Systematic Criteria for Type and Screen Based on Procedure’s Probability of Erythrocyte Transfusion

Dexter, Franklin; Ledolter, Johannes; Davis, Erika; Witkowski, Thomas A.; Herman, Jay H.; Epstein, Richard H.

doi:10.1097/01.sa.0000418899.14247.63

Cited by 21 publications

(47 citation statements)

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“…d However, far fewer than 5% of patients undergoing anesthesia receive a blood transfusion. 20,30,31 2. STAFF SCHEDULING, CASE SCHEDULING, AND STAFF ASSIGNMENT An opportunity for cost reduction through the Surgical Home's enhanced coordination of care is literally the coordination of care: staff scheduling months in advance, case scheduling into the staffed time, and then staff assignment to the most appropriate cases.…”

Section: Reduce Unnecessary Interventions That Do Not Have Potential mentioning

confidence: 99%

Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

Dexter

Wachtel²

2014

Anesthesia &Amp; Analgesia

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The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. One opportunity is to reduce unnecessary interventions that do not have potential to benefit patients (e.g., preoperative laboratory studies in healthy patients undergoing low-risk surgery and use of substantial fresh gas flows with volatile anesthetics). The other opportunity is to optimize staff scheduling, case scheduling, and staff assignment. These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay.

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Section: Reduce Unnecessary Interventions That Do Not Have Potential mentioning

confidence: 99%

Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

Dexter

Wachtel²

2014

Anesthesia &Amp; Analgesia

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“…There are multiple explanations for this missingness, although the most common reason has been shown to be minimal blood loss, which is not accurately documented in a computerized record that requires numeric input. 14 We performed multiple imputation to impute missing values for estimated blood loss. We first constructed a regression model using age, procedure code, lowest hemoglobin value, difference between initial and lowest hemoglobin value, IV fluid administered during anesthesia, and intraoperative transfusion of packed red blood cell units.…”

Section: Discussionmentioning

confidence: 99%

Odds of Transfusion for Older Adults Compared With Younger Adults Undergoing Surgery

Brown¹,

Savage²,

Masear³

et al. 2014

Survey of Anesthesiology

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BACKGROUND-Recent randomized controlled trials have shown no benefit for transfusion to a hemoglobin >10 g/dL compared with lower hemoglobin thresholds in the perioperative period, even among older adults. Nevertheless, physicians may choose to transfuse older adults more liberally than younger adults. It is unclear whether older patients have higher odds than younger patients of being transfused in the perioperative period. Our objective in this study was to determine whether the odds of transfusion are higher in older patients than in younger patients in the perioperative period.

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“…A separate category was created for cases in which fluid was not charted. Estimated blood loss was not included in the model because of known inaccuracies in the recording of this variable [12]. The code for calculation of HRVO was written using Structured Query Language (SQL), and statistical analysis was performed using R 3.0.1 (the R Foundation for Statistical Computing, Vienna, Austria).…”

Section: Statistical Analysesmentioning

confidence: 99%

Low intraoperative heart rate volatility is associated with early postoperative mortality in general surgical patients: a retrospective case–control study

Mandel-Portnoy

Levin

Bansilal

et al. 2015

J Clin Monit Comput

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Heart rate volatility (HRVO) is hypothesized to be a physiological measure of sympathetic activity and is defined by the standard deviation (SD) of the heart rate (HR) in beats per minutes (BPM) over fixed time intervals. To investigate the relationship between low HRVO (SD < 0.5 BPM) during surgical procedures and mortality within 48 h post-procedure. We retrospectively reviewed all adult general surgical procedures performed at our center from January 1, 2003 through July 1, 2013 to identify patients who died within 48 h post-procedure. Demographic, heart rate, and mortality data were extracted from the electronic anesthesia record. Propensity score analysis was used to find matching controls based on age, gender, ASA score, anesthesia type, Charlson index, procedure type, emergency status, year, use of preoperative beta blocker, hypertension, diabetes, atrial fibrillation and heart failure. HRVO was calculated for each 5 min interval as the SD of all HR's within that interval. Negative binomial regression was then used to model the count of intervals with HRVO < 0.5 BPM for the duration of the surgery. During the 10 year study period, 283 patients died within 48 h of procedure finish. These patients were matched to 566 patients who did not die within 48 h after procedure. Patients who died had a 39 % increase in frequency of low HRVO episodes compared to patients who survived (RR 1.39, 95 % CI 1.13-1.72; p = 0.003). Low HRVO during surgical procedure is associated with increased mortality risk within 48 h after procedure. Strategies to identify HRVO early and modify it may lead to improvement in outcomes.

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Systematic Criteria for Type and Screen Based on Procedure’s Probability of Erythrocyte Transfusion

Cited by 21 publications

References 0 publications

Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

Odds of Transfusion for Older Adults Compared With Younger Adults Undergoing Surgery

Low intraoperative heart rate volatility is associated with early postoperative mortality in general surgical patients: a retrospective case–control study

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