Introduction: In a prior analysis, delirium was seen more often in patients with at least one incident of IDH in the first 48 hours compared to those who remained normotensive (8.1 vs 3.0%). Here we explored events over the entire hospital stay and focused on a subpopulation of patients with a history of substance abuse (SA). Their treatment would include a narcotic or benzodiazepine, as potential vasodilators they could increase the likelihood of IDH. Methods: We performed Aa retrospective chart review of patients >18 years with blunt trauma, Glascow Coma Scale ≥ 14 and head/neck Abbreviated Injury Score ≤ 1 admitted to our Level I trauma center from 8/1/16 to 4/1/20, to avoid potential confounding from COVID-19., was doneperformed. This study focused on two groups: normotensive (systolic blood pressure (SBP) >100 and diastolic blood pressure (DBP) >60) throughout their stay and IDH (SBP > 100 and DBP < 60) at any point during their admission. We compared them these two groups on the occurrence of delirium after an IDH episode using. The statistical comparisons were done using chi-square tests and logistic regressions, which included other patient characteristics associated with IDH and delirium. Results: A total of 1656 patients met inclusion criteria and were assessed for delirium (613 normotensive and 1043 IDH). As hypothesized, delirium was significantly more likely in the IDH than in the normotensive group (5.1 vs 1.5%; p < 0.001). As predicted patients with SA history were more likely to have IDH (62.2 vs 56.0%) and were more likely to develop delirium (6.2% vs. 3.4%) although these differences were not statistically significant. The IDH effect on delirium was significant only for patients without SA history and SA history was significant for delirium only in the normotensive group (both p <.0.001). The effect of IDH and its interaction with SA remained significant in multivariate analysis. Age also remained an independent risk factor for delirium. Conclusions: These results confirm our prior work on the association of IDH and delirium and suggest that SA has an impact on IDH. Surprisingly, these two factors do not appear to compound each other. This pattern remains significant in a multivariate approach. More exploration of the interaction of substance abuse on IDH and other factors is needed.

The safe release of a patient from hospital care after bariatric surgery depends upon the achievement of satisfactory health status. Here, we describe a new objective scale (the Readiness for Discharge, RFD Scale) to measure the patient’s suitability for hospital discharge after bariatric surgery. We conducted a retrospective, observational analysis of data collected in a randomized clinical trial of an enhanced recovery after surgery protocol for laparoscopic sleeve gastrectomy from 3/15/2018 to 1/12/2019. Nursing staff assessed 122 patients every 4–8 h after surgery using a checklist to document 5 components: ambulation, vital signs, pain, nausea, and oral intake of clear fluid. Satisfaction of each component was scored as “1” (satisfactory) or “0” (not satisfactory). Scores were summed and analyzed for patterns. RFD = 5 marked the patient as ready for discharge. Sufficient intake of clear liquid was the last RFD component satisfied in 87% of patients. Two overall response patterns emerged: “Steady Progressors” (n = 51) whose RFD score rose steadily from 0 to 5 without reversion to a lower score; and “Oscillators” (n = 71) who had at least one temporary decrease in RFD score on the way to attaining 5, or showed a simultaneous oscillation of components without change in RFD. The RFD checklist allows objective scoring of medical readiness for discharge after LSG and has the potential to improve clinical communication.

The purpose of this study was to evaluate the effect of an enhanced recovery after surgery (ERAS) protocol on opioid and anti-emetic use, length of stay and safety after laparoscopic sleeve gastrectomy (LSG). Patients who underwent LSG between March 2018 and January 2019 at our accredited, high-volume bariatric surgery center were randomized to either standard of care (SOC) or ERAS. ERAS included a pre- and post-surgical medication regimen designed to reduce postoperative nausea, vomiting and pain. Outcomes included post-operative symptom scores, opioid use, anti-emetic use, time to achieve readiness for discharge (RFD) and inpatient and 30-day adverse events, readmissions and emergency department visits. The final analysis included 130 patients, (SOC 65; ERAS 65). Groups did not differ on demographics or comorbidities. Relative to SOC, fewer ERAS patients utilized opioids in the hospital ward (72.3

Enhanced recovery after surgery (ERAS) aligns the practice of anesthesia with the care given by the surgical team before, during, and after surgery. In bariatric surgery, randomized clinical trials (RCT) on ERAS are few. We report the Results of an RCT testing an ERAS protocol incorporating a novel multidrug strategy in patients undergoing laparoscopic sleeve gastrectomy (LSG).