Journal of perioperative practice最新文献

Background: A lack of awareness of who should conduct research, conflicting workload priorities, lack of research skills, lack of confidence and lack of supportive relationships are often cited as barriers for undertaking research within the perioperative environment. Building a robust research capacity for Operating Department Practitioners and Theatre Nurses to engage with and lead primary research is critical to develop perioperative clinical outcomes, and for professional and research excellence.

Aims: This study aimed to explore the attitudes of Operating Department Practitioners and Theatre Nurses towards research.

Methods: An online questionnaire was distributed nationally between 1 October 2022 and 31 December 2022. The questionnaire received 164 responses from 114 Operating Department Practitioners, 44 Theatre Nurses and 6 respondents identifying as other.

Findings: These revealed that those with a positive attitude towards research were most likely to have obtained a Master's level qualification (i.e. MSc) and had gained experience in research post-registration. When explored further, the overall positive attitude to research was found to be possibly linked to a belief in the usefulness of research and to prior exposure. The findings of this study can be used to help support, inform and strengthen research in clinical practice and research career aspirations.

Conclusion: Analysis of the data suggests that participants holding a Master of Science degree and having previous experience of research reported a more positive attitude to research. When the specific attitudes to research were explored individually, there was also some evidence that the overall positive attitude to research was more likely to be related to a belief in the usefulness of research.

Background: The National Emergency Laparotomy Audit (NELA) is credited with improving outcomes after emergency laparotomy in England and Wales. Yet audit data do not save lives on their own; human effort to implement change does. This article examines how perioperative teams can convert NELA metrics into meaningful improvements, drawing on three implementation studies to separate genuine effect from 'audit spotlight' artefact.Key insights:First: outcome gains depend on implementation fidelity with local adaptation. Where bundle adherence was high and teams had senior champions, effective feedback, and practical enablers, mortality and length of stay improved. Where fidelity to the bundle faltered, benefits disappeared. Second: early wins plateau, so teams should expect diminishing returns and target the remaining vital few barriers (e.g. timely imaging, senior presence, postoperative critical care). Third: equity matters. Smaller hospitals lag on several NELA indicators, suggesting a need for focused support and shared learning. Finally, what matters to patients should be tracked, using patient-reported outcome measures (PROMs) and follow-up where feasible.

Conclusion: For perioperative services, the message is practical: NELA data should be paired with near-real-time feedback, pathway steps under clinicians' control need resources, what matters to patients needs to be measured, and local adaptation helps to sustain gains.

Postoperative deterioration remains a challenge, particularly in rural and remote hospitals. Early recognition of complications is critical, yet intermittent ward monitoring may fail to detect subtle physiological changes. Wearable biosensors offer a promising strategy to extend high-dependency surveillance beyond intensive care. These devices can provide continuous, real-time monitoring, enabling earlier intervention, supporting clinical decision-making, and reducing reliance on limited rural health care staff. Evidence suggests these devices are feasible and well tolerated. This viewpoint examines their potential to enhance postoperative surveillance in resource-limited settings and highlights the need for targeted evaluation in rural Australian hospitals to assess effectiveness, cost-benefit, and integration into perioperative practice.

Health promotion has been made as one of the top priorities by the Lord Darzi's independent investigation of the NHS. Patients who smoke have increased risks of perioperative complications. Similarly, alcohol consumption is linked with higher rates of perioperative infections. Resident anaesthetists and the multidisciplinary team are in unique positions to positively influence patients and promote lifestyle modifications. Transformations of education, working culture and integration of primary and secondary health systems are vital in achieving true holistic perioperative care.

Background: Under general anaesthesia, the impact of body positioning on different organs is mostly determined by the subsequent changes in the cardiovascular system, which are monitored with standard monitors. However, there is no objective method of neuromonitoring, therefore impacts on brain homeostasis are mainly conjectural. Near-infrared spectroscopy is a non-invasive method for monitoring tissue cerebral oxygenation. In this study, we aimed to observe the effects of the prone position on cerebral oxygenation in patients under general anaesthesia.

Methods: The study involved 44 patients undergoing spine surgeries in a prone position under general anaesthesia. Regional oxygen saturation readings were initially taken in the supine position and monitored continuously after transitioning to the prone position. A decrease in regional oxygen saturation of more than 20% was considered clinically significant.

Results: A significant drop in blood pressure (p = 0.02) and heart rate (p = 0.04) was observed after positioning patients prone under general anaesthesia. In addition, end-tidal carbon dioxide levels rose notably after 30 min in the prone position (p = 0.017). Importantly, while no significant differences were found in cerebral oxygenation between the supine and prone positions, one patient did experience right-sided vision loss postoperatively.

Conclusion: Using near-infrared spectroscopy monitors is recommended for patients with comorbidities and those undergoing surgeries with extended durations in the prone position.

Objectives: This study investigates the outcomes after very early chest drain removal following off-pump endoscopic coronary artery bypass grafting.

Methods: A single-centre retrospective cohort study was conducted at our hospital. All patients undergoing a primary endoscopic coronary artery bypass grafting procedure between May 2021 and January 2025 were eligible. Both single- or multivessel endoscopic coronary artery bypass grafting procedures were analysed. Patients were excluded if they underwent a redo-operation, coronary unroofing procedure, or conversion to sternotomy.

Results: A total of 476 patients were included in the final analysis: 246 patients in the conventional drain removal protocol and 230 patients in the early drain removal protocol. Patients in the early drain removal group had significantly higher rates of preexisting comorbidities, preoperative antithrombotic therapy, and urgent procedures (52.6% vs. 36.2%, p < 0.001). The total drain time (5.1 vs. 22.4 h, p < 0.001) and the total drain volume (135 vs. 310 mL, p < 0.001) were both significantly lower in the early postoperative drain removal protocol. There were no significant differences between protocols in the incidence of cardiac tamponade in the first 30 postoperative days (1.3% vs. 0.4%, p = 0.569) and thoracentesis rates (8.7% vs. 5.3%, p = 0.199).

Conclusions: Very early chest drain removal after endoscopic coronary artery bypass grafting is safe and does not increase postoperative complications for both single- and multivessel revascularisation. This approach enables early ambulation and may contribute to enhanced postoperative recovery.

Background: The optimal length of epidural use following open pancreaticoduodenectomy has not been defined. The aim of this study was to investigate whether the length of patient-controlled epidural analgesia affected pain and ability to mobilise on epidural termination following open pancreaticoduodenectomy in the context of enhanced recovery after surgery.

Methods: A retrospective single-centre cohort analysis was performed between November 2015 and December 2021 on patients who underwent open pancreaticoduodenectomy. As part of a continual review process of the enhanced recovery after surgery protocol, patient-controlled epidural analgesia duration changed allowing stratification of patients into either three- or five-day patient-controlled epidural analgesia groups.

Results: Of the 196 patients identified, 157 were included with 80 (50.9%) and 77 (49.1%) allocated to the three-day and five-day patient-controlled epidural analgesia groups, respectively. Patient-controlled epidural analgesia termination on postoperative day 3 was associated with transiently higher pain and less mobilisation, although no greater rescue analgesia requirement. Conversely, longer patient-controlled epidural analgesia usage following open pancreaticoduodenectomy was associated with less pain and greater mobilisation in the immediate postoperative period.

Conclusions: Earlier patient-controlled epidural analgesia termination transiently leads to increased pain and decreased mobilisation following open pancreaticoduodenectomy. Ensuring appropriate analgesia requirements or longer patient-controlled epidural analgesia usage should be considered to avoid patient discomfort and enhance recovery.

BackgroundThe COVID-19 pandemic challenges the recommendations for patients' preoperative assessment for preventing severe acute respiratory syndrome coronavirus type 2 transmission and COVID-19-associated postoperative complications and morbidities.PurposeTo evaluate the contribution of chest computed tomography for preoperatively assessing patients who are not suspected of being infected with COVID-19 at the time of referral.MethodsCandidates for emergency surgery screened via chest computed tomography from 8 to 27 April 2020 were retrospectively evaluated. Computed tomography images were analysed for the presence of COVID-19-associated intrapulmonary changes. When applicable, laboratory and recorded clinical symptoms were extracted.ResultsEighty-eight patients underwent preoperative chest computed tomography; 24% were rated as moderately suspicious and 11% as highly suspicious on computed tomography. Subsequent reverse transcription polymerase chain reaction (RT-PCR) was performed for seven patients, all of whom tested negative for COVID-19. Seven patients showed COVID-19-associated clinical symptoms, and most were classified as being mildly to moderately severe as per the clinical classification grading system. Only one case was severe. Four cases underwent RT-PCR with negative results.ConclusionIn a cohort without clinical suspicion of COVID-19 infection upon referral, preoperative computed tomography during the COVID-19 pandemic can yield a high suspicion of infection, even if the patient lacks clinical symptoms and is RT-PCR-negative. No recommendations can be made based on our results but contribute to the debate.