JMIR perioperative medicine最新文献

Background: Hypothermia, defined as a core body temperature below 36 °C, is a common postoperative complication associated with adverse outcomes, including delayed wound healing, infections, and increased bleeding.

Objective: This randomized controlled trial evaluated the efficacy of different forced-air warming system temperature settings in treating postoperative hypothermia in the postanesthesia care unit.

Methods: A total of 132 patients undergoing elective surgery at Ramathibodi Hospital between April 2023 and May 2024 were randomized into 3 groups (n=44 per group): group C (warming set to 38 °C), group F1 (warming set to 42 °C), and group F2 (warming set to 42 °C, reduced to 38 °C after achieving 36 °C). Tympanic temperature was recorded at 5-minute intervals during rewarming and every 10 minutes after normothermia (≥36 °C) was achieved. The primary outcome was rewarming time. Secondary outcomes included the incidence of temperature drops, hemodynamic parameters, adverse events, and patient comfort scores.

Results: Baseline characteristics and clinical variables, including vital signs, were comparable among groups (P>.05). Group F2 achieved the shortest mean rewarming time of 33.3 (SD 13.81) min; however, differences between groups were not statistically significant (P=.460). Group F2 had the lowest incidence of temperature drops below 36 °C after normothermia (1/44, 2.27%; P=.009). Group C had the highest incidence of rewarming exceeding 1 hour (10/44, 22.73%; P=.017).

Conclusions: While rewarming times were similar across groups, the protocol using an initial setting of 42 °C followed by a reduction to 38 °C (group F2) effectively minimized temperature drops after normothermia, suggesting its superiority for managing postoperative hypothermia in the postanesthesia care unit.

Background: Health care provider burnout worsened during the COVID-19 pandemic.

Objective: This qualitative study described general surgery residents' perceptions of burnout and the impact of the COVID-19 pandemic and their attitudes toward wellness initiatives.

Methods: General surgery residents at a large training program in Canada completed a 21-item survey focused on self-reported burnout, mental health, perceptions of wellness resources, and the effects of the COVID-19 pandemic. Free-text responses were extracted for qualitative thematic content analysis. A coding framework was established, and emergent themes were identified.

Results: A total of 62% (51/82) of the residents completed the survey. Most respondents were senior residents (21/51, 41%) and identified as male (32/51, 63%). In total, 65% (33/51) of the residents met the criteria for burnout. Three themes were identified: (1) the culture of general surgery does not promote wellness, (2) the COVID-19 pandemic worsened existing access to vacation days and rest, and (3) wellness education in general surgery is ineffective and onerous to complete. General surgery residents emphasized the rigid lifestyle and culture of the specialty. Residents said that the idea of wellness was poorly executed. COVID-19 protocols increased the acceptance of taking sick days, but this was offset by staff shortages during the pandemic. Finally, residents emphasized the inefficacy of wellness education. They felt that they did not lack knowledge on reaching wellness but simply lacked the adequate time and resources to improve their well-being.

Conclusions: There are persistent concerns within the culture of general surgery that were further impacted by workload and stress during the pandemic. These results may inform future programmatic efforts to decrease resident burnout.

Background: The perioperative environment is complex and may be challenging for patients and guardians to navigate. The emotional burden and stressors inherent to the perioperative process commonly result in preoperative anxiety. Many studies have demonstrated the usefulness of virtual reality (VR) in various patient populations.

Objective: The aim of this study is to evaluate the impact of a VR-based preoperative education tool on anxiety levels in pediatric patients undergoing ambulatory ear, nose, and throat surgery, as well as in their guardians.

Methods: We performed a single-center prospective randomized controlled trial including children 6-12 years of age, presenting for ambulatory tonsillectomy and/or adenoidectomy, with or without bilateral ear tube insertion. The patients were randomized to receive VR instruction of the perioperative workflow or standard preoperative experience (non-VR). The primary outcome was patient and guardian preoperative anxiety, as measured by the 6-item State-Trait Anxiety Inventory.

Results: The study cohort included 107 patient-guardian dyads-51 in the intervention (VR) group and 56 in the control (non-VR) group. Baseline characteristics between the study and control groups were comparable; however, patients in the control group were more likely to report feeling upset compared to the VR group. The VR intervention was associated with reduced preoperative anxiety in patients and guardians compared to the control group. Patients exposed to the VR intervention had higher odds of feeling calm (OR 4.95, 95% CI 2.32-10.61; P<.001) and lower odds of feeling worried (OR 0.25, 95% CI 0.12-0.53; P<.001) compared to the control group. Similarly, guardians in the VR group had higher odds of feeling calm (OR 3.55, 95% CI 1.69-7.49; P=.001) and lower odds of feeling worried (OR 0.45, 95% CI 0.22-0.93; P=.03) compared to the control group. Both patients and guardians exposed to VR were significantly less likely to have moderate or high levels of preoperative anxiety than the control group (patients: OR 0.15, 95% CI 0.05-0.41, P<.001; guardians: OR 0.14, 95% CI 0.06-0.38, P<.001).

Conclusions: VR exposure may be effective in reducing pediatric and guardian anxiety. VR may be a suitable alternative to pharmacologic anxiolysis and future studies should compare the effect to premedication techniques.

Background: Reducing the time to surgery for patients requiring cholecystectomy may lessen the risk of adverse outcomes. Dedicated day-surgery lists supported by out-of-hospital remote monitoring have been explored as a potential solution; however, the cost-effectiveness of such innovative care models remains largely unexplored.

Objective: This study presents a cost-effectiveness analysis comparing an acute day-surgery care model with remote patient monitoring to a conventional inpatient-centric care model for high-acuity cases of cholecystitis.

Methods: Post-surgical complications, effectiveness (measured by bed days saved and quality-adjusted life years [QALYs]), and health care costs associated with the two models of care were compared over a 1-year time horizon using a decision tree model. Health care costs were estimated from the Australian health care funder perspective and expressed in 2023 Australian dollars. Uncertainty was assessed using both deterministic and probabilistic sensitivity analyses.

Results: The acute day-surgery care model dominated the conventional inpatient-centric care model by saving a mean of 1.7 inpatient days per patient (3.2 days for the conventional model versus 1.5 days for the acute day-surgery model) and lowering net health care costs by a mean of AU $1,416 (US $935) per case over the 1-year time horizon. There was no meaningful difference in QALYs between the care models. These results remained robust in both deterministic and probabilistic sensitivity analyses.

Conclusions: An acute day-surgery care model with remote patient monitoring for individuals with acute cases of cholecystitis requiring cholecystectomy would likely free bed days and provide economic benefits to the health care system compared to inpatient-centric practice. Uncertainty in QALY estimates remains a limitation.

Background: Increasing arthroplasty volumes are testing health care system capacity, budgets, and workforce resilience. Clinical pathways (CPWs) provide a practical, evidence-based structure that aligns perioperative actions from preparation through follow-up. In this review, we treat three aims as coprimary: quality (patient outcomes and adherence to best practice); resource management and efficiency at the episode level (eg, length of stay, perioperative flow, direct costs); and sustainability, defined as the ability to maintain high-quality services over time by optimizing financial, human, and environmental resources while safeguarding equitable access.

Objective: This study aimed to describe the main CPW subtypes used in hip and knee arthroplasty and synthesize evidence on their effects on quality of care, resource management, and sustainability.

Methods: We conducted a narrative review of studies indexed in PubMed and Cochrane (2013-2024) that evaluated CPWs in total hip and knee arthroplasty. Screening and selection were documented with a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-style flow diagram for transparency, and findings were synthesized thematically.

Results: Across CPW models, consistent signals of benefit were identified. Enhanced Recovery After Surgery (ERAS) pathways accelerate recovery and enable earlier discharge without increasing complications, often reducing opioid exposure and time to mobilization. Integrated Clinical Pathways improve standardization and multidisciplinary coordination across settings, reducing unwarranted variability and supporting safer transitions of care. Fast-track programs emphasize early mobilization and streamlined perioperative processes, improving patient flow and satisfaction while decreasing length of stay. Outpatient arthroplasty pathways allow same-day discharge in carefully selected, low-risk patients, reducing bed occupancy and freeing inpatient capacity. Virtual clinics support remote follow-up, patient education, and complication surveillance, decreasing unnecessary in-person visits and optimizing clinician time. Collectively, these pathways align quality improvement with sustainability by lowering bed-days, improving adherence to evidence-based practices, and enabling more efficient use of operating rooms, wards, and workforce.

Conclusions: This review highlights the importance of CPWs in improving care delivery and patient outcomes in orthopedic surgery. Future efforts should refine CPWs, integrate digital tools and platforms, adopt standardized sustainability metrics, and stay flexible to evolving service demands.

[This corrects the article DOI: 10.2196/34453.].