Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2018
ReviewImproving outcomes in ambulatory anesthesia by identifying high risk patients.
Currently, outcome data in ambulatory anesthesia are somewhat limited though results are quite good with low reported rates of mortality and major morbidity. As patient comorbidities and surgical invasiveness increase, identifying those patients at higher risk will help to focus quality improvement energy and research where most effective. Better data collection and analysis will refine patient and procedure selection and improve outcomes going forward. ⋯ Identifying high-risk ambulatory patients can help facilitate development of a strategy to triage these patients, optimize their conditions prior to surgery, and manage their care and disposition postoperatively. Inpatient surgery or admission should be considered for higher risk patients having high invasive surgery.
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The purpose of this review is to provide an update on the current knowledge about patient safety and outcomes in the office-based setting. Ambulatory procedures performed outside the hospital are steadily increasing, resulting in an increasing number and complexity of office-based procedures and patient comorbidities over the past two decades. In this review we focus on most recent outcomes studies encompassing different surgical specialties and patient populations. ⋯ Overall, these studies contribute positively to our current understanding of the safety of office-based anaesthesia. As an increasing number of procedures migrate from the hospital setting to ambulatory and office-based environments, it will be critically important to ensure high quality and safe patient care in these settings.
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Curr Opin Anaesthesiol · Dec 2018
ReviewEarly warning scores in the perioperative period: applications and clinical operating characteristics.
Early warnings scores are designed to detect clinical deterioration and promote intervention at the earliest possible moment. Although the ultimate effects on patient outcomes are unclear, early warning scores are now legally mandated in several countries. Here, we review the performance of early warning scores in surgical and perioperative populations. ⋯ Early warning scores may facilitate protocolized escalation of care for patients at risk of adverse events and can be used in surgical and postoperative patients, but high nonevent rates and practical implementation problems can restrict their usefulness.
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The prevalence of obesity continues to rise in developed countries. Increasingly, anaesthesiologists are faced with management of this cohort of patient in the ambulatory setting. This review summarizes the factors involved with such management of the obese patient as well as provision of guidance on recently accrued evidence. ⋯ Perioperative care of the obese patient is a multidisciplinary team exercise involving staff, equipment and insight into the condition. On the proviso of this insight, there is no reason why ambulatory care cannot be safely provided.