Perioperative Management Center (PERIO) for Neurosurgical Patients

Abstract

Perioperative management is critical for positive neurosurgical outcomes. In order to maintain safe and authentic perioperative management, a perioperative management center (PERIO) was introduced to patients of our Neurosurgery Department beginning in June 2014. PERIO involves a multidisciplinary team consisting of anesthesiologists, dentists/dental hygienists/technicians, nurses, physical therapists, pharmacists, and nutritionists. After neurosurgeons decide on the course of surgery, a preoperative evaluation consisting of blood sampling, electrocardiogram, chest X-ray, and lung function test was performed. The patients then visited the PERIO clinic 7–14 days before surgery. One or two days before surgery, the patients without particular issues enter the hospital and receive a mouth cleaning one day before surgery. After surgery, postoperative support involving eating/swallowing evaluation, rehabilitation, and pain control is provided. The differences in duration from admission to surgery, cancellation of surgery, and postoperative complications between PERIO and non-PERIO groups were examined. Eighty-five patients were enrolled in the PERIO group and 131 patients in the non-PERIO group. The duration from admission to surgery was significantly decreased in the PERIO group (3.6 ± 0.3 days), compared to that in the non-PERIO group (4.7 ± 0.2 days). There was one cancelled surgery in the PERIO group and six in the non-PERIO group. Postoperative complications and the overall hospital stay did not differ between the two groups. The PERIO system decreased the duration from admission to surgery, and it is useful in providing high-quality medical service, although the system should be improved so as not to increase the burden on medical staff.

Effects of the Multidisciplinary Preoperative Clinic on the Incidence of Elective Surgery Cancellation

“…In such situations, anesthesiologists might detect, typically on the day before surgery, significant comorbidities requiring further examinations and/or treatment, and medications not stopped appropriately, which could result in surgery cancellation. The potential to reduce such cancellation is one of the essential roles of the POC, along with enhancing patient satisfaction [8], optimizing preoperative tests [9], shortening the hospital stay [5], reducing medical costs [10,11], and improving postoperative outcomes [12].…”

“…The presence of such a POC may reduce surgery cancellation, compared with its absence. Although several studies explored the impact of the POC on surgery cancellation, most of them focused on the work of anesthesiologists alone [3,4], and research on the effects of a multidisciplinary POC remains limited only to a specific surgical area [5].…”

Spinal Surgery after Bilateral Subthalamic Stimulation for Patients with Parkinson’s Disease: A Retrospective Outcome Analysis of Pain and Functional Control

“…The perioperative management of a multidisciplinary team and the partnership between neurosurgeons and neurologists are essential for perioperative care, and early intervention against adverse events is desirable. 14 , 19) …”

Avaliação de saúde bucal e ocorrência de pneumonia durante internação hospitalar

“…Nesse contexto, o estabelecimento de protocolos clínicos para manejo dos pacientes pela equipe multidisciplinar é indispensável uma vez que há evidências da redução do tempo de internação dos pacientes e há utilidade na prestação dos cuidados após a alta 2 . Por exemplo, no sistema de saúde do Japão, há um amplo reconhecimento da importância do manejo préoperatório pelas equipes de odontologia e existe a cultura dos médicos-cirurgiões encaminharem os pacientes previamente a cirurgias para atendimento odontológico, sendo comprovada a eficácia desse sistema em estudos de base populacional -Uma taxa de intervenção odontológica de 20% foi associada a uma significativa redução da incidência de pneumonia pós-operatória 12,13 .…”