On the development and validation of large language model-based classifiers for identifying social determinants of health.

The assessment of social determinants of health (SDoH) within healthcare systems is crucial for comprehensive patient care and addressing health disparities. Current challenges arise from the limited inclusion of structured SDoH information within electronic health record (EHR) systems, often due to the lack of standardized diagnosis codes. This study delves into the transformative potential of large language models (LLM) to overcome these challenges.

Association of amisulpride and recovery room length of stay among patients with postoperative nausea and vomiting following outpatient surgery.

Study Objective: Postoperative nausea and vomiting (PONV) is a common sequela of surgery in patients undergoing general anesthesia. Amisulpride has shown promise in its ability to treat PONV. The objective of this study was to determine if amisulpride is associated with significant changes in PACU efficiency within a fast-paced ambulatory surgery center.

A Retrospective Analysis Investigating Whether Case Volume Experience of the Anesthesiologist Correlates with Intraoperative Efficiency for Joint Arthroplasty.

The objective of this retrospective study was to determine if there was an association between anesthesiology experience (e.g. historic case volume) and operating room (OR) efficiency times for lower extremity joint arthroplasty cases.

Surgical pit crew: initiative to optimise measurement and accountability for operating room turnover time.

Background And Objectives: Turnover time (TOT), defined as the time between surgical cases in the same operating room (OR), is often perceived to be lengthy without clear cause. With the aim of optimising and standardising OR turnover processes and decreasing TOT, we developed an innovative and staff-interactive TOT measurement method.

Methods: We divided TOT into task-based segments and created buttons on the electronic health record (EHR) default prelogin screen for appropriate staff workflows to collect more granular data.

Machine Learning Prediction Models to Reduce Length of Stay at Ambulatory Surgery Centers Through Case Resequencing.

The post-anesthesia care unit (PACU) length of stay is an important perioperative efficiency metric. The aim of this study was to develop machine learning models to predict ambulatory surgery patients at risk for prolonged PACU length of stay - using only pre-operatively identified factors - and then to simulate the effectiveness in reducing the need for after-hours PACU staffing. Several machine learning classifier models were built to predict prolonged PACU length of stay (defined as PACU stay ≥ 3 hours) on a training set.

Development and benchmarking of machine learning models to classify patients suitable for outpatient lower extremity joint arthroplasty.

Study Objective: Performing hip or knee arthroplasty as an outpatient surgery has been shown to be operationally and financially beneficial for selected patients. By applying machine learning models to predict patients suitable for outpatient arthroplasty, health care systems can better utilize resources efficiently. The goal of this study was to develop predictive models for identifying patients likely to be discharged same-day following hip or knee arthroplasty.

Identification of Preanesthetic History Elements by a Natural Language Processing Engine.

Background: Methods that can automate, support, and streamline the preanesthesia evaluation process may improve resource utilization and efficiency. Natural language processing (NLP) involves the extraction of relevant information from unstructured text data. We describe the utilization of a clinical NLP pipeline intended to identify elements relevant to preoperative medical history by analyzing clinical notes.

Body Mass Index Is Not an Independent Factor Associated With Recovery Room Length of Stay for Patients Undergoing Outpatient Surgery.

Objectives: Prolonged recovery time in the postanesthesia care unit (PACU) increases cost and administrative burden of outpatient surgical staff. The primary aim of this study was to determine whether body mass index (BMI) is associated with prolonged recovery in the PACU after outpatient surgery in a freestanding ambulatory surgery center.

Methods: We retrospectively studied 3 years of surgeries performed at a freestanding ambulatory surgery center.

Predictive Analytics for Inpatient Postoperative Opioid Use in Patients Undergoing Mastectomy.

Introduction: The use of opioids in mastectomy patients is a particular challenge, having to balance the management of acute pain while minimizing risks of continuous opioid use postoperatively. Despite attempts to decrease postmastectomy opioid use, including regional anesthetics, gabapentinoids, topical anesthetics, and nonopioid anesthesia, prolonged opioid use remains clinically significant among these patients. The goal of this study is to identify risk factors and develop machine-learning-based models to predict patients who are at higher risk for postoperative opioid use after mastectomy.

A Novel Fellowship in Perioperative Administration, Quality and Informatics: A Pilot Experience for Training Surgical Leaders.

Value-based, outcome-oriented care supported with innovative technology is the future of surgery. We established a novel fellowship in Perioperative Administration, Quality, and Informatics. The aim is to equip future surgeon scholars with the requisite knowledge base and skillset to serve as institutional leaders capable of transforming surgical healthcare delivery.

Machine Learning-Based Models Predicting Outpatient Surgery End Time and Recovery Room Discharge at an Ambulatory Surgery Center.

Background: Days before surgery, add-ons may be scheduled to fill unused surgical block time at an outpatient surgery center. At times, outpatient surgery centers have time limitations for end of block time and discharge from the postanesthesia care unit (PACU). The objective of our study was to develop machine learning models that predicted the following composite outcome: (1) surgery finished by end of operating room block time and (2) patient was discharged by end of recovery room nursing shift.

Is Obesity Associated With Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation.

Background: The rise in obesity in the United States, along with improvements in antiviral therapies, has led to an increase in the number of obese patients receiving liver transplants. Currently, obesity is a relative contraindication for liver transplant, although exact body mass index (BMI) limits continue to be debated. Studies conflict regarding outcomes in obese patients, while some argue that BMI should not be used as an exclusion criterion at all.

The price is right: Routine fluorescent cholangiography during laparoscopic cholecystectomy.

Background: Early experience with indocyanine green-based fluorescent cholangiography during laparoscopic cholecystectomy suggests the potential to improve outcomes. However, the cost-effectiveness of routine use has not been studied. Our objective was to evaluate the cost-effectiveness of fluorescent cholangiography versus standard bright light laparoscopic cholecystectomy for noncancerous gallbladder disease.

Recommendations for developing clinical care protocols during pandemics: From theory and practice.

In 2019, a novel coronavirus called the severe acute respiratory syndrome coronavirus 2 led to the outbreak of the coronavirus disease 2019, which was deemed a pandemic by the World Health Organization in March 2020. Owing to the accelerated rate of mortality and utilization of hospital resources, health care systems had to adapt to these major changes. This affected patient care across all disciplines and specifically within the perioperative services.

National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics.

Purpose Of Review: Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends.

Recent Findings: National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR.

Should there be a body mass index eligibility cutoff for elective airway cases in an ambulatory surgery center? A retrospective analysis of adult patients undergoing outpatient tonsillectomy.

Study Objective: It is unclear what the body mass index (BMI) should be when performing surgery involving the airway at an outpatient surgery facility. The objective of this study was to evaluate the association of Class 3 obesity versus a composite cohort of Class 1 and 2 obesity with same-day hospital admission following outpatient tonsillectomy in adults.

Design: Retrospective cohort study.

Efficiency Metrics at an Academic Freestanding Ambulatory Surgery Center: Analysis of the Impact on Scheduled End-Times.

Background: Understanding the impact of key metrics on operating room (OR) efficiency is important to optimize utilization and reduce costs, particularly in freestanding ambulatory surgery centers. The aim of this study was to assess the association between commonly used efficiency metrics and scheduled end-time accuracy.

Methods: Data from patients who underwent surgery from May 2018 to June 2019 at an academic freestanding ambulatory surgery center was extracted from the medical record.

Patient health status and case complexity of outpatient surgeries at various facility types in the United States: An analysis using the National Anesthesia Clinical Outcomes Registry.

Study Objective: Among the various types of outpatient surgery centers, there are differences in higher American Society of Anesthesiologists Physical Status (ASA PS) scores and surgical complexity among patients who are undergoing surgery. The primary objective of this study was to describe the differences performed at various types of outpatient surgery facilities.

Design: We performed a retrospective analysis of the National Anesthesia Clinical Outcomes Registry (NACOR) data.

Genomics testing and personalized medicine in the preoperative setting: Can it change outcomes in postoperative pain management?

Postoperative pain and opioid use are major challenges in perioperative medicine. Pain perception and its response to opioid use are multi-faceted and include pharmacological, psychological, and genetic components. Precision medicine is a unique approach to individualized health care in which decisions in management are based on genetics, lifestyle, and environment of each person.

Functional status as a marker of need for hospital admission following outpatient hernia repair.

Introduction: The careful selection of patients for hernia repair in ambulatory surgery centres is critical to prevent unanticipated inpatient admissions. The aim of this study was to evaluate risk factors associated with inpatient admission.

Methods: A multivariable logistic regression was performed utilising the ACS NSQIP database from 2007 to 2016.

Association of Electronic Surgical Consent Forms With Entry Error Rates.

This study compares use of electronic surgical consent forms with paper-based forms and their association with decreased error rates.

Obesity and unanticipated hospital admission following outpatient laparoscopic cholecystectomy.

Introduction: Compared to other common outpatient operations, laparoscopic cholecystectomy has higher rates of unanticipated hospital admission with reports ranging from 1.0 to 39.5%.