Category Archives: Peri-Operative Medicine

SSRIs associated with higher perioperative risks

This large propensity matched study found perioperative SSRIs were associated with higher in-hospital mortality, bleeding, and 30 day readmission rates compared to those not on SSRIs. More data is needed to determine if the association is due to the SSRI … Continue reading

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Perioperative beta blockers

This large retrospective analysis of VA medical centers found that patients who received perioperative beta blockers (for noncardiac surgery) had significantly lower 30 day mortality if their revised cardiac risk index was 2 or higher. This study adds more evidence … Continue reading

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Surgical complications make money

This large cohort found the contribution margin in patients who suffered a post surgical complication was actually higher for most payers, compared to patients who did not suffer a complication. Unfortunately, in the short term, reducing complications may have a … Continue reading

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Post op adverse events higher among schizophrenics

This population based study found schizophrenics were significantly more likely to suffer post operative adverse events, including acute renal failure, pneumonia, sepsis, bleeding, stroke and mortality. Hospitalists should be aware of the need for careful postoperative monitoring of schizophrenic patients … Continue reading

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DM controls does not affect outcomes after knee arthroplasty

This large retrospective cohort of patients undergoing elective knee arthroplasty found HbA1c above or below 7% did not affect any major outcomes (VTE, revisions, infections, readmissions, or AMI). There is not a clear correlation between preop HbA1c levels and postop … Continue reading

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Antibiotic timing and risk of SSI

This large retrospective VA cohort found timing of perioperative antibiotics did not have any effect on SSIs (eg within or not within 60 minutes of skin incision). Despite longstanding public reporting for CMS, antibiotic timing does not appear to affect … Continue reading

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No benefit for IVC filters with bariatric surgery

In this large statewide registry of bariatric patients, there was no benefit of prophylactic IVC filters, but there was significant harm, including higher rates of PE, DVT, complications, and death. There does not appear to be any benefit of IVC … Continue reading

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Incidence of cardiac arrest among surgical patients

In this large analysis from NSQUIP, the overall incidence of CPR among surgical patients was ~1/200 but varied by surgical type (~1/33 cardiac surgery and ~1/250 for general surgery). Mortality at 30 days was 72%. These provide excellent benchmarks for … Continue reading

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No need for pre-operative urinary culture

This study found that the use of preoperative urine cultures was associated with higher rates of surgical site infections, diarrhea and Cdiff infections; and bacteriuria alone was not associated with higher surgical site infections. Based on this, there does not … Continue reading

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TKA volume markedly increased

In this large observational cohort of Medicare patients, the volume of total knee arthroplasty (TKA) increased 162% from 1991 to 2010, while revisions increased 106%. Length of stay dropped from 7.9 to 3.5 days, and 30 day readmissions increased from … Continue reading

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