Unequal rates of postoperative complications in relatively healthy bariatric surgical patients of white and black race

BackgroundRacial disparities in postsurgical complications are often presumed to be due to a higher preoperative co-morbidity burden among patients of black race, although being relatively healthy is not a prerequisite for a complication-free postoperative course.ObjectivesTo examine the association of race with short-term postbariatric surgery complications in seemingly healthy patients.SettingsMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (2015–2018).MethodsWe studied a relatively healthy (American Society of Anesthesiologists physical status 1 or 2), propensity score–matched cohort of adult non-Hispanic black and non-Hispanic white bariatric surgery patients. We compared the risk-adjusted incidences of postoperative complications, serious adverse events, and measures of postoperative resource utilization across racial groups.ResultsWe identified 44,090 matched pairs of relatively healthy black and white bariatric surgery patients. Patients of black race were 72% more likely than those of white race to develop 1 or more postoperative complications (.7% versus .4%, respectively; odds ratio [OR], 1.72; 95% confidence interval [CI], 1.32–2.24; P < .01). Measures of postbariatric resource utilization were significantly higher in patients of black race than those of white race, including unplanned reoperations (1.3% versus 1.0%, respectively; OR, 1.28; 95% CI, 1.07–1.52; P = .01), unplanned readmissions (4.5% versus 3.0%, respectively; OR, 1.53; 95% CI, 1.38–1.69; P < .01), unplanned interventions (1.6% versus 1.2%, respectively; OR, 1.36; 95% CI, 1.16–1.60; P < .01), and extended hospital lengths of stay (51.2% versus 42.7%, respectively; OR, 1.41; 95% CI, 1.36–1.46; P < .01).ConclusionEven among relatively healthy patients, race appears to be an important determinant of postbariatric surgery complications and resource utilization. Research and interventions aimed at narrowing the racial disparities in bariatric surgery outcomes may need to broaden the focus beyond the racial variation in the preoperative co-morbidity burden.     

小儿麻醉医师迈向围术期医师理念的培养

随着现代医学的飞速发展,麻醉学正向围术期医学转变。培养小儿麻醉医师向围术期医师转变的理念,需要在了解儿童病理生理特点的前提下,重点培训小儿麻醉术前访视、术中麻醉相关技能、术后访视、围术期疼痛相关管理及心理创伤的预防与治疗。让患儿安全舒适地度过围术期、减少术后并发症及死亡率、改善远期预后,是每位小儿围术期医师的责任。     

术前戒烟干预对患者术后戒烟的影响

目的评估麻醉医师术前戒烟干预对患者术后戒烟影响的有效性及安全性。方法选择当前吸烟男性择期手术患者182例,年龄18~79岁,ASAⅠ~Ⅲ级,按1∶1比例及手术大小分层随机分为对照组和干预组,每组91例。在术前访视时实施戒烟干预,措施为:吸烟对麻醉影响宣教、戒烟宣传资料(包括吸烟危害文字部分、吸烟所致器官损害图片、北京朝阳医院戒烟门诊热线电话及微信公众号),记录麻醉方式、手术时间、PACU治疗时间和术中术后并发症发生情况,术后30d电话随访戒烟率、吸烟下降率、戒烟门诊或戒烟热线随访率。结果在182例患者中,失访16例,最后纳入分析166例。术后30d两组戒烟率差异无统计学意义;术后30d干预组自报吸烟下降率(36.9%)明显高于对照组(22.0%);在术后30d自报戒烟患者中,干预组术前呼气末CO值为轻度吸烟者占83.3%,对照组占40.0%(P0.05);两组术中术后并发症发生率差异无统计学意义。结论麻醉医师术前实施戒烟干预具有安全性,可使患者术后30d吸烟量下降,并提高轻度吸烟患者术后30d戒烟率。     

Work stress and workload of full-time anesthesiologists in acute care hospitals in Japan

Purpose  The number of anesthesiologists per population in Japan is small compared with that in Europe and North America. While there is a growing concern that hard work causes anesthesiologists’ fatigue and may compromise patient safety, the workload and physical stress, as well as the impact of staff support on physicians’ stress have not been assessed in detail. The goal of this study was to evaluate the working environment, anesthesia workload, and occupational stress of anesthesiologists in Japan. Methods  A questionnaire survey was performed targeting 1010 members of the Japanese Society of Anesthesiologists working as anesthesiologists affiliated with acute care hospitals in Japan. Data on background information, working environment, operation anesthesia duties, and stress were collected, and the relationship of work stress with background, environment, and anesthesia duties was evaluated by linear regression analysis. Results  Responses were obtained from 383 full-time anesthesiologists (response rate, 43.9%). The total anesthesia time per week was 23.6 h on average. The work stress score was 114.3 ± 30.2 (mean ± SD) when the average workers’ work stress score in Japan was 100. The work stress score was significantly associated with “years of experience” (with experience < 10 years considered as the reference; 10–19 years: β = −0.18, P = 0.02, ≥20 years: β = −0.15, P = 0.04), “hospital with ≥500 beds” (with a hospital with ≤ 299 beds considered as the reference; β = 0.15, P = 0.04), “total time of anesthesia per week” (β = 0.18, P.02), “estimated annual cases managed by an anesthesiologist” (β = 0.12, P = 0.04) and “no-support stress” (β = 0.21, P < 0.01) on linear regression analysis (R² = 0.12). Conclusion  Our results provide a quantitative assessment of the duties of anesthesiologists and show that work stress among anesthesiologists is related to workload and other factors. Summaries of this study were presented at the 53rd and 54th General Meetings of the Japanese Society of Anesthesiologists (JSA) at Kobe (2006) and Sapporo (2007).     

海南省麻醉医师的职业压力调查与分析

目的了解海南省麻醉医师的职业压力现状,提高麻醉的安全性。方法采用普查和分层抽样方法,应用自制调查表对海南省三甲、二级、一级医院的麻醉医师工作中的阻力、困难、烦恼及对工作环境的希望22个问题进行问卷调查,所得结果分三甲医院(Ⅰ组)与二、一级医院(Ⅱ组)两组,进行比较分析,P﹤0.05为差异有统计学意义。结果发放问卷287张,回收280张,有效273张,回收有效率95.1%。工作中的困难及阻力:缺乏麻醉设备百分率最高48.7%,同事不理解率最低9.5%;手术医生不配合、缺乏麻醉设备、药品不足,Ⅱ组比Ⅰ组高,P﹤0.05。对工作环境及设备的希望:建立层流手术间63.0%,安装手术室排污设备42.5%,购买麻醉设备75.1%,安装手术室内背景音乐62.3%;两组对比P﹥0.05。麻醉医师的烦恼:收入与付出不符最高62.6%;患者术前准备不全,手术医师指挥用药,麻醉不全时手术医师抱怨,Ⅱ组比Ⅰ组高,P﹤0.05。结论海南麻醉医师的职业压力主要是收入与付出不符,麻醉设备和抢救药品不足,手术医师不配合,术前患者准备不全,手术室环境欠缺。二、一级医院麻醉医师工作压力比三甲医院麻醉医师高。     

Does Dosage or Duration of Concurrent Oral Corticosteroid Influence Elevated Risk of Postoperative Complications After Total Joint Arthroplasty?

BackgroundThis report seeks to clarify whether the dosage and duration of preoperative concurrent corticosteroid use influence postoperative complications after primary total joint arthroplasty (TJA).MethodsThis retrospective single institutional study enrolled 1128 primary TJA cases, including 905 total hip arthroplasties and 223 total knee arthroplasties at a minimum 6 months of follow-up. Mean follow-up period was 51.9 ± 34.1 months (range 6-146). Of all joints, 120 joints (10.6%) were associated with chronic concurrent oral corticosteroid use. Multivariate analysis was performed to identify whether chronic concurrent oral corticosteroid use elevated the risk of postoperative complications including surgical site infection/periprosthetic joint infection, delayed wound healing, periprosthetic fracture, and implant loosening. For chronic concurrent oral corticosteroid user, we determined whether the dosage and duration of preoperative concurrent corticosteroid use influenced postoperative complications and have an effective threshold for postoperative complications using receiver operating characteristic curve analysis.ResultsThe multivariate analysis revealed that American Society of Anesthesiologist Physical Status 3 was an independent risk factor for postoperative complications, while concurrent oral corticosteroid use was not an independent risk factor. When we compared joints with (n = 13) and without (n = 107) postoperative complications in chronic concurrent oral corticosteroid user, there was no statistical difference in the dosage (P = .97) and duration (P = .69) between the 2 groups. Area under the curve values for the oral corticosteroid dosages and duration were 0.482 and 0.549, respectively.ConclusionThis study revealed that neither dosage nor duration of concurrent oral corticosteroid use was predictive of postoperative complications after TJA. American Society of Anesthesiologist Physical Status 3 is a major factor in postoperative complications after TJA.     

国内麻醉科医师应用二氧化碳吸收剂的现状调查

目的 调查国内麻醉科医师应用二氧化碳（CO₂）吸收剂的现状,为统一CO₂吸收剂更换的指标、限值和流程提供参考。
方法 采用自主设计调查问卷开展网络问卷调查,主要内容包括麻醉科医师的基本情况、对CO₂吸收剂应用理论的理解和CO₂吸收剂临床应用的现状。
结果 本次调查发放并回收有效问卷475份,其中49.9%来自华南地区,其他地区的麻醉科医师占50.1%。在对CO₂吸收剂应用理论的理解方面,被调查者最常使用的CO₂吸收剂种类为钠石灰,6.3%的被调查者尚不清楚所在机构使用的CO₂吸收剂种类;13.5%的被调查者能选出全部影响CO₂吸收剂吸收效率的理论因素;分别有79.8%、66.7%和44.8%的被调查者认为CO₂吸收剂“缺乏统一的更换标准和流程”、“环境污染”和“更换操作复杂”应得到关注。在CO₂吸收剂临床应用的现状方面,更换频率与麻醉科医师所在医院的等级显著相关（P<0.05）;更换标准主要依赖FiCO₂和CO₂吸收剂变色量;96.4%的被调查者选择整罐更换,仍有23.8%的被调查者错误地在手术室内更换CO₂吸收剂,有粉尘吸入经历的被调查者高达73.7%。
结论 目前国内麻醉科医师对CO₂吸收剂的应用理论和安全性认识不足,对CO₂吸收剂的更换缺乏统一标准、更换流程欠规范,建议对各级麻醉科医师开展针对性专题培训,并应进一步探索安全高效的CO₂吸收剂更换标准化流程。     

江苏省部分城市麻醉科医师工作压力来源及影响因素调查研究

目的调查江苏省部分城市麻醉科医师工作压力来源及影响因素,提出相应对策,并探讨医院逐步建立麻醉科、麻醉医师健康和可持续发展的干预机制。方法采用整群随机抽样法,在江苏省23所医院432名麻醉科医师中开展问卷调查。结果江苏省部分城市麻醉科医师工作压力来源依次为麻醉工作中的风险或意外,劳动时间过长,科研、职称晋升,领导的要求,医患关系,外科医师的干预,麻醉设备、药品不足。麻醉科医师的工作压力主要受工作风险、休假制度、每日手术例数的影响,差异均有统计学意义（P〈O．05）。结论江苏省部分麻醉科医师工作压力来源虽是多方面的,但有所侧重,各医院应有针对性地逐步建立切实可行的应对策略,以减轻麻醉科医师压力,更好地为患者服务。