Reduction of airway complications with fluid management protocol in patients undergoing cervical decompression and fusion across the cervicothoracic junction.

STUDY DESIGN: Retrospective comparative cohort analysis. OBJECTIVE: To evaluate the effect of an intraoperative and intensive care unit protocol on incidence of airway complications for patients undergoing combined anterior-posterior cervical decompression and fusion crossing the cervicothoracic junction (CTAPF). SUMMARY OF BACKGROUND DATA: Airway compromise remains an important potential complication for patients undergoing CTAPF. Volume of intravenous fluid replacement perioperatively has been correlated with risk of airway complications in this patient population. METHODS: A retrospective cohort study was performed comparing airway complications (postoperative airway edema requiring reintubation and/or prolonged need for intubation) in patients undergoing CTAPF prior to and after introduction of a standardized protocol. The protocol required limitation of crystalloid fluid resuscitation intraoperatively, with maintenance of blood pressure using vasopressors. Comparisons between the 2 cohorts included operative time, intraoperative blood loss, volume of IV fluid replacement, and incidence of airway complications and dysphagia. RESULTS: Among patients operated prior to establishment of the protocol, 45% (9/20) experienced airway edema requiring extended intubation or reintubation. This rate was reduced to zero among 8 patients operated after the adoption of the protocol (P = 0.029). Intraoperative IV fluid volumes were reduced from 6190 mL to 4802 mL after institution of the protocol (P = 0.016). EBL and total surgical time did not differ between the 2 cohorts (1024 mL vs. 869 mL, P = 0.443; and 6.76 hr vs. 7.18 hr, P = 0.460). Incidence of dysphagia was not significantly different between the 2 cohorts. CONCLUSION: Establishment of a fluid and airway management protocol for patients undergoing CTAPF reduced the incidence of prolonged intubation or reintubation. Given the potentially life-threatening impact of loss of airway patency, intraoperative restriction of IV fluid while maintaining adequate blood pressure may be helpful in increasing the safety of surgical intervention in this complex patient population. LEVEL OF EVIDENCE: 4.

Impact of faculty-specific electronic reminders on faculty compliance with daily resident evaluations: a retrospective study.

STUDY OBJECTIVE: To assess the effectiveness of faculty-specific electronic reminders on increasing faculty compliance with completing daily anesthesia resident evaluations. DESIGN: Retrospective study. SETTING: Anesthesiology Residency Program at Oregon Health & Science University. MEASUREMENTS: 41 faculty members on staff from February 2004 through January 2006 were studied for compliance with submitting daily anesthesia resident evaluations 12 months before and 12 months after implementation of a faculty-specific electronic reminder system. Evaluations were entered into a customized, web-based Daily Resident Evaluation database. Data for the reminders were obtained from the Surgical Schedule database. At the end of the study period, data on compliance with our daily resident evaluation system was aggregated by month and compared before versus after system implementation. MAIN RESULTS: A total of 1,222 of 3,893 possible evaluations (31.4%) were submitted before the faculty-specific electronic reminder system was in place, with 38 faculty submitting at least one evaluation (93% participation). After the intervention, 1,824 of 4,263 possible evaluations (42.8%) were submitted, with all 41 faculty submitting at least one evaluation (100% participation). The percentage of resident evaluations submitted by the faculty increased from 29.3% to 42.9% (P < 0.0001) after introducing the faculty-specific reminders. Faculty in the lowest quartile of compliance prior to the intervention showed the largest improvement (446% increase). CONCLUSIONS: A faculty-specific electronic reminder system improved faculty compliance with submitting resident evaluations. The faculty members with the lowest compliance prior to implementation of this system benefited the most.