Surgical apgar score
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lowest heart rate lowest mean arterial pressure estimated blood loss A score built from these 3 predictors has proved strongly predictive of the risk of major postoperative complications and death in general and vascular surgery
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cardiac assessment for anesthesia and surgery .Annotated bibliography ,raw material to be used for a lecture on the topic.
Role of CRT and CRTD in CHF
1) The document discusses the role of cardiac resynchronization therapy (CRT) in treating chronic heart failure based on results from clinical trials.
2) Landmark trials like CARE-HF, MADIT-CRT and REVERSE showed that CRT reduces mortality and hospitalization in patients with heart failure symptoms.
3) Later trials also found benefits of CRT in mildly symptomatic patients with reduced left ventricular function and wide QRS duration, including decreased heart failure events and increased left ventricular ejection fraction, though effects on quality of life and exercise capacity were less clear.
802e498d341ca759878f5db467d0b0fe.pdf
This study analyzed 12-lead electrocardiograms from 90 patients with inferior myocardial infarction to determine the influence of the measurement point of ST segment elevation on algorithms for localizing the culprit artery. ST elevation was measured at the J-point and 80 ms after the J-point, and three algorithms were applied to each measurement. The area under the curve was significantly better for two algorithms when measuring at the J-point compared to 80 ms. Agreement between the J-point and 80 ms measurements was suboptimal for all three algorithms. The results suggest that the point used to measure ST segment elevation can significantly impact the performance of algorithms to identify the responsible artery.
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IRJET - Comparative Study of Cardiovascular Disease Detection Algorithms
The document compares four algorithms - K-Nearest Neighbors, Support Vector Machine, Decision Tree, and Random Forest - for cardiovascular disease detection using data mining techniques. It summarizes previous studies that have used these algorithms on cardiovascular disease data and evaluated their performance. The document concludes that K-Nearest Neighbors, Support Vector Machine, Decision Tree, or Random Forest algorithms could be used for cardiovascular disease detection, and that the best algorithm depends on the specific dataset and type of disease being diagnosed.
Heart Disease Prediction Using Machine Learning Techniques
This document describes a study that used five machine learning algorithms to predict heart disease: Random Forest classification, Support Vector Machine, AdaBoost Classifier, Logistic Regression, and Decision Tree Classifier. The algorithms were tested on a dataset of 270 patients described by 14 attributes. Random Forest classification achieved the highest test accuracy of 85.22%, compared to accuracies ranging from 67.43% to 81.23% for the other algorithms. Therefore, the study concludes that Random Forest classification is the best performing algorithm for predicting heart disease based on this dataset and analysis.
Preoperative hematological parameters predicting mortality in stanford type a...
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This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.IRJET- Study of Hypocalcemic Cardiac Disorder by Analyzing the Features o...
This document presents a study that analyzes ECG signals using discrete wavelet transform (DWT) to detect hypocalcemia, a condition caused by low calcium levels. The proposed methodology involves denoising the ECG signal, detecting peaks (Q, R, S) using DWT, calculating time intervals, and using statistical measures like mean square error, root mean square deviation, and percentage deviation to distinguish between healthy and hypocalcemic patients. The results of applying this methodology to ECG signals from a database are discussed.
これから医療とカネの話をしよう 医療の経済評価入門
This document summarizes a seminar on health technology assessment and economic evaluation. It discusses key concepts like incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs). It also summarizes a past study on the cost-effectiveness of treating hypertension at worksites versus regular care. The study found that the worksite program had an ICER of $5.63/mmHg reduction in blood pressure, which was more cost-effective than the regular care ICER of $32.51/mmHg. Sensitivity analysis supported these findings.
IRJET- A Survey on ECG Signals Classification for Early Detection of Cardiova...
This document summarizes a research paper that proposes a new methodology for the automated classification of cardiovascular diseases using electrocardiogram (ECG) signals. The methodology involves extracting nonlinear features from ECG signals after applying a five-level discrete wavelet transform. Only a reduced number of features are considered to increase efficiency. Feature ranking is performed using ANOVA and Relief methods to select important features for classification. The proposed system aims to classify ECG segments into normal, hypertrophic cardiomyopathy, dilated cardiomyopathy, and myocardial infarction classes with higher accuracy compared to existing methods.
Espessamento medio intimal carótidal trials
Carotid intima-media thickness (CIMT) is a measure of subclinical atherosclerosis that can be assessed noninvasively using ultrasound. CIMT has been shown to be related to traditional cardiovascular risk factors and predicts future cardiovascular events. Several studies have found that therapies which slow the progression of CIMT, such as statins, antihypertensives, and lifestyle changes, can reduce cardiovascular risk. However, CIMT is an imperfect surrogate and definitive outcomes trials are still needed to determine the clinical impact of therapies that affect CIMT progression.
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This study compared outcomes for patients in the intensive care unit (ICU) who received contrast echocardiography (cTTE) versus non-contrast echocardiography (nTTE). cTTE patients had a significantly lower risk of death during hospitalization compared to nTTE patients. There was no significant difference in length of stay, ICU length of stay, total hospitalization cost, or cost of cardiac function tests between the two groups. However, cTTE patients required significantly fewer additional cardiac function tests after echocardiography compared to nTTE patients.
Poster Experimental Biology 2014
A prospective study was conducted at a critical care department and post-anesthesia care unit of a university teaching hospital in Barcelona, Spain. The study recruited 707 patients with invasive BP and finger PPG waves over a period of 26 months. Exclusion criteria were presence of major arrhythmia, immediate death condition and disturbances in the arterial or PPG curve morphology. For each patient we automatically recorded the systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and PPG curve for 30 minutes. The PPG signal was further processed to obtain a set of features that were used to construct a Deep Belief Network with Gaussian Restricted Boltzmann Machine (DBN-RBM). The available dataset was split into three subsets (Training, Validation and Testing). The training and validation datasets included 85% of data and the testing dataset included 15% of the available data. The regression error was assessed through a Bland-Altman analysis and the AAMI standard. The mean prediction error were -2.98+-19.35 mmHg for SBP, -3.38+-10.35 mmHg for MAP and 3.65+-8.69 mmHg for DBP.
The results obtained are promising for the assessment of MAP and DBP with DBN-RBM. Further research and clinical validation are needed to bring this technology to standard medical practice.
What do we need to indicate CTO PCI?
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2. Randomized trials are still needed to provide high-level evidence on the benefits of CTO PCI given limitations of observational data though several large randomized trials are underway.
3. Expert operators can now achieve high success rates of over 90% for CTO PCI with low complication rates even for complex CTOs, using bilateral injections, IVUS, retrograde approaches and specialized guidewires and catheters.
Blood Transfusion success rate prediction using Artificial Intelligence
This document discusses using machine learning models to predict whether patients will require an intraoperative blood transfusion during mitral valve surgery. Specifically, it examines using the XGBoost and gradient boost techniques to predict transfusion success rates. It finds that XGBoost achieves an accuracy of about 93% for predicting transfusions, compared to 90% for gradient boost, making XGBoost the better performing model. The document concludes that machine learning can successfully predict transfusion needs with an accuracy of 93% using XGBoost.
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Right Anterior Thoracotomy Minimally Invasive Aortic Valve Replacement vs. Co...
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Clinical evidence picco technology
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Tranexamic acid in hip hemiarthroplasty
This study examined whether administering tranexamic acid (TXA) before hip hemiarthroplasty surgery reduces postoperative blood transfusions. The study reviewed 271 patient records, with 84 patients receiving TXA and 187 not receiving it. Patients receiving TXA saw a lower drop in postoperative hemoglobin levels and lower transfusion rates. Specifically, the TXA group saw a 26% transfusion rate compared to 42% in the non-TXA group. The study concluded that TXA reduces postoperative blood loss and transfusions in hip hemiarthroplasty patients, and is a safe and cost-effective intervention.
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More from Claudio Melloni
Conscious sedation intero inglese pptx
Conscious sedation for dentistry requires processes, facilities, equipment, and personnel similar to MAC anesthesia in an operating room to ensure patient safety. The author has extensive experience in anesthesia and publishes in peer-reviewed journals on topics like conscious sedation, monitoring, and risk assessment for noncardiac surgery. Guidelines from organizations like the ASA provide standards for preoperative assessment, monitoring during conscious sedation, and post-operative care to maintain patient safety and appropriate levels of sedation.
Conscious sedation for moscow windows
Conscious sedation in dentistry,presented to a meeting of Euroscicon at Moscow,Oct.2018,shortened.This is the full version
Nora e reversal colorato slideshare; NaPoli i SIA 2016
This document discusses complications that can occur during MRI, endoscopy, and dental procedures when sedation or anesthesia is used. It provides data on adverse events and deaths from studies in the United States and United Kingdom. Risk factors discussed include the type of sedation used, the age of the patient, and procedures occurring outside of an operating room. The need for proper patient monitoring during non-operating room anesthesia is emphasized.
Are there limits to ga?
Lecture delivered in 2003 about possibilites and limitations in the delivery of general anesthesia.Pharmacokinetics,dynamics,practice,theory,...
Importanza anestesista in oftalmologia 2013/IMportance of the anesthesiologis...
This document discusses the role of anesthesiologists in ophthalmic surgery, with a focus on day/office surgery. It outlines the safety services anesthesiologists provide, including screening patients, administering and monitoring anesthesia, preventing and treating complications, and safe discharge. It also discusses value-added services like developing policies, purchasing equipment, and providing drug formulary advice. Specific responsibilities in the operating room and ways anesthesiologists can improve efficiency are covered. The document also discusses monitoring, equipment, training, and standards required for day surgery anesthesia care.
Corso sul cisatracurium per glaxo 2007 ottobre
This study examined the incidence of postoperative weakness in patients who received either cisatracurium or rocuronium as muscle relaxants during surgery. The drugs were administered and antagonized using a strict protocol based on tactile train-of-four (TOF) counts rather than quantitative neuromuscular monitoring. Results showed no significant differences between the two drugs. At 10 minutes post-antagonism, mean TOF ratios were above 0.7. By 15 minutes, only one patient in each group had a TOF ratio below 0.7. No patients arrived in the post-anesthesia care unit with weakness. The study concludes that tactile TOF assessment can safely guide administration and reversal of these muscle relax
Update on NSAID's,Coxibs(2008???)
Update on Nsaid.s with special emphasis on postoperative analgesia; references to be improved,work in progress,stopped 2008(?)
Valut az rischio anest sia napoli dic 2008;italian + bibliografy
evaluation of operative risk for non cardiac surgery ;for anesthesia and surgery.Cardiac conditions,including heart failure ,use of betablockers,stains.Diabetes risk,including difficult intubation.Thromboembolic risk,
Various surgical and anesthesiological risks
The document describes a study that aimed to develop and validate a concise screening tool called the STOP questionnaire for detecting obstructive sleep apnea (OSA) in surgical patients. The STOP questionnaire consists of 4 yes/no questions related to snoring, daytime tiredness, observed breathing stops during sleep, and high blood pressure. The study found the STOP questionnaire had a sensitivity of 65.6-79.5% for detecting different severities of OSA compared to polysomnography. Incorporating additional risk factors into the STOP-Bang model increased the sensitivity to over 83%. The study validated the STOP questionnaire as an easy-to-use screening tool for OSA in surgical patients.
Ryanodex,a new dantrolene formulation
A new dantrolene formulation for the treatment of Malignant hyperthermia(MH).Receptors,pharmacokinetics,dosages,preparation of dantrolene,practical tips,advantages.
The traveling anesthesiologist
office based anesthesia,sedation,guidelines,anesthesiologists vs sedationists,monitoring,drugs,safety,transport.A personal perspective
Raccomandazioni val reope mal card pptx
preop. assessment of patients with cardiac disease;anesthesia and surgery risk,scores.
annotated bibliography
Raccomandazioni per la valutazione preoperatoria malattie remalii
The document describes a study that developed an Acute Kidney Injury (AKI) risk index for patients undergoing general surgery. The study used data from over 75,000 patients to identify 11 independent preoperative predictors of AKI. These predictors were used to create a risk index with a high predictive capability (c statistic of 0.80). Patients who experienced AKI had an eightfold increase in 30-day mortality. The risk index can help identify patients at risk of AKI so preventative measures or closer monitoring can be taken.
Raccomandazioni per la val preop in chirurgia non cardiaca;pazienti diabetici
This document provides guidelines for preoperative evaluation of adult patients undergoing non-cardiac surgery, with an emphasis on respiratory diseases. It discusses risk factors for postoperative pneumonia and respiratory failure, including patient characteristics like age, functional status, smoking history; and type of surgery. Spirometry and chest X-rays are assessed, with evidence suggesting they have limited value in predicting postoperative pulmonary complications for individual patients. Risk indices are presented that stratify patients into categories of increasing probability of developing postoperative pneumonia or respiratory failure based on their risk factor profile.
Raccomandazioni per la val preop mal resp
This document summarizes guidelines for preoperative evaluation of adult patients undergoing non-cardiac surgery, with an emphasis on respiratory diseases. It identifies several risk factors for postoperative pneumonia, including age over 60, dependent functional status, weight loss, COPD, and surgery type. A risk index for predicting postoperative respiratory failure is also described, which includes patient factors like albumin level, BUN, functional status, and COPD, as well as surgery type. The document discusses strategies for reducing postoperative pulmonary complications, such as various lung expansion techniques.
Pulmonary complications risk
This document discusses the development and validation of a multifactorial risk index to predict the risk of postoperative pneumonia in patients undergoing major noncardiac surgery. It describes defining postoperative pneumonia as new radiographic lung findings accompanied by changes in sputum, a positive blood culture, or isolation of a pathogen from respiratory samples. Risk factors identified for the index included age, functional status, weight loss, COPD, anesthesia type, impaired sensorium, steroid use, smoking, and medical history. The risk index stratified patients into five classes from lowest to highest risk of developing postoperative pneumonia.
Ponv corso itinerante 2008.
postoperative nausea and vomiting,risk factors,prediction,scoring,annoated bibliography, a lot of pubmed summaries.....
Obesity risk in anesthesia a nd surgery
Obesity and sleep apnea are associated with several health risks. Screening tools can help identify patients at high risk for obstructive sleep apnea (OSA) so they can be properly treated before surgery to prevent postoperative complications. Studies have shown that untreated OSA is linked to increased risks of pulmonary issues like pneumonia and respiratory distress after surgery. The STOP questionnaire is a validated screening tool that uses 4 simple questions about snoring, tiredness, breathing pauses witnessed by others, and blood pressure to help identify patients likely to have undiagnosed OSA.
Mortality morbidity risk
risk of mortality and morbidity in surgery ;thromboembolism risk,diabetes,smoking,nutritional status,albumin
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Nora e reversal colorato slideshare; NaPoli i SIA 2016
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Valut az rischio anest sia napoli dic 2008;italian + bibliografy
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Raccomandazioni per la valutazione preoperatoria malattie remalii
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Identification and nursing management of congenital malformations .pptxMGM SCHOOL/COLLEGE OF NURSING
Identification and nursing management of congenital malformations Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeProf. Marcus Renato de Carvalho
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Non-respiratory Functions of the Lungs.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Physiology of Chemical Sensation of smell.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Journal Article Review on Rasamanikya
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Light House Retreats: Plant Medicine Retreat Europe
Our aim is to organise conscious gatherings and retreats for open and inquisitive minds and souls, with and without the assistance of sacred plants.
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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share - Lions, tigers, AI and health misinformation, oh my!.pptx
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
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Top Effective Soaps for Fungal Skin Infections in India
Swisschem Dermacare has mentioned the List of The Best Antifungal Soap In India 2022. All of these soaps are trusted by various Dermatology Experts.
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Surgical apgar score
- 2. Surgical Apgar Score Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008. • lowest heart rate • lowest mean arterial pressure • estimated blood loss • A score built from these 3 predictors has proved strongly predictive of the risk of major postoperative complications and death in general and vascular surgery. • The score was thus developed using these 3 variables, and their beta coefficients were used to weight the points allocated to each variable in a 10-point score ( Table 1).
- 3. Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008.
- 5. Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008.
- 6. Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008.
- 7. Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008.
- 8. Frequenza delle complicanze a seconda del Surgical Apgar Score Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008. %
- 9. Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008. • We find that even after detailed adjustment for comorbidity • and procedure-specific risk factors, the amount of • blood loss, lowest heart rate, and lowest blood pressure were • still important predictors of the risk of a major complication. • The Surgical Apgar Score, therefore, conveyed useful prognostic • information, either in isolation or in combination with • assessments of the risks that patients brought to the operating • room. It also may provide an immediate assessment of how • well or poorly the operation has gone for a patient. In this • cohort, surgical teams could cut a patient’s risk-adjusted • odds of major complications nearly in half with a score of • 9 –10, or conversely, nearly triple the risk-adjusted odds • with scores 4. • This finding, that intraoperative blood loss, heart rate, • and blood pressure are critical predictors of postoperative • risk, is consistent with a variety of previous observations.
- 10. Regenbogen, Scott E. MD, MPH *+; Lancaster, R Todd MD *+; Lipsitz, Stuart R. ScD ++; Greenberg, Caprice C. MD, MPH ++; Hutter, Matthew M. MD, MPH +; Gawande, Atul A. MD, MPH *++ Does the Surgical Apgar Score Measure Intraoperative Performance? Annals of Surgery. 248(2):320-328, August 2008. • In summary, we have found that a simple clinimetric • surgical outcome score can provide both clinical surgeons • and surgical safety researchers with useful and important • information. The Surgical Apgar Score integrates components • of patient susceptibility, procedure complexity, and • operative performance, providing a measure of immediate • postoperative condition and prognostication beyond standard • risk-adjustment. As a decision-support tool, the score can • inform postoperative prognostication, communication, and • triage, regardless of the sophistication of preoperative risk • stratification available. Finally, as a simple intraoperative • outcome measure and safety improvement metric, it may • prove useful as an indicator of surgical performance