Biomarkers and Cellular Biology in Perioperative Medicine.

Surgical procedures alter tissue integrity; are associated with pain and activation of the sympathetic nervous system; and sometimes, cause exposure to foreign materials used during the surgery or implanted perioperatively [...]

Letter to the editor regarding "Epidemiologic analysis of 8000 acute vertebral fractures: evolution of treatment and complications at 10-year follow-up".

In this letter to the editor, we discuss the article by Bigdon et al., published recently in the Journal of Orthopaedic Surgery and Research, about their accurate single-centre cohort study of 8000 vertebral fractures in 4772 patients. As the complication rate of this cohort is low, it seems that severe trauma patients needing damage control resuscitation/procedures may have undergone damage control in the first treating hospital before being transferred to the trauma centre. It will be interesting to see how both activity and health trends within the ageing population will change osteoporotic occurrence of fractures and enable more conservative trends versus operative stabilization to continue an active life even in the seventh or eighth decade

Administrative structures: Options for achieving success in perioperative medicine.

Without the appropriate administrative structure, even well-thought-out strategic plans or detailed process improvement initiatives will fail. Developing a strong foundation for governance and leadership is a critical element of any high-functioning organization, and it applies just as well in the perioperative setting. Yet, perioperative patient care teams and operating room (OR) management structures can be very complex, due to relationships both within the OR and between the OR and other departments. Frequently, reliable management of the perioperative process is lacking. We aim to provide an overview of the structural and elemental components and roles of perioperative management teams, as well as the administrative structure that guides them, since effective perioperative care teams and OR leaders are of paramount importance for any successful hospital

Postcraniotomy Headache: Etiologies and Treatments.

PURPOSE OF REVIEW Postcraniotomy headache (PCH) is a highly underappreciated and very common adverse event following craniotomy. RECENT FINDINGS Analgetic medication with opioids often interferes with neurologic evaluation in the acute phase of recovery and should be kept to a minimal, in general, in the treatment of chronic pain as well. We provide an update on the latest evidence for the management of acute and chronic PCH. Especially in the neurosurgical setting, enhanced recovery after surgery protocols need to include a special focus on pain control. Patients at risk of developing chronic pain must be identified and treated as early as possible

Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection.

PURPOSE OF REVIEW The goal of this narrative review is to describe the current understanding of the pathology of Complex Regional Pain Syndrome (CRPS), as well as diagnostic standards and therapeutic options. We will then make the case for early recognition and management. RECENT FINDINGS CRPS remains an enigmatic pain syndrome, comprising several subtypes. Recent recommendations clarify diagnostic ambiguities and emphasize the importance of standardized assessment and therapy. Awareness of CRPS should be raised to promote prevention, early detection, and rapid escalation of therapy in refractory cases. Comorbidities and health costs (i.e., the socioeconomic impact) must also be addressed early to prevent negative consequences for patients

Managing bottlenecks in the perioperative setting: Optimizing patient care and reducing costs.

Bottlenecks limit the maximum output of a system and indicate operational congestion points in process management. Bottlenecks also affect perioperative care and include dimensions such as infrastructure, architectural design and limitations, inefficient equipment and material supply chains, communication-related limitations on the flow of information, and patient- or staff-related factors. Improvement of workflow is, therefore, becoming a priority in most healthcare settings. We provide an overview of bottleneck management in the perioperative setting and introduce dimensions, including aligned strategic decision-making, tactical planning, and operational adjustments