Thursday, 1 May 2014

Redesigning Surgical Decision Making for High-risk Patients. NEJM April 2014

This is an interesting perspective on moving towards patient-centred counselling when it comes to offering invasive procedures. Who should help patients weigh the risk / benefit of surgery? Are surgeons inherently biased towards more aggressive treatment? Would a multidisciplinary group serve the patient better?  

Rates and risk factors for prolonged opioid use after major surgery:population based cohort study. BMJ 11 February 2014.

Of the 39 140 opioid naive patients over the age of 66 who had major elective surgery, 1229 (3.1%) of patients continued to use opioids more than 3 months post discharge. This is a smaller rate compared to prolonged opioid use reported in low risk surgery and highlights that opioid dependence is less problematic when prescribed appropriately. Factors associated with prolonged opioid use are discussed. An editorial discussing the role of an anaesthetist in this matter is attached.

Adult obstructive Sleep Apnoea. Lancet 2014; 383: 736-47

This article in the Lancet is for those who crave to know more about OSA….

Aspirin in patients Undergoing Non-cardiac Surgery. NEJM March 2014.

What is the best management of peri-operative aspirin? This international randomised, controlled trial looked at the value of peri-operative aspirin in patients at risk of vascular complication undergoing non-cardiac surgery. Neither the rate of death nor nonfatal myocardial infarction was affected by the use of peri-operative aspirin. There was an increased risk of major bleeding in the aspirin group. In fact, major bleeding was an independent predictor of myocardial infarction. Patients who had received a bare-metal stent (less than 6 weeks) or a drug-eluting stent (less than 1 year) before surgery were excluded.