Primjena programa ubrzanog oporavka nakon barijatrijske kirurgije: analiza kliničkih ishoda i isplativosti

Enhanced recovery after surgery (ERAS) programs are perioperative evidencebased interventions that have the purpose of making the perioperative pathway more efficient in safeguarding patient safety and quality of care. Recently, several ERAS components have been introduced in the setting of bariatric surgery (Enhanced Recovery After Bariatric Surgery, ERABS). The aim of the present study was to evaluate clinical efficiency and cost-effectiveness of the implementation of an ERABS program. It was a retrospective case-control study comparing a group of adult obese (body mass index >40) patients treated according to the ERABS protocol (2014-2015) with a historical control group that received standard care (2013-2014) in the General and Emergency Surgery Department, Arcispedale S. Maria Nuova Hospital, Reggio Emilia, Italy. Data on the occurrence of complications, mortality, re-admissions and re-operations were extracted retrospectively from medical case notes and emergency patient admission lists. Length of hospital stay was significantly different between the two cohort patients. In the control group, the mean length of stay was 12.6±10.9 days, whereas in the ERABS cohort it was 7.1±2.9 days (p=0.02). During hospital stay, seven patients in the control group developed surgical complications, including one patient with major complications, whereas in the ERABS group three patients developed minor complications. Economic analysis revealed a different cost distribution between the two groups. On the whole, there were significant savings for almost all the variables taken into consideration, mainly driven by exclusion of using intensive are unit, which is by far more expensive than the average cost of post-anesthesia care unit. Our study confirmed the implementation of an ERABS protocol to have shortened hospital stay and was cost-saving while safeguarding patient safety.Programi ubrzanog oporavka nakon operacije (Enhanced Recovery After Surgery, ERAS) su perioperacijske intervencije zasnovane na dokazima kojima je svrha učiniti perioperacijski tijek učinkovitijim osiguravajući bolesnikovu sigurnost i kvalitetu skrbi. Odnedavno je nekoliko sastavnica programa ERAS uvedeno u okruženje barijatrijske kirurgije (Enhanced Recovery After Bariatric Surgery, ERABS). Cilj ovoga istraživanja bio je procijeniti kliničku učinkovitost i isplativost provođenja programa ERABS. U ovoj retrospektivnoj studiji slučaja i kontrola uspoređena je skupina odraslih pretilih bolesnika (indeks tjelesne mase >40) liječenih prema protokolu ERABS (2014.-2015.) s povijesnom kontrolnom skupinom koja je primala standardnu skrb (2013.-2014.) u Klinici za opću i hitnu kirurgiju, Bolnica Arcispedale S. Maria Nuova, Reggio Emilia, Italija. Podaci o pojavnosti komplikacija, smrtnosti, ponovnom prijmu i ponovljenim operacijama retrospektivno su izvedeni iz bolesničkih kartona i prijamnih lista. Duljina boravka u bolnici značajno se razlikovala među dvjema skupinama bolesnika. U kontrolnoj skupini srednja duljina boravka u bolnici bila je 12,6±10,9 dana, dok je skupini ERABS iznosila 7,1±2,9 dana (p=0,02). Kod prijma se kirurška komplikacija razvila u 7 osoba iz kontrolne skupine; od toga je jedan bolesnik imao teže komplikacije, dok su u skupini ERABS manje komplikacije zabilježene kod 3 bolesnika. Ekonomska analiza pokazala je drukčiju raspoređenost troškova u dvjema skupinama. Sve u svemu, značajne uštede u gotovo svim ispitivanim varijablama uglavnom su nastale zbog isključenja uporabe jedinice intenzivnog liječenja, što je daleko skuplje od prosječnih troškova u jedinici skrbi poslije anestezije. Naše je istraživanje potvrdilo da primjena protokola ERABS skraćuje boravak u bolnici i snižava troškove pritom osiguravajući sigurnost bolesnika

Airway Rescue using the LMA Supreme™ in the prone position: a case report

Surgery in prone positioning may pose considerable challenges to Anesthesiologists because of general accessibility to the patient; this is particularly true if referring to airway management, because the airway could be relatively inaccessible while the patient is lying prone. We report a case of an obese women scheduled for lower limbs surgery in the prone position in which the initial anesthetic choice for spinal anesthesia needed to be switched to general anesthesia during the procedure both for the occurrence of surgical complications and because the patient began to become uncooperative. We successfully managed this problem by inserting a LMA SupremeTM leaving the patient in the same prone position, and maintaining anesthesia in mechanical ventilation, thus allowing surgical procedure to be completed uneventfully. The possible options in similar cases and the specific features of LMA SupremeTM which allowed such a choice are discussed