Articles: postoperative-complications.
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Acta Anaesthesiol Scand · Sep 2020
Randomized Controlled Trial Multicenter StudyEffect of non-sedation on posttraumatic stress and psychological health in survivors of critical illness.
Critical illness can cause post-traumatic stress and impaired mental health. The NONSEDA trial was a Scandinavian multicenter RCT, assessing non-sedation versus sedation with a daily wake-up call during mechanical ventilation in critically ill adults. The aim of this substudy was to assess the effect of non-sedation on post-traumatic stress and mental health. ⋯ Levels of PTSD, anxiety and depression and quality of life regarding mental health were similar between the non-sedated and sedated group.
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Randomized Controlled Trial Multicenter Study
Effect of Pharmacologic Prophylaxis on Venous Thromboembolism After Radical Prostatectomy: The PREVENTER Randomized Clinical Trial.
Direct high-quality evidence is lacking evaluating perioperative pharmacologic prophylaxis (PP) after radical prostatectomy (RP) to prevent venous thromboembolism (VTE) leading to significant practice variation. ⋯ In this report, we randomized patients undergoing radical prostatectomy to perioperative pharmacologic prophylaxis or routine care alone. We found that pharmacologic prophylaxis did not reduce postoperative symptomatic venous thromboembolism significantly for men at routine risk. Importantly, pharmacologic prophylaxis did not increase adverse events, such as formation of lymphoceles or bleeding, and can safely be implemented when indicated for patients with risk factors undergoing radical prostatectomy.
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Reducing inpatient readmissions is a national priority for improving healthcare quality and decreasing costs. Previous studies have shown that readmissions after surgical aortic valve replacement are frequent and contribute to increased healthcare costs, yet no studies have analyzed risk factors for readmission. ⋯ Using a national inpatient database, we found readmission after surgical aortic valve replacement to be common and resource-intensive. Enhanced management of comorbidities and targeted postdischarge interventions for patients at high risk of readmission may help decrease healthcare utilization.
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Acta Anaesthesiol Scand · Sep 2020
Randomized Controlled Trial Multicenter StudyLong-term mortality in the Intermediate care after emergency abdominal surgery (InCare) trial - a post-hoc follow-up study.
Patients undergoing emergency abdominal surgery are at high risk of post-operative complications. Although post-operative treatment at an intermediate care unit may improve early outcome, there is a lack of studies on the long-term effects of such therapy. The aim of this study was to assess the long-term effect of intermediate care versus standard surgical ward care on mortality in the Intermediate Care After Emergency Abdominal Surgery (InCare) trial. ⋯ We found no statistically significant difference in 6-year mortality between patients randomized to post-operative intermediate care or ward care after emergency abdominal surgery. However, we detected an absolute mortality risk reduction of 5% in favour of ward care, possibly due to random error.
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Multicenter Study
The Impact of Mental Illness on Postoperative Outcomes Among Medicare Beneficiaries: A Missed Opportunity to Help Surgical Patients?
The aim of this study was to define the prevalence of preexisting mental illness, as well as characterize the impact of a preexisting mental illness diagnosis on postoperative outcomes. ⋯ Three in 10 Medicare beneficiaries had a preexisting mental illness diagnosis, which was strongly associated with worse postoperative outcomes, as well as suicide risk. Surgeons need to optimize mental health assessment and services in the preoperative setting to improve outcomes for this vulnerable population.