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L Reuven Pasternak

Publications and source records attributed to L Reuven Pasternak.

8 recordsLinked to original sources
PubMed2005

Ambulatory gynaecological surgery: risk and assessment.

Assessment of patients undergoing elective surgical procedures on an outpatient basis carries risks that range from mortality through non-lethal injuries to costs incurred for inappropriate testing. Ambulatory surgery accounts for over 60% of elective surgical procedures for most areas of the USA, Canada and Australia and a growing proportion of procedures in Europe and Asia. However, data to determine the true risk of these procedures are difficult to find due to standardized criteria for risk assessment and management. Nonetheless, this type of medical procedure, with appropriate preparation, is regarded as safe and standard. Assessment of patients undergoing these procedures must take into consideration the nature of the medical and surgical conditions. Diagnostic testing is only performed if the results might change the management of the patient. At present, the American Society of Anesthesiology (ASA) classification system and the ASA guidelines for pre-anesthesia evaluation serve as the most current examples of risk assessments and algorithms that can be used for appropriate management of patients undergoing elective surgical procedures.

Algorithms↗
PubMed2004

Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care.

HYPOTHESIS: Surgery at different outpatient care locations in the higher-risk elderly (age >65 years) population is associated with similar rates of inpatient hospital admission and death. DESIGN: Claims analysis of patients undergoing 16 different surgical procedures in a nationally representative (5%) sample of Medicare beneficiaries for the years 1994 through 1999. SETTING: Hospital-based outpatient centers, freestanding ambulatory surgery centers (ASCs), and physicians' office facilities. PATIENTS: Medicare beneficiaries older than 65 years. MAIN OUTCOME MEASURES: Rate of death, emergency department risk, and admission to an inpatient hospital within 7 days of outpatient surgery. RESULTS: We studied 564,267 outpatient surgical procedures: 360,780 at an outpatient hospital, 175,288 at an ASC, and 28,199 at a physician's office. There were no deaths the day of surgery at a physician's office, 4 deaths the day of surgery at an ASC (2.3 per 100,000 outpatient procedures), and 9 deaths the day of surgery at an outpatient hospital (2.5 per 100,000 outpatient procedures). The 7-day mortality rate was 35 per 100,000 outpatient procedures at a physician's office, 25 per 100,000 outpatient procedures at an ASC, and 50 per 100,000 outpatient procedures at an outpatient hospital. The rate of admission to an inpatient hospital within 7 days of outpatient surgery was 9.08 per 1000 outpatient procedures at a physician's office, 8.41 per 1000 outpatient procedures at an ASC, and 21 per 1000 outpatient procedures at an outpatient hospital. In multivariate models, more advanced age, prior inpatient hospital admission within 6 months, surgical performance at a physician's office or outpatient hospital, and invasiveness of surgery identified those patients who were at increased risk of inpatient hospital admission or death within 7 days of surgery at an outpatient facility. CONCLUSION: This study represents an initial effort to demonstrate the risk associated with outpatient surgery in a large, diverse population of elderly individuals.

Age Factors↗
PubMed2004

Preoperative laboratory testing: general issues and considerations.

The challenge of preoperative laboratory testing has been increased during the past 20 years because now fewer than 30% of patients undergoing surgery are admitted to the hospital before the day of surgery. Even with the advent of formal preoperative systems in many institutions, it is believed that well over 50% of patients do not have a definitive preoperative visit with anesthesia staff before the day of surgery. Thus, anesthesia teams are dependent on other providers to provide appropriate data to best judge who is an appropriate candidate for anesthesia. This issue is becoming all the more difficult because the acuity of patients and complexity of procedures being managed on an outpatient or same day admission basis increases.

Anesthesia↗
PubMed2004

Introduction: guidelines and advisory development.

Since 1992, the American Society of Anesthesiologists has produced 12 evidence-based practice guidelines, 2 practice advisories, and 3 guideline updates. These documents have assisted anesthesiologists and practitioners in many other specialties. Their brevity, practicality, and ease of use, coupled with a thorough and systematic evaluation of the evidence have been instrumental in bringing together the science and practice of medicine. The application of formal evidence-collection processes for literature and opinion and efficient analytic evaluations combine with the experience and practical knowledge of clinicians to produce widespread application of the guidelines. The evidence-based process developed by the ASA has been found to be adaptable to a wide variety of issues relating to clinical practice. The goal is to systematically collect and evaluate evidence from multiple sources and apply it ina comprehensive manner to the guideline recommendations. The ASA guideline and advisory development process is continuing to evolve in response to changes in medical technology, research, and practice. By providing synthesized evidence from multiple sources and robust clinical recommendations the ASA offers the practice of anesthesiology, an invaluable bridge between science and clinical practice.

Anesthesiology↗
PubMed2003

Preoperative screening for ambulatory patients.

Preoperative assessment of patients undergoing elective ambulatory procedures is constantly changing. Though the need for testing and outside consultation is decreasing, the challenges of creating systems that allow for timely review of information is growing. This article provides suggestions for addressing these issues during a period of increasing constraints in budgets and manpower.

Ambulatory Surgical Procedures↗