Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 2021
Successful Implementation of a Perioperative Data Warehouse Using Another Hospital's Published Specification From Epic's Electronic Health Record System.
Many hospitals have replaced their legacy anesthesia information management system with an enterprise-wide electronic health record system. Integrating the anesthesia data within the context of the global hospital information infrastructure has created substantive challenges for many organizations. A process to build a perioperative data warehouse from Epic was recently published from the University of California Los Angeles (UCLA), but the generalizability of that process is unknown. We describe the implementation of their process at the University of Miami (UM). ⋯ The data schema developed at UCLA proved to be a practical and scalable method to extract information from the Epic electronic health system database into the perioperative data warehouse in use at UM. Implementing the process developed at UCLA to build a comprehensive perioperative data warehouse from Epic is an extensible process that other hospitals seeking more efficient access to their electronic health record data should consider.
-
Anesthesia and analgesia · Feb 2021
Intraoperative Data Enhance the Detection of High-Risk Acute Kidney Injury Patients When Added to a Baseline Prediction Model.
Aspects of intraoperative management (eg, hypotension) are associated with acute kidney injury (AKI) in noncardiac surgery patients. However, it is unclear if and how the addition of intraoperative data affects a baseline risk prediction model for postoperative AKI. ⋯ Intraoperative data, when added to a baseline risk prediction model for postoperative AKI in intra-abdominal surgery patients, improves the performance of the model.
-
Anesthesia and analgesia · Feb 2021
Multicenter StudyUsing Machine Learning to Evaluate Attending Feedback on Resident Performance.
High-quality and high-utility feedback allows for the development of improvement plans for trainees. The current manual assessment of the quality of this feedback is time consuming and subjective. We propose the use of machine learning to rapidly distinguish the quality of attending feedback on resident performance. ⋯ Harnessing the potential of machine learning allows for rapid assessment of attending feedback on resident performance. Using predictive models to rapidly screen for low-quality and low-utility feedback can aid programs in improving feedback provision, both globally and by individual faculty.
-
Anesthesia and analgesia · Feb 2021
Comparative Study Observational StudyAssociations of a Preoperative Anemia and Suboptimal Iron Stores Screening and Management Clinic in Colorectal Surgery With Hospital Cost, Reimbursement, and Length of Stay: A Net Cost Analysis.
In 2016, a preoperative clinic was implemented to screen, evaluate, and manage anemia and suboptimal iron stores at a major tertiary care medical center in Western Australia. Few studies compare the costs and reimbursements associated with preoperative anemia and suboptimal iron stores management. The objective of our study was to conduct a net cost analysis associated with the implementation of this clinic. ⋯ The implementation of a preoperative anemia and suboptimal iron stores screening and management clinic in elective colorectal surgery was associated with reductions in red cell transfusions, length of stay, and net costs.
-
Anesthesia and analgesia · Feb 2021
ReviewImmune-Related Adverse Events Associated With Immune Checkpoint Inhibitor Therapy.
As part of immune surveillance, killer T lymphocytes search for cancer cells and destroy them. Some cancer cells, however, develop escape mechanisms to evade detection and destruction. One of these mechanisms is the expression of cell surface proteins which allow the cancer cell to bind to proteins on T cells called checkpoints to switch off and effectively evade T-cell-mediated destruction. ⋯ Management requires a multidisciplinary approach and consists mainly of immunosuppression, cessation or postponement of ICI treatment, and supportive therapy, which may require surgical intervention and/or intensive care. We herein review the current literature surrounding IRAEs of interest to anesthesiologists and intensivists. With proper care, fatality (0.3%-1.3%) is rare.