Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital: an ambispective cohort study

Abstract Objective To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital. Methods Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence. Results In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p = 0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p = 0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI] = 0.02 [0.00, 0.59], p = 0.03) and length of stay (HR [95% CI] = 18.5 [4.39, 78.4], p < 0.001). Conclusions The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.

Implementation of a maternal early warning system during early postpartum. A prospective observational study.

OBJECTIVE: To evaluate the implementation of a maternal early warning system (MEWS) for monitoring patients during the first two hours after delivery in a tertiary level hospital. METHODS: Implementation of the criteria between 15 March and 15 September 2018 was evaluated in 1166 patients. The parameters collected were systolic and diastolic blood pressure, heart rate, oxygen saturation, urine output, uterine involution, and bleeding. Out-of-range values of any of these parameters triggered a warning, and an obstetrician was called to examine the patient. The obstetrician then decided whether to call the anesthesiologist. We carried out a sensitivity-specificity study of triggers and a multivariate analysis of the factors involved in developing potentially fatal disorders (PFD), reintervention, critical care admission, and stay. RESULTS: The MEWS was triggered in 75 patients (6.43%). Leading trigger was altered systolic blood pressure in 32 patients (42.7%), and 11 patients had a PFD. Twenty-eight triggers were false-negatives. Sensitivity and specificity of the system was 0.28 (0.15, 0.45) and 0.94 (0.93, 0.96), respectively. The multivariate analysis showed a correlation between trigger activation and PFD. CONCLUSION: Our MEWS presented low sensitivity and high specificity, with a significant number of false-negatives.

Manejo anestésico de épulis congénito / Anesthetic management of congenital epulis

Introducción. El épulis del recién nacido es un tumor de células granulares originado en la mucosa de la cresta alveolar dental. Se presenta como una masa de tejido blando pedunculado, que puede ser lobular o multinodular. Es más habitual en mujeres que en hombres (8:1), debido, quizás, a factores hormonales en su génesis. Puede acompañarse de otras malformaciones congénitas. El manejo anestésico se basa en su potencial dificultad para la intubación y el riesgo de sangrado. Objetivos. Presentar el caso de un recién nacido con épulis congénito y hacer revisión de esta entidad y de su manejo anestésico. Métodos y resultados. Presentación de este caso clínico. Conclusiones. Hay descritos varios tipos de anestesia, dependiendo, entre otros factores, del tamaño del tumor y de los profesionales que intervienen en su exéresis. En nuestro caso, y dadas las características del tumor, optamos por una sedación inhalatoria con O2 /aire / sevofluorane, posición en decúbito lateral e infiltración local en la base del implantación. El éxito de la intervención debe basarse en una buena colaboración quirúrgico-anestésica.

Introduction. epulis of the newborn is agranular cell tumor arising in the mucosa of the dental ridge. It presents as a pedunculated soft tissue mass that can be lobular or multinodular.It is more common in females than inmales (8:1) perhaps due to hormonal factors. It may be accompanied by other congenital malformations. Anesthetic management is based on a potentially difficult intubation and the risk of bleeding. Objectives. To present the case of a newborn with congenital epulis and to review this pathologyand its anesthetic management.Methods and Results Clinical case presentation. Conclusions. Several types of anesthesia havebeen described depending, among other factors, on tumor size and on the professionals involved in excising the lesion. In our case, and given the characteristics of the tumor, we chose inhalation sedation with O2 / air / sevoflurane, lateral decubitus position and local infiltration at the base of implantation. Good collaboration between the surgeon and the anesthetist is critical for success.