Perioperative quality – Jan Jakobssons research group

Perioperative quality, monitoring of the perioperative and early postoperative course

We study the operative process and early recovery, specifically the time patients are monitored in the recovery unit. The operating theatre and recovery unit are resource-intensive settings that should be utilised efficiently. Early recovery is a crucial phase in which body functions must return so that patients can either move to a standard ward or be mobilised for discharge. Efficient patient flow in the operating theatre is highly important. The early postoperative period is also significant from both process and quality perspectives. Pain, nausea and lingering anaesthetic effects should be minimised. Postoperative mortality is now very rare, but monitoring 30-day mortality remains an important measure of perioperative quality. We use the Swedish perioperative quality register, SPOR, to systematically study the perioperative process in Sweden.

Robotic-assisted laparoscopy for benign hysterectomy, effects on duration of surgery and theatre occupancy time

Robotic assisted surgery has gain increasing interest. There is no recent study assessing the effects of the increasing use of robotic assisted surgical technique impact on perioperative course, time events, blood loss and recovery room pain and PONV during recent years.
SPOR is a national Swedish perioperative register collecting perioperative observation, surgical technique, duration of theatre occupancy, duration of surgery, anaesthesia and recovery room stay, peroperative complication and mortality within 30 days. With the availability of the SPOR register the lack of information about robot-assisted laparoscopic hysterectomy impact on perioperative course can be filled.
The aim of the present single centre study is to assess surgical techniques used for benign hysterectomy and compare the perioperative course and early postoperative quality between the different surgical techniques, robot assisted, laparoscopic, open and vaginal. Secondary objective is change in techniques over the 5-year study period 2021 – 2025, severe peroperativ complication (grade 4 and5) and all-cause 30-day mortality based on SPOR data covering Danderyds University hospital

Anaesthesia care time for emergent caesarean section

Urgent Caesarean section is classified if there is a serious threat for the life of the mother or the foetus. There are in Sweden about 20 000 CS annual whereof 50% are emergent . Guidelines suggest that time from decision to delivery should be kept as short as possible. Danderyds University hospital is one of the larger delivery units in Sweden   . There are some 2 000 Caesarean section annual and similar to the national data 50% are emergent. The DDI for emergency CS was defined as the interval in minutes from the time of the decision by obstetrician to the time of delivery of the baby. The total DDI was calculated as a continuum of the following four intervals:
•    Interval I (A–B): Decision by obstetrician (A) and transfer of patient to operation theater (B)
•    Interval II (B–C): Arrival of the patient in operation theater (B) to induction of anesthesia (C)
•    Interval III (C–D): From anesthesia induction (C) to surgical incision (D)
•    Interval IV (D–E): From surgical incision (D) to delivery of baby (E).
The present project is assessing the time events associated to anaesthesia service, B-C and C-D.
The aim of the presents study is to assess the anaesthesia related time delays in care of emergent Caesarean section at Danderyd hospital, assessing potential time difference during on call hours.

Postoperative nausea and vomiting has the incidence decreased following its implementation as a national key quality indicator 

Postoperative nausea and vomiting (PONV) is a well-known adverse effects associated with perioperative care. There are several risk factors for its occurrence. Patient factors are well-documented, female sex, none smoking, pervious experience of PONV are strong factors, there are further weaker such as motions sickness, age etc. There are also well know perioperative factors laparoscopic surgery, breast surgery, and ear nose and throat are associated with higher risk. It is also well documented that propofol based anaesthesia is associated with lower PONV during the first postoperative day   . SPOR implemented PONV as a national quality indicator in 2023. Apfepl risk score has been shown effective in reducing PONV. 
There is today common practice to implement procedure specific programs to enhance the recovery process and reduce the occurrence of PONV. The ERAS society has provided several evidence based procedural specific guidelines for enhanced recovery after surgery. 
There is however sparse information about the everyday clinical practice impact of the increased knowledge to minimize and adhere to the quality indicator. There is a need for further studies assessing occurrence of PONV in routine practice. Danderyd is one of university hospitals in the Stockholm area and report to the Swedish Periopreative register . There is no recent follow-up of the adherence to the PONV quality indicator, a more than 90% PONV-free patients during the recovery room stay.
The aim of the present observational single centre study is to assess the occurrence of PONV during the recovery room stay over a 5-year period.
The hypothesis is that early PONV has decreased and has reached the QI level f less than overall 10%