Peri-Operative Medicine

Post op adverse events higher among schizophrenics

This population based study found schizophrenics were significantly more likely to suffer post operative adverse events, including acute renal failure, pneumonia, sepsis, bleeding, stroke and mortality. Hospitalists should be aware of the need for careful postoperative monitoring of schizophrenic patients (abstract).

DM controls does not affect outcomes after knee arthroplasty

This large retrospective cohort of patients undergoing elective knee arthroplasty found HbA1c above or below 7% did not affect any major outcomes (VTE, revisions, infections, readmissions, or AMI). There is not a clear correlation between preop HbA1c levels and postop outcomes (abstract).

Antibiotic timing and risk of SSI

This large retrospective VA cohort found timing of perioperative antibiotics did not have any effect on SSIs (eg within or not within 60 minutes of skin incision). Despite longstanding public reporting for CMS, antibiotic timing does not appear to affect SSI rates (abstract).

No benefit for IVC filters with bariatric surgery

In this large statewide registry of bariatric patients, there was no benefit of prophylactic IVC filters, but there was significant harm, including higher rates of PE, DVT, complications, and death. There does not appear to be any benefit of IVC filters for patients undergoing bariatric surgery (abstract).

Incidence of cardiac arrest among surgical patients

In this large analysis from NSQUIP, the overall incidence of CPR among surgical patients was ~1/200 but varied by surgical type (~1/33 cardiac surgery and ~1/250 for general surgery). Mortality at 30 days was 72%. These provide excellent benchmarks for expectations for medical co-managment and consult services (abstract).
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