Journal of clinical anesthesia
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This study assessed whether implementation of an enhanced recovery-based pathway decreased length of stay without increasing readmissions among patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. ⋯ Patients undergoing PSF for AIS experienced shorter hospital stays without increased readmissions following the implementation of an enhanced recovery pathway. Development of this pathway required buy-in from multiple stakeholders and significant coordination among services. The principles used to develop this pathway may be applied in other institutions and to other patient populations using the model outlined here.
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Observational Study
Development and validation of a risk score for predicting postoperative delirium after major abdominal surgery by incorporating preoperative risk factors and surgical Apgar score.
To develop and validate a simple delirium-predicting scoring system in patients undergoing major abdominal surgery by incorporating preoperative risk factors and intraoperative surgical Apgar score (SAS). ⋯ The prognostic scoring system, which used both preoperative risk factors and surgical Apgar score, serves as a good first step toward a clinically useful predictive model for postoperative delirium in patients undergoing major open abdominal surgery.
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Observational Study
Most surgeons' daily elective lists in Florida comprise only 1 or 2 elective cases, making percent utilization unreliable for planning individual surgeons' block time.
Operating room (OR) utilization has been shown in multiple studies to be an inappropriate metric for planning OR time for individual surgeons. Among surgeons with low daily caseloads, percentage utilization cannot be measured accurately because confidence limits are extremely wide. In Iowa, a largely rural state, most surgeons performed only 1 or 2 elective cases on their OR days. To assess generalizability, we analyzed Florida, a state with many high-population density areas. ⋯ Most surgeons' lists of elective surgical cases comprised 1 or 2 cases in the largely urban state of Florida, as previously found in the largely rural state of Iowa. Results were insensitive to organizational size or county population. Thus, our finding is generalizable in the United States. Consequently, neither adjusted nor raw utilization should be used solely when allocating OR time to individual surgeons. Anesthesia and nursing coverage of cases can be based on maximizing the efficiency of use of OR time.