenggang, additional, Hogg, Rosemary, additional, Kehlet, Henrik, additional, Kessler, Paul, additional, Kopp, Sandra, additional, Lavand'homme, Patricia, additional, Macfarlane, Alan, additional, MacLean, Catherine, additional, Mantilla, Carlos, additional, McIsaac, Dan, additional, McLawhorn, Alexander, additional, Neal, Joseph M, additional, Parks, Michael, additional, Parvizi, Javad, additional, Peng, Philip, additional, Pichler, Lukas, additional, Poeran, Jashvant, additional, Poultsides, Lazaros, additional, Schwenk, Eric S, additional, Sites, Brian D, additional, Stundner, Ottokar, additional, Sun, Eric C, additional, Viscusi, Eugene, additional, Votta-Velis, Effrossyni Gina, additional, Wu, Christopher L, additional, YaDeau, Jacques, additional, and Sharrock, Nigel E, additional

Published
2021
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43. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty:recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature

Author

Memtsoudis, Stavros G., Cozowicz, Crispiana, Bekeris, Janis, Bekere, Dace, Liu, Jiabin, Soffin, Ellen M., Mariano, Edward R., Johnson, Rebecca L., Go, George, Hargett, Mary J., Lee, Bradley H., Wendel, Pamela, Brouillette, Mark, Kim, Sang Jo, Baaklini, Lila, Wetmore, Douglas S., Hong, Genewoo, Goto, Rie, Jivanelli, Bridget, Athanassoglou, Vassilis, Argyra, Eriphili, Barrington, Michael John, Borgeat, Alain, De Andres, Jose, El-Boghdadly, Kariem, Elkassabany, Nabil M., Gautier, Philippe, Gerner, Peter, Gonzalez Della Valle, Alejandro, Goytizolo, Enrique, Guo, Zhenggang, Hogg, Rosemary, Kehlet, Henrik, Kessler, Paul, Kopp, Sandra, Lavand'homme, Patricia, Macfarlane, Alan, MacLean, Catherine, Mantilla, Carlos, McIsaac, Dan, McLawhorn, Alexander, Neal, Joseph M., Parks, Michael, Parvizi, Javad, Peng, Philip, Pichler, Lukas, Poeran, Jashvant, Poultsides, Lazaros, Schwenk, Eric S., Sites, Brian D., Stundner, Ottokar, Sun, Eric C., Viscusi, Eugene, Votta-Velis, Effrossyni Gina, Wu, Christopher L., YaDeau, Jacques, Sharrock, Nigel E., Memtsoudis, Stavros G., Cozowicz, Crispiana, Bekeris, Janis, Bekere, Dace, Liu, Jiabin, Soffin, Ellen M., Mariano, Edward R., Johnson, Rebecca L., Go, George, Hargett, Mary J., Lee, Bradley H., Wendel, Pamela, Brouillette, Mark, Kim, Sang Jo, Baaklini, Lila, Wetmore, Douglas S., Hong, Genewoo, Goto, Rie, Jivanelli, Bridget, Athanassoglou, Vassilis, Argyra, Eriphili, Barrington, Michael John, Borgeat, Alain, De Andres, Jose, El-Boghdadly, Kariem, Elkassabany, Nabil M., Gautier, Philippe, Gerner, Peter, Gonzalez Della Valle, Alejandro, Goytizolo, Enrique, Guo, Zhenggang, Hogg, Rosemary, Kehlet, Henrik, Kessler, Paul, Kopp, Sandra, Lavand'homme, Patricia, Macfarlane, Alan, MacLean, Catherine, Mantilla, Carlos, McIsaac, Dan, McLawhorn, Alexander, Neal, Joseph M., Parks, Michael, Parvizi, Javad, Peng, Philip, Pichler, Lukas, Poeran, Jashvant, Poultsides, Lazaros, Schwenk, Eric S., Sites, Brian D., Stundner, Ottokar, Sun, Eric C., Viscusi, Eugene, Votta-Velis, Effrossyni Gina, Wu, Christopher L., YaDeau, Jacques, and Sharrock, Nigel E.

Abstract

BACKGROUND: Evidence-based international expert consensus regarding the impact of peripheral nerve block (PNB) use in total hip/knee arthroplasty surgery. METHODS: A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications.Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020.The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. RESULTS: Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). CONCLUSIONS: Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. RECOMMENDATION: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.

Published
2021

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