Association of Prophylactic Antibiotic Guideline Non-Adherence with Surgical Site Infections in Patients Receiving Perioperative Vancomycin: Results from a Multi-Institutional Combined NSQIP and MPOG Registry.

Objective: To investigate whether non-adherence to the combined Infectious Disease Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA) guideline based antibiotic choice, timing, and/or dose of vancomycin was associated with Surgical Site infections in surgeries where vancomycin was administered.

Summary Background Data: Despite the pivotal role of antibiotics in preventing surgical site infections (SSIs), widespread non-adherence to IDSA/SIS/SHEA guidelines especially related to vancomycin for intraoperative antibiotic prophylaxis continues. It is unclear whether this non-adherence is associated with SSIs.

Evidence from a Bayesian reanalysis of the iPROVE-OLV study: is it time to update our prior assumptions regarding neuromuscular block and reversal?

In a Bayesian secondary analysis of a subset of 698 patients in the iPROVE-OLV study, Mazzinari and colleagues report evidence of benefit for the use of neuromuscular monitoring and reversal under a range of prior assumptions (i.e. assumptions of probability of benefit or harm).

Clinical and Genetic Factors Associated with Intraoperative Minimum Alveolar Concentration Ratio: A Single-center Retrospective Cohort and Genome-wide Association Study.

Background: Minimum alveolar concentration (MAC) is a standard dosing metric for general anesthesia. Although influences of MAC have been identified in controlled studies, the determinants of clinical delivery of MAC ratio are largely unknown. To address this knowledge gap, the authors performed this single-center retrospective study.

Association of neuromuscular reversal drug with postoperative pulmonary complications in bronchoscopy: definitional challenges.

A recent retrospective study examined a composite of postoperative pulmonary complications after neostigmine or sugammadex for reversal of neuromuscular block in patients undergoing interventional pulmonology and bronchoscopic procedures. This study reviewed the electronic medical records of 8557 patients across hospitals within a single health system, finding an increased risk of a composite of postoperative pulmonary complications in those receiving sugammadex (odds ratio 1.44; 95% confidence interval: 1.

Accounting for Healthcare Structures When Measuring Variation in Care.

Health services research frequently focuses on variation in the structure, process, and outcomes of clinical care. Robust approaches for detection and attribution of variation are foundational to both quality improvement and outcomes research. Describing care in structured healthcare systems across hospitals in which clinicians work to provide care for patients as a multileveled structure allows the impact of organization on practice and outcome to be ascertained.

Environmental and patient safety outcomes of a health-system Green Anesthesia Initiative (GAIA): a retrospective observational cohort study.

Background: Inhaled anaesthetics are greenhouse gases. However, changes in the delivery of inhaled anaesthetics can mitigate environmental impact. We hypothesised that system-wide changes to the delivery of anaesthesia care would reduce environmental harm without compromising patient outcomes.

Neuromuscular Blockade and Antagonism in Patients with Renal Impairment: A Multicenter Retrospective Cross-sectional Study.

Background: Current practice guidelines do not address the use of neuromuscular blocking and antagonism agents in patients with renal impairment. The U.S.

Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study.

Background: Sugammadex was initially approved for reversal of neuromuscular blockade in adults in the United States in 2015. Limited data suggest sugammadex is widely used in pediatric anesthesia practice however the factors influencing use are not known. We explore patient, surgical, and institutional factors associated with the decision to use sugammadex versus neostigmine or no reversal, and the decision to use 2 mg/kg vs 4 mg/kg dosing.

Disparities in Anti-emetic Prophylaxis Care Processes are Predicted by Patient Neighborhood: A Retrospective Cohort and Geospatial Analysis.

Background: Social Determinants of Health (SDoH) continue to drive persistent disparities in perioperative care. Our team has previously demonstrated racial and socioeconomic disparities in perioperative processes, notably in the administration of antiemetic prophylaxis, in several large perioperative registries. Given how neighborhoods are socially segregated in the US, we examined geospatial clustering of perioperative antiemetic disparities.

Weight-Based Standardized Sugammadex Dosing in Pediatrics: A Quality Improvement Initiative to Improve Compliance with Dosing Guidelines and Reduce Waste and Cost.

Methods: Sugammadex vials were fractionated into 25, 50, or 100 mg aliquots, which would be distributed to anesthesia staff by pharmacy staff in approximate 2 mg/kg of actual body weight doses (±10%). We analyzed changes in sugammadex waste and dosing practices 1/1/2019 to 3/15/2023 pre/postintervention (4/1/2021). We gauged dose appropriateness using last train of four (TOF) prior to sugammadex administration.

Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study.

Background: Sugammadex is a neuromuscular blockade (NMB) reversal agent introduced in the United States in 2016, which allows the reversal of deep NMB, not possible with neostigmine. Few data describe associated practice changes, if any, in NMB medication use that may have resulted from its availability. We hypothesized that after institutional introduction, use of NMB agents increased.

Sugammadex use in pediatric patients with stage IV-V chronic kidney disease in a quaternary referral hospital: a case series.

Background: Sugammadex is a pharmacologic agent that provides rapid reversal of neuromuscular blockade via encapsulation of the neuromuscular blocking agent (NMBA). The sugammadex-NMBA complex is primarily cleared through glomerular filtration from the kidney, raising the possibility that alterations in renal function could affect its elimination. In pediatric patients, the benefits of sugammadex have led to widespread utilization; however, there is limited information on its application in pediatric renal impairment.

Variability in Intraoperative Opioid and Nonopioid Utilization During Intracranial Surgery: A Multicenter, Retrospective Cohort Study.

Background: Key goals during intracranial surgery are to facilitate rapid emergence and extubation for early neurologic evaluation. Longer-acting opioids are often avoided or administered at subtherapeutic doses due to their perceived risk of sedation and delayed emergence. However, inadequate analgesia and increased postoperative pain are common after intracranial surgery.

Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study.

Background: The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings.

Feasibility pilot trial for the Trajectories of Recovery after Intravenous propofol versus inhaled VolatilE anesthesia (THRIVE) pragmatic randomised controlled trial.

Introduction: Millions of patients receive general anaesthesia for surgery annually. Crucial gaps in evidence exist regarding which technique, propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA), yields superior patient experience, safety and outcomes. The aim of this pilot study is to assess the feasibility of conducting a large comparative effectiveness trial assessing patient experiences and outcomes after receiving propofol TIVA or INVA.

Airway driving pressure is associated with postoperative pulmonary complications after major abdominal surgery: a multicentre retrospective observational cohort study.

Background: High airway driving pressure is associated with adverse outcomes in critically ill patients receiving mechanical ventilation, but large multicentre studies investigating airway driving pressure during major surgery are lacking. We hypothesised that increased driving pressure is associated with postoperative pulmonary complications in patients undergoing major abdominal surgery.

Methods: In this preregistered multicentre retrospective observational cohort study, the authors reviewed major abdominal surgical procedures in 11 hospitals from 2004 to 2018.

Association between choice of reversal agent for neuromuscular block and postoperative pulmonary complications in patients at increased risk undergoing non-emergency surgery: STIL-STRONGER, a multicentre matched cohort study.

Background: Postoperative pulmonary complications are a source of morbidity after major surgery. In patients at increased risk of postoperative pulmonary complications we sought to assess the association between neuromuscular blocking agent reversal agent and development of postoperative pulmonary complications.

Methods: We conducted a retrospective matched cohort study, a secondary analysis of data collected in the prior STRONGER study.

Design of a novel multifunction decision support/alerting system for in-patient acute care, ICU and floor (AlertWatch AC).

Background: Multifunction surveillance alerting systems have been found to be beneficial for the operating room and labor and delivery. This paper describes a similar system developed for in-hospital acute care environments, AlertWatch Acute Care (AWAC).

Results: A decision support surveillance system has been developed which extracts comprehensive electronic health record (EHR) data including live data from physiologic monitors and ventilators and incorporates them into an integrated organ icon-based patient display.