Peri-Operative Medicine

Mortality higher in late-week elective surgeries

This large cohort of elective surgical patients found those that underwent surgery later in the week or on a weekend had higher 30 day mortality compared to those that underwent surgery earlier in the week. Although uncontrolled confounding may have affected the results, the authors speculate the risk may be higher due to lower staffing on weekends (abstract).

ASA for post-THA VTE prophylaxis

This trial randomized post-THA patients to dalteparin or ASA for 28 days (after 10 days of dalteparin) and found no significant difference in VTE or bleeding rates. After 10 days of dalteparin, 28 days of ASA is safe and effective for VTE prevention post-THA (abstract)

SSRIs associated with higher perioperative risks

This large propensity matched study found perioperative SSRIs were associated with higher in-hospital mortality, bleeding, and 30 day readmission rates compared to those not on SSRIs. More data is needed to determine if the association is due to the SSRI itself, and if so, if perioperative suspension of SSRIs is warranted (abstract).

Perioperative beta blockers

This large retrospective analysis of VA medical centers found that patients who received perioperative beta blockers (for noncardiac surgery) had significantly lower 30 day mortality if their revised cardiac risk index was 2 or higher. This study adds more evidence base to the practice of continuing or starting perioperative beta blockers in those with a RCRI of 2 or more (abstract).

Surgical complications make money

This large cohort found the contribution margin in patients who suffered a post surgical complication was actually higher for most payers, compared to patients who did not suffer a complication. Unfortunately, in the short term, reducing complications may have a negative financial impact on hospitals (abstract).