Transfers and anesthesia-related postoperative outcomes after 3361 same-day cancer surgeries at a freestanding surgery center: An observational retrospective study.

BACKGROUND AND OBJECTIVES: Expanding outpatient surgery to the increasing number of procedures and patient populations warrants continuous evaluation of postoperative outcomes to ensure the best care and safety. We describe adverse postoperative outcomes and transfer rates related to anesthesia in a large sample of patients who underwent same-day cancer surgery at a freestanding ambulatory surgery center. METHODS: Between January 2017 and June 2021, 3361 cancer surgeries, including breast and plastic, head and neck, gynecology, and urology, were performed. The surgeries were indicated for diagnosis, staging, and/or treatment. We report the incidence of transfers and adverse postoperative outcomes related to anesthesia. RESULTS: Breast and plastic surgeries were the most common (1771, 53%), followed by urology (1052, 31%), gynecology (410, 12%), and head and neck surgeries (128, 4%). Based on patients' first procedure, comorbidity levels were highest for urology (75% American Society of Anesthesiologists physical status score 3, 1.7% score 4) and lowest for breast surgeries (31% score 3, 0.2% score 4). Most gynecology surgeries used general anesthesia (97.6%), whereas breast surgeries used the least (38%). A total of seven patients (0.2%; 95% CI: 0.08%-0.4%) were immediately transferred to an outside hospital; four due to anesthesia-related reasons. Only 7 (0.2%) patients needed additional postoperative care related to anesthesia-related adverse events, specifically cardiac events (4), difficult intubations (2), desaturation (1), and agitation, nausea, and headache (1). CONCLUSIONS: The incidence of anesthesia-related adverse postoperative outcomes is low in cancer patients undergoing outpatient surgeries at our freestanding ambulatory surgery center. This suggests that carefully selected cancer patients, including patients with metastatic cancer, can undergo anesthesia for same-day surgery, making cancer care accessible locally and reducing stress associated with travel for treatment. More research investigating complication rates related to surgery and to cancer disease trajectory are needed to establish a complete evaluation of safety for outpatient cancer surgery.

Unanticipated Myocarditis in a Surgical Patient Treated With Pembrolizumab: A Case Report.

We report a case of fatal immune checkpoint inhibitor (ICI)-associated myocarditis in a 77-year-old man with metastatic non-small cell lung cancer (NSCLC) who presented for mediport placement at our outpatient surgical center. He denied any cardiac complaints and had a previously normal electrocardiogram (EKG) off treatment. Intraoperatively and postoperatively, he displayed cardiac rhythm abnormalities. The patient was then transferred to a tertiary facility, where he expired within 48 hours. As cancer immunotherapy becomes increasingly prominent, ICI-associated myocarditis should be considered a potentially critical contributor to perioperative cardiac morbidity and mortality.

Perioperative Care of the Breastfeeding Patient.

Nurses providing surgical care in nonobstetrical ambulatory surgery centers or specialty hospitals without traditional lactation resources may need to care for patients who are breastfeeding. Nurses in these settings play an important role in supporting and protecting the breastfeeding relationship for nursing mothers separated from their infants during illness or surgical procedures. It is important for care providers to understand how hospitalization and the medications administered before, during, and after a surgical procedure affect mothers who are breastfeeding their infants. This article examines the effects of hospitalization on breastfeeding and focuses on preoperative and postoperative care considerations, including medication use, radiology imaging, interrupting and resuming breastfeeding, breast assessment, and milk storage.

Implementation and Organization of a Perioperative Lactation Program: A Descriptive Study.

INTRODUCTION: As breastfeeding rates rise, perioperative care of lactating women is an increasingly important issue. There is a lack of reports describing the implementation of perioperative lactation programs. Beginning in 2014, Memorial Sloan Kettering Cancer Center developed a perioperative lactation program to address the comprehensive care of lactating patients. The aim of this study was to determine the incidence of lactation in our perioperative population, as well as to describe preliminary data and experiences during the implementation of our program. MATERIALS AND METHODS: This retrospective descriptive study included lactating patients who underwent procedures requiring anesthesia care at our institution from August 2014 to February 2017. This period coincided with implementation of the lactation program, which focused on patient identification, education, and support, as well as staff education and collaboration. Patient volume and characteristics, procedure types, and intraoperative non-narcotic analgesic use were analyzed. RESULTS: Over the 30-month study period, we identified 80 lactating perioperative patients, with ∼2-3 patients presenting monthly. The median (range) age of the child was 5 (0.6-24) months. Most of our lactating patients were American Society of Anesthesiologists class I-II patients (81%), who underwent general anesthesia (89%), and received at least one non-narcotic analgesic intraoperatively (89%). CONCLUSION: Our study showed that we cared for lactating patients undergoing a wide range of procedures on a regular basis. The results from this study are intended to inform the next phase of our research, which will focus on determining how this work impacts outcomes such as postoperative lactation complications, breastfeeding resumption, and overall patient satisfaction.

Successful performance of Cox-Maze procedure on beating heart using bipolar radiofrequency ablation: a feasibility study in animals.

BACKGROUND: The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation with proven long-term efficacy. However, its application has been limited by its complexity and significant morbidity. The purpose of this study was to test the feasibility and safety of performing the Cox-Maze procedure using bipolar radiofrequency ablation on the beating heart without cardiopulmonary bypass. METHODS: After median sternotomy, 6 Hanford mini-pigs underwent a modified Cox-Maze procedure using bipolar radiofrequency energy. The animals survived for 30 days. Atrial function, coronary artery, pulmonary vein anatomy, and valve function were assessed by magnetic resonance imaging. At reoperation, pacing documented electrical isolation of the pulmonary veins. Induction of atrial fibrillation was attempted by burst pacing with cholinergic stimulation. Histologic assessment was performed after sacrifice. RESULTS: There were no perioperative mortalities or neurologic events. At 30 days, atrial fibrillation was unable to be induced, and pulmonary vein isolation was confirmed by pacing. Magnetic resonance imaging assessment revealed no coronary artery or pulmonary vein stenoses. Although atrial ejection fraction decreased slightly from 0.344 +/- 0.0114 to 0.300 +/- 0.055 (p = 0.18), atrial contractility was preserved in every animal. Histologic assessment showed all lesions to be transmural, and there were no significant stenoses of the coronary vessels or injuries to the valves. CONCLUSIONS: Virtually all of the lesions of the Cox-Maze procedure can be performed without cardiopulmonary bypass using bipolar radiofrequency energy. There were no late stenoses of the pulmonary veins. Clinical trials of this new technology on the beating heart are warranted.