Obstetric operating room staffing and operating efficiency using queueing theory.

Introduction: Strategies to achieve efficiency in non-operating room locations have been described, but emergencies and competing priorities in a birth unit can make setting optimal staffing and operation benchmarks challenging. This study used Queuing Theory Analysis (QTA) to identify optimal birth center operating room (OR) and staffing resources using real-world data.

Methods: Data from a Level 4 Maternity Center (9,626 births/year, cesarean delivery (CD) rate 32%) were abstracted for all labor and delivery operating room activity from July 2019-June 2020.

Generalizability of COBRA: A Parsimonious Perioperative Venous Thromboembolism Risk Assessment Model.

Introduction: Standardized use of venous thromboembolism (VTE) risk assessment models (RAMs) in surgical patients has been limited, in part due to the cumbersome workflow addition required to use available models. The COBRA score-capturing cancer diagnosis, (old) age, body mass index, race, and American Society of Anesthesiologists Physical Status score-has been reported as a potentially automatable VTE RAM that circumvents the cumbersome workflow addition that most RAMs represent. We aimed to test the ability of the COBRA model to effectively risk-stratify patients across various populations.

Timing is Everything: Surgical Outcomes for SARS-CoV-2 Positive Patients.

Background: A debate remains on how long to postpone surgery after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to determine surgical outcomes at different time points after a positive SARS-CoV-2 test.

Methods: This cohort study included non-preoperative critically ill adult surgical patients from 5/2020-5/2021 and a subset of SARS-CoV-2 positive patients 15-30 days before surgery from 5/2020-12/2021.

Anatomy of a successful stewardship intervention: Improving perioperative prescribing in penicillin-allergic patients.

Objective: To evaluate whether a series of quality improvement interventions to promote safe perioperative use of cephalosporins in penicillin-allergic patients improved use of first-line antibiotics and decreased costs.

Design: Before-and-after trial following several educational interventions.

Setting: Academic medical center.

Approach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management.

Purpose Of Review: The goal of the paper is to review the epidemiology, pathogenesis, diagnosis, and manifestations of perioperative anaphylaxis (POA). We seek to review the most common culprits of POA and different diagnostic modalities for evaluation.

Recent Findings: Specific IgE testing has a limited role in POA evaluation due to lack of widespread availability and low sensitivity.

Development of a Novel Preoperative Venous Thromboembolism Risk Assessment Model.

Introduction: Standardization of preoperative venous thromboembolism (VTE) risk assessment remains challenging due to variation in risk assessment models (RAMs) and the cumbersome workflow addition that most RAMs represent. We aimed to develop a parsimonious RAM that is automatable and actionable within the preoperative workflow.

Methods: We performed a case-controlled review of all 18 VTE cases reported over a 12-month period and 171 matched controls included in an institutional National Surgical Quality Improvement Project (NSQIP) data set.

Management of Coronavirus Disease 2019 Intubation Teams.

Some patients infected with the Coronavirus Disease 2019 (COVID-19) require endotracheal intubation, an aerosol-generating procedure that is believed to result in viral transmission to personnel performing the procedure. Additionally, donning and doffing personal protective equipment can be time consuming. In particular, doffing requires strict protocol adherence to avoid exposure.

A Streamlined Approach to Optimize Perioperative Antibiotic Prophylaxis in the Setting of Penicillin Allergy Labels.

Background: Patients with penicillin allergy labels often receive alternative antibiotics for perioperative prophylaxis, as opposed to first-line cephalosporins (cefazolin/cefuroxime). Provider misconceptions about the risk of cross-reactivity likely drive this prescribing behavior, which is problematic because of its association with increased risk of surgical-site infections.

Objective: To develop, implement, and assess the safety of a streamlined approach to perioperative antibiotic selection for surgical patients with a penicillin allergy label, to reduce the use of second-line antibiotics.

Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study.

Background: The significance of intraoperative anesthesia handoffs on patient outcomes are unclear. One aspect differentiating the disparate results is the treatment of confounding factors, such as patient comorbidities and surgery time of day. We performed this study to quantify the significance of confounding variables on composite adverse events during intraoperative anesthesia handoffs.

Chronic Atypical Antipsychotic Use Is Associated With Reduced Need for Postoperative Nausea and Vomiting Rescue in the Postanesthesia Care Unit: A Propensity-Matched Retrospective Observational Study.

Background: Atypical antipsychotics are efficacious for chemoprophylaxis against chemotherapy-induced nausea and vomiting, but perioperative investigations have been scant. We sought to examine the association between chronic atypical antipsychotic therapy and the likelihood of postoperative nausea and vomiting.

Methods: In this single-center, propensity-matched, retrospective, observational study, elective noncardiac surgical cases from January 2014 to December 2017 were examined with regard to the primary outcome of rescue antiemetic administration in the postanesthesia care unit as a measure of postoperative nausea and vomiting.

Highly visible sepsis publications from 2012 to 2017: Analysis and comparison of altmetrics and bibliometrics.

Purpose: We sought to delineate highly visible publications related to sepsis. Within these subsets, elements of altmetrics performance, including mentions on Twitter, and the correlation between altmetrics and conventional citation counts were ascertained.

Materials And Methods: Three subsets of sepsis publications from 2012 to 2017 were synthesized by the overall Altmetric.

Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon's up-and-down sequential allocation method.

Background: With the increasing occurrence of drug shortages, understanding the pharmacokinetics of alternative intrathecal opioid administration has gained importance. In particular, additional data are needed to comprehensively evaluate the analgesic properties of intrathecal hydromorphone in the laboring patient. In a phase 2 clinical trial, we set out to determine the median effective dose (ED) and time to effectiveness for this drug in this population.

Crowdsourcing sugammadex adverse event rates using an in-app survey: feasibility assessment from an observational study.

Background: Mobile applications (apps) have become a ubiquitous source of clinical decision support. We sought to ascertain the feasibility of using an app platform to obtain a crowdsourced measure of adverse drug reaction reporting rates associated with sugammadex administration and compare it with traditionally-derived estimates.

Methods: Using the widely-distributed anesthesia calculator app, 'Anesthesiologist', we surveyed anesthesia providers regarding their experience with adverse drug reactions associated with sugammadex administration.

Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes.

Background: Sugammadex rapidly reverses deep neuromuscular blockade, but owing to cost, questions remain about its optimal utilization. After the unrestricted introduction of sugammadex at Emory University Hospital, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS) and emergence time (surgery end to anesthesia end time in the PACU).

Methods: This retrospective observational study included patients undergoing general anesthesia over a 12-month period.

Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation.

Background: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia.

Evidence for increased use of the Society of Pediatric Anesthesia Critical Events Checklist in resource-limited environments: A retrospective observational study of app data.

Background: Electronic decision support tools in anesthesiology practice have great value, including the potential for mobile applications to simplify delivery of best-practice guidelines.

Aims: We sought to combine demographics with usage information to elucidate important patterns in the rate of use of the Society of Pediatric Anesthesia Critical Events Checklist, as measured by in-app accesses of the checklist via the freely available anesthesia calculator app anesthesiologist.

Methods: We performed a retrospective analytic observational case-control study using analytics and survey data collected from the app.

Working toward quality in obstetric anesthesia: a business approach.

Purpose Of Review: Physicians are increasingly required to demonstrate that they provide quality care. How does one define quality? A significant body of literature in industries outside of health care provides guidance on how to define appropriate metrics, create teams to troubleshoot problem areas, and sustain those improvements.

Recent Findings: The modern quality movement in the United States began in response to revolutionary gains in both quality and productivity in Japanese manufacturing in the 1980's.

Update in the Management of Patients with Preeclampsia.

Hypertensive disorders of pregnancy complicate approximately 10% of all deliveries in the United States and are a leading cause of maternal and fetal morbidity and mortality. Preeclampsia is defined as hypertension in association with proteinuria, thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, or new-onset cerebral or visual disturbances. The greatest risk factor for the development of preeclampsia is a history of preeclampsia.