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Frances Chung - One of the best experts on this subject based on the ideXlab platform.
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selection of obese patients undergoing Ambulatory Surgery a systematic review of the literature
Anesthesia & Analgesia, 2013Co-Authors: Girish P Joshi, Shireen Ahmad, Waleed Riad, Stanley Eckert, Frances ChungAbstract:BACKGROUND:The incidence of obesity has increased over the past 2 decades. In recent years, several studies have assessed perioperative outcomes in obese patients undergoing Ambulatory Surgery. However, this evidence has not been reviewed and evaluated systematically.METHODS:We conducted a systemati
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society for Ambulatory anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for Ambulatory Surgery
Anesthesia & Analgesia, 2012Co-Authors: Girish P Joshi, Tong J Gan, Saravanan P Ankichetty, Frances ChungAbstract:The suitability of Ambulatory Surgery for a patient with obstructive sleep apnea (OSA) remains controversial because of concerns of increased perioperative complications including postdischarge death. Therefore, a Society for Ambulatory Anesthesia task force on practice guidelines developed a consensus statement for the selection of patients with OSA scheduled for Ambulatory Surgery. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Although the studies evaluating perioperative outcome in OSA patients undergoing Ambulatory Surgery are sparse and of limited quality, they do provide useful information that can guide clinical practice. Patients with a known diagnosis of OSA and optimized comorbid medical conditions can be considered for Ambulatory Surgery, if they are able to use a continuous positive airway pressure device in the postoperative period. Patients with a presumed diagnosis of OSA, based on screening tools such as the STOP-Bang questionnaire, and with optimized comorbid conditions, can be considered for Ambulatory Surgery, if postoperative pain can be managed predominantly with nonopioid analgesic techniques. On the other hand, OSA patients with nonoptimized comorbid medical conditions may not be good candidates for Ambulatory Surgery. What other guidelines are available on this topic? The American Society of Anesthesiologists (ASA) practice guidelines for management of surgical patients with OSA published in 2006. Why was this guideline developed? The ASA guidelines are outdated because several recent studies provide new information such as validated screening tools for clinical diagnosis of OSA and safety of Ambulatory laparoscopic bariatric Surgery in OSA patients. Therefore, an update on the selection of patients with OSA undergoing Ambulatory Surgery is warranted. How does this guideline differ from existing guidelines? Unlike the ASA guidelines, this consensus statement recommends the use of the STOP-Bang criteria for preoperative OSA screening and considers patients' comorbid conditions in the patient selection process. Also, current literature does not support the ASA recommendations that upper abdominal procedures are not appropriate for Ambulatory Surgery. Why does this guideline differ from existing guidelines? This consensus statement differs from existing ASA guidelines because of the availability of new evidence.
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society for Ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing Ambulatory Surgery
Anesthesia & Analgesia, 2010Co-Authors: Girish P Joshi, Frances Chung, Tong J Gan, Mary Ann Vann, Shireen Ahmad, Daniel T Goulson, Douglas G Merrill, Rebecca S TwerskyAbstract:Optimal evidence-based perioperative blood glucose control in patients undergoing Ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing Ambulatory Surgery. A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. The consensus panel used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for providing suggestions. It was revealed that there is insufficient evidence to provide strong recommendations for the posed clinical questions. In the absence of high-quality evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. In addition, areas of further research were also identified.
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development of the functional recovery index for Ambulatory Surgery and anesthesia
Anesthesiology, 2009Co-Authors: Jean Wong, Doris Tong, Yoshani De Silva, Amir Abrishami, Frances ChungAbstract:Background: It is increasingly important to evaluate patients’ recovery after Ambulatory Surgery. The authors developed the Functional Recovery Index (FRI) to assess postdischarge functional recovery for Ambulatory surgical patients. Methods: The scale development involved four phases: item generation, item selection, reliability, and validity testing. A draft questionnaire was tested and revised. Items were selected through testing endorsement frequency, factor analysis, and testing internal consistency. The interrater reliability was calculated. Construct validity was tested by multiple hypotheses on convergent validity, extreme groups, and discriminant validity. Responsiveness was assessed by measuring the FRI postoperatively and comparing minor versus more extensive Surgery. The rate of response and the time for completion of the questionnaire were recorded. Results: The final questionnaire had 14 items grouped under 3 factors. Each item was scored from 0 to 10, with 0 no difficulty and 10 extreme difficulty with the activity. The 3 factors were summated for a total score. Internal consistency for the 3 factors (pain and social activity, lower limb activity, and general physical activity) was as follows: Cronbach 0.90, 0.89, and 0.86, respectively. Interrater reliability was 0.99. Convergent validity for FRI versus verbal rating scale pain score was 0.76. Discriminant validity testing showed that the type of Surgery was significant and that intermediate ( 0.138) and major Surgery ( 0.337) were associated with higher FRI scores than minor Surgery. The time to complete the questionnaires ranged between 4 min 10 s and 4 min 35 s. Conclusions: The FRI had excellent reliability, good validity, responsiveness, and acceptability, indicating that this questionnaire will be a good instrument for assessing functional recovery of Ambulatory surgical patients. AS more complex procedures on higher risk patients are performed as Ambulatory Surgery, it is increasingly important to evaluate patients’ recovery after their hospital discharge. Data on postdischarge recovery are crucial not only as indicators for quality of care, but also as outcome measurements for the evaluation of new surgical and anesthetic techniques being developed for Ambulatory Surgery. In-hospital morbidity, such as unanticipated admission, delayed discharge, 1–3 and postdischarge morbidity, such as readmission and symptom severity, have been used as
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Elimination of preoperative testing in Ambulatory Surgery.
Anesthesia and analgesia, 2009Co-Authors: Frances Chung, Hongbo Yuan, Ling Yin, Santhira Vairavanathan, David T. WongAbstract:BACKGROUND: Preoperative testing has been criticized as having little impact on perioperative outcomes. We conducted a randomized, single-blind, prospective, controlled pilot study to determine whether indicated preoperative testing can be eliminated without increasing the perioperative incidence of adverse events in selected patients undergoing Ambulatory Surgery. METHODS: One thousand sixty-one eligible patients were randomized either to have indicated preoperative testing or no preoperative testing. In the indicated testing group, patients received indicated preoperative testing: a complete blood count, electrolytes, blood glucose, creatinine, electrocardiogram, and chest radiograph according to the Ontario Preoperative Testing Grid as per current practice, whereas in the no testing group, no testing was ordered. The investigators, data collectors, and patient outcome reviewers were blinded to the group assignment. The primary outcome measures were the rate of perioperative adverse events and the rates of adverse events within 7 and 30 days after Surgery. RESULTS: Patients’ age, gender, American Society of Anesthesiologists status, type of Surgery, and anesthesia were similar between the two groups. There were no significant differences in the rates of perioperative adverse events and the rates of adverse events within 30 days after Surgery between the no testing group and the indicated testing group. Hospital revisits 7 days were higher in the indicated testing group (P 0.05). None of the adverse events were related to the indicated testing or no testing. CONCLUSIONS: This pilot study showed that there was no increase in the perioperative adverse events as a result of no preoperative testing in our study population. A larger study is needed to demonstrate that indicated testing may be safely eliminated in selected patients undergoing Ambulatory Surgery without increasing perioperative complications. (Anesth Analg 2009;108:467‐75)
Girish P Joshi - One of the best experts on this subject based on the ideXlab platform.
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covid 19 role of Ambulatory Surgery facilities in this global pandemic
Anesthesia & Analgesia, 2020Co-Authors: Niraja Rajan, Girish P JoshiAbstract:Coronavirus disease 2019 (COVID-19) has now become a global pandemic. This has led the United States to declare a national emergency and resulted in a ban on all elective diagnostic and therapeutic procedures as well as elective Surgery in inpatient and outpatient settings. Ambulatory Surgery facilities (ASF) that perform only elective procedures are thus likely to be closed. However, these facilities may be able to assist acute care hospitals as essential (urgent and emergent) surgeries and diagnostic and therapeutic procedures will still need to be performed. The aim of this article is to explore the potential contribution of ASFs in the current health care crisis. It is important to understand that COVID-19-related information is continually evolving, and thus, the discussion provided here is subject to change.
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selection of obese patients undergoing Ambulatory Surgery a systematic review of the literature
Anesthesia & Analgesia, 2013Co-Authors: Girish P Joshi, Shireen Ahmad, Waleed Riad, Stanley Eckert, Frances ChungAbstract:BACKGROUND:The incidence of obesity has increased over the past 2 decades. In recent years, several studies have assessed perioperative outcomes in obese patients undergoing Ambulatory Surgery. However, this evidence has not been reviewed and evaluated systematically.METHODS:We conducted a systemati
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society for Ambulatory anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for Ambulatory Surgery
Anesthesia & Analgesia, 2012Co-Authors: Girish P Joshi, Tong J Gan, Saravanan P Ankichetty, Frances ChungAbstract:The suitability of Ambulatory Surgery for a patient with obstructive sleep apnea (OSA) remains controversial because of concerns of increased perioperative complications including postdischarge death. Therefore, a Society for Ambulatory Anesthesia task force on practice guidelines developed a consensus statement for the selection of patients with OSA scheduled for Ambulatory Surgery. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Although the studies evaluating perioperative outcome in OSA patients undergoing Ambulatory Surgery are sparse and of limited quality, they do provide useful information that can guide clinical practice. Patients with a known diagnosis of OSA and optimized comorbid medical conditions can be considered for Ambulatory Surgery, if they are able to use a continuous positive airway pressure device in the postoperative period. Patients with a presumed diagnosis of OSA, based on screening tools such as the STOP-Bang questionnaire, and with optimized comorbid conditions, can be considered for Ambulatory Surgery, if postoperative pain can be managed predominantly with nonopioid analgesic techniques. On the other hand, OSA patients with nonoptimized comorbid medical conditions may not be good candidates for Ambulatory Surgery. What other guidelines are available on this topic? The American Society of Anesthesiologists (ASA) practice guidelines for management of surgical patients with OSA published in 2006. Why was this guideline developed? The ASA guidelines are outdated because several recent studies provide new information such as validated screening tools for clinical diagnosis of OSA and safety of Ambulatory laparoscopic bariatric Surgery in OSA patients. Therefore, an update on the selection of patients with OSA undergoing Ambulatory Surgery is warranted. How does this guideline differ from existing guidelines? Unlike the ASA guidelines, this consensus statement recommends the use of the STOP-Bang criteria for preoperative OSA screening and considers patients' comorbid conditions in the patient selection process. Also, current literature does not support the ASA recommendations that upper abdominal procedures are not appropriate for Ambulatory Surgery. Why does this guideline differ from existing guidelines? This consensus statement differs from existing ASA guidelines because of the availability of new evidence.
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society for Ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing Ambulatory Surgery
Anesthesia & Analgesia, 2010Co-Authors: Girish P Joshi, Frances Chung, Tong J Gan, Mary Ann Vann, Shireen Ahmad, Daniel T Goulson, Douglas G Merrill, Rebecca S TwerskyAbstract:Optimal evidence-based perioperative blood glucose control in patients undergoing Ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing Ambulatory Surgery. A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. The consensus panel used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for providing suggestions. It was revealed that there is insufficient evidence to provide strong recommendations for the posed clinical questions. In the absence of high-quality evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. In addition, areas of further research were also identified.
Rebecca S Twersky - One of the best experts on this subject based on the ideXlab platform.
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society for Ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing Ambulatory Surgery
Anesthesia & Analgesia, 2010Co-Authors: Girish P Joshi, Frances Chung, Tong J Gan, Mary Ann Vann, Shireen Ahmad, Daniel T Goulson, Douglas G Merrill, Rebecca S TwerskyAbstract:Optimal evidence-based perioperative blood glucose control in patients undergoing Ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing Ambulatory Surgery. A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. The consensus panel used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for providing suggestions. It was revealed that there is insufficient evidence to provide strong recommendations for the posed clinical questions. In the absence of high-quality evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. In addition, areas of further research were also identified.
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what happens after discharge return hospital visits after Ambulatory Surgery
Anesthesia & Analgesia, 1997Co-Authors: Rebecca S Twersky, David Fishman, Peter HomelAbstract:The purpose of this study was to examine the frequency of return hospital visits after Ambulatory Surgery discharge and to identify any predictor variables for its occurrence. A retrospective review of hospital records for all patients returning to the same hospital within 30 days after Ambulatory Surgery was conducted. Data on return hospital visits that resulted in rehospitalization (as an inpatient or to the Ambulatory Surgery unit [ASU]) or treatment as an outpatient in the emergency room were recorded. A total of 6243 patients underwent Ambulatory Surgery over 12 consecutive months and 187 returned to the same hospital of which 1.3% were for complications. Of all the returns, 54% returned to the emergency room (ER) and 46% were rehospitalized as inpatients or to ASU. To identify factors associated with an increased likelihood of return, two case controls for each return visit were obtained from medical records of Ambulatory surgical patients operated on during the same time period. Results of the multivariate analysis on the matched case controls identified urology as the only significant surgical service that predicted returns. (Odds ratio 27.87; confidence interval [CI] 3.78-74.86; P = 0.0002). A separate analysis of the most common ASU procedures performed identified two surgical procedures that predicted hospital return as compared with overall Ambulatory Surgery population: patients undergoing varicocelectomy and hydrocelectomy procedures were 8.3 times more likely to return (CI 2.090-23.75; P = 0.0042); patients undergoing dilation and curettage were three times as likely to return (CI 1.78-5.55; P = 0.0002). Bleeding was the most common reason for all hospital returns (41.5%), with 76.5% of these patients treated and discharged through the ER. The increased likelihood of return visits after urology procedures warrants further evaluation. As patients with bleeding were most likely to return to the ER and discharged, more effective pre- and postprocedure patient education may further reduce this occurrence. Better informing patients regarding the prognosis of bleeding, and advising them of medical alternatives, could reduce inappropriate patient returns to the ER.
Lin Fritschi - One of the best experts on this subject based on the ideXlab platform.
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risk of respiratory complications and wound infection in patients undergoing Ambulatory Surgery smokers versus nonsmokers
Anesthesiology, 2002Co-Authors: Paul S Myles, George A Iacono, Jennifer O Hunt, Helen Fletcher, John Morris, David R Mcilroy, Lin FritschiAbstract:Background: Smoking is considered to be a risk factor for patients undergoing Surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing Ambulatory Surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers. Methods: The authors studied a random selection of 489 adult patients undergoing Ambulatory Surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge ± positive microbial culture, requiring antibiotic therapy) in smokers versus nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner's smoking status, domiciliary smoking exposure, and extent and duration of Surgery. Results: Most smokers continued to smoke up until the day of Surgery. Smokers had a higher rate of respiratory complications (32.8% vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.84; P = 0.038) and wound infection (3.6% vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58-175; P = 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications. Conclusions: Smoking was associated with an increased risk of respiratory complications and postoperative wound infection in Ambulatory Surgery patients. These findings warrant increased efforts at promoting smoking avoidance and cessation.
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risk of respiratory complications and wound infection in patients undergoing Ambulatory Surgery smokers versus nonsmokers
Anesthesiology, 2002Co-Authors: Paul S Myles, George A Iacono, Jennifer O Hunt, Helen Fletcher, John Morris, David R Mcilroy, Lin FritschiAbstract:Background: Smoking is considered to be a risk factor for patients undergoing Surgery and anesthesia, but it is unclear whether this is applicable to patients undergoing Ambulatory Surgery. The aim of this study was to determine the risk of respiratory complications and wound infection among smokers. Methods: The authors studied a random selection of 489 adult patients undergoing Ambulatory Surgery. Smoking status was determined by self-report and confirmed with end-expired carbon monoxide analysis. The risk of respiratory complications (i.e., desaturation, cough, laryngospasm, bronchospasm, breath-holding, or apnea) and wound infection (i.e., wound redness or discharge positive microbial culture, requiring antibiotic therapy) in smokers versus nonsmokers was ascertained. Odds ratios were estimated from multivariable logistic regression and adjusted for age, gender, body mass index, partner’s smoking status, domiciliary smoking exposure, and extent and duration of Surgery. Results: Most smokers continued to smoke up until the day of Surgery. Smokers had a higher rate of respiratory complications (32.8% vs. 25.9%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03‐2.84; P 0.038) and wound infection (3.6% vs. 0.6%; odds ratio, 16.3; 95% confidence interval, 1.58‐175; P 0.019). Odds ratios comparing current plus ex-smokers with nonsmokers were of similar magnitude for most of these complications. Conclusions: Smoking was associated with an increased risk of respiratory complications and postoperative wound infection in Ambulatory Surgery patients. These findings warrant increased efforts at promoting smoking avoidance and cessation. SMOKING is a major health risk, with just under 20% of all deaths in developed countries attributed to tobacco. 1 It is also generally accepted that smoking increases the risk of complications in patients undergoing anesthesia and Surgery. 2–11 Despite this, it is our experience, and that of others, 12 that recommendations to stop smoking before elective Surgery are rarely heeded. Most previous studies of perioperative risk associated with smoking were based on self-reporting and did not control for additional risk factors. Also, they may not represent current surgical and anesthetic practice. For example, there has been a marked increase in the proportion of Surgery performed on an Ambulatory (daystay) basis, and this important group has not been previously studied. We therefore studied a broad range of patients undergoing Ambulatory Surgery and confirmed their smoking status with end-expired carbon monoxide (COexp) analysis.
Guohua Li - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness analysis of stocking dantrolene in Ambulatory Surgery centers for the treatment of malignant hyperthermia
Anesthesiology, 2014Co-Authors: Taiwo Aderibigbe, Barbara H Lang, Henry Rosenberg, Qixuan Chen, Guohua LiAbstract:BACKGROUND: Malignant hyperthermia (MH) is a rare hypermetabolic syndrome of the skeletal muscle and a potentially fatal complication of general anesthesia. Dantrolene is currently the only specific treatment for MH. The Malignant Hyperthermia Association of the United States has issued guidelines recommending that 36 vials (20 mg per vial) of dantrolene remain in stock at every Surgery center. However, the cost of stocking dantrolene in Ambulatory Surgery centers has been a concern. The purpose of this analysis is to assess the cost-effectiveness of stocking dantrolene in Ambulatory Surgery centers as recommended by the Malignant Hyperthermia Association of the United States. METHODS: A decision tree model was used to compare treatment with dantrolene to a supportive care-only strategy. Model assumptions include the incidence of MH, MH case fatality with dantrolene treatment and with supportive care-only. Sensitivity analyses were performed to assess the robustness of the estimated cost-effectiveness. RESULTS: The estimated annual number of MH events in Ambulatory Surgery centers in the United States was 47. The incremental effectiveness of dantrolene compared with supportive care was 33 more lives saved per year. The incremental cost-effectiveness ratio was $196,320 (in 2010 dollars) per life saved compared with a supportive care strategy. Sensitivity analysis showed that the results were robust for the plausible range of all variables and assumptions tested. CONCLUSION: The results of this analysis suggest that stocking dantrolene for the treatment of MH in Ambulatory Surgery centers as recommended by the Malignant Hyperthermia Association of the United States is cost-effective when compared with the estimated values of statistical life used by U.S. regulatory agencies.
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cost effectiveness analysis of stocking dantrolene in Ambulatory Surgery centers for the treatment of malignant hyperthermia
Anesthesiology, 2014Co-Authors: Taiwo Aderibigbe, Barbara H Lang, Henry Rosenberg, Qixuan Chen, Guohua LiAbstract:BACKGROUND: Malignant hyperthermia (MH) is a rare hypermetabolic syndrome of the skeletal muscle and a potentially fatal complication of general anesthesia. Dantrolene is currently the only specific treatment for MH. The Malignant Hyperthermia Association of the United States has issued guidelines recommending that 36 vials (20 mg per vial) of dantrolene remain in stock at every Surgery center. However, the cost of stocking dantrolene in Ambulatory Surgery centers has been a concern. The purpose of this analysis is to assess the cost-effectiveness of stocking dantrolene in Ambulatory Surgery centers as recommended by the Malignant Hyperthermia Association of the United States. METHODS: A decision tree model was used to compare treatment with dantrolene to a supportive care-only strategy. Model assumptions include the incidence of MH, MH case fatality with dantrolene treatment and with supportive care-only. Sensitivity analyses were performed to assess the robustness of the estimated cost-effectiveness. RESULTS: The estimated annual number of MH events in Ambulatory Surgery centers in the United States was 47. The incremental effectiveness of dantrolene compared with supportive care was 33 more lives saved per year. The incremental cost-effectiveness ratio was $196,320 (in 2010 dollars) per life saved compared with a supportive care strategy. Sensitivity analysis showed that the results were robust for the plausible range of all variables and assumptions tested. CONCLUSION: The results of this analysis suggest that stocking dantrolene for the treatment of MH in Ambulatory Surgery centers as recommended by the Malignant Hyperthermia Association of the United States is cost-effective when compared with the estimated values of statistical life used by U.S. regulatory agencies.