Overlapping Surgery Largely Safe but surgeons should not take simultaneous high risk or bypass surgery cases

Overlapping surgery means when the primary surgeon is involved in more than one case simultaneously. In a JAMA study across seven common surgeries: total knee or hip arthroplasty; lumbar, thoracic, or cervical spine surgery; coronary artery bypass graft (CABG) surgery; and craniotomy; for which the primary surgeon had two or more operations running simultaneously for at least an hour of longer procedures, or the entire procedure if duration was less than an hour, the findings were:

A similar unadjusted mortality rate of 2.1% vs 1.6% for nonoverlapping surgeries; equivalent in-hospital mortality adjusted for surgeon-procedure fixed effects and patient characteristics (1.9% vs 1.6%); no difference in the unadjusted complication rate (14.0% vs 11.7%) and similar adjusted postoperative complication rates (12.8% vs 11.8%). Overlapping surgeries were longer in both unadjusted (237 vs 169 min, P<0.001) and adjusted (204 vs 173 min, P<0.001) analyses and for every subgroup.

Overlapping surgery is a reasonable practice for many cases. However, there were signals of greater risk in overlapping surgery for cardiac bypass and in higher risk cases. A prespecified, exploratory analysis looked specifically at CABG surgery and found overlap associated with both greater in-hospital mortality (4.0% vs 2.2%) and more complications (34.5% vs 30.2%).  High-risk patients also saw increased mortality (5.8% vs 4.7%) and more complications (29.2% vs 27.0%), which were both significant compared with nonoverlapping procedures and compared with low-risk patients in a test of interactions.

Say no to these Herbs in cancers

1. Alfalfa, black cohosh, chasteberry, dehydroepiandrosterone (DHEA), red clover, soy, and wild yam in breast cancer
2. Alfalfa, chasteberry, DHEA, red clover, soy, and wild yam in gynecologic cancer
3. Chasteberry, DHEA, flaxseed, and saw palmetto in prostate cancer
4. Echinacea in leukemia.
5. Phytoestrogens are herbal compounds that mimic estradiol. Foods containing phytoestrogens, such as soy, have been shown to confer protective effects against breast cancer. However, genistein, an isoflavone present in soy, may stimulate the proliferation of breast tumors and interfere with the action of tamoxifen. These herbs are best avoided by patients with hormone-sensitive cancers.
6. Dang gui if pateints are taking warfarin

Potentially Inappropriate Medication Use in Older Adults(Part 2)

Analgesics/anti-inflammatory agents

Ketorolac (H)

• Meloxicam (H)
• Meperidine (H)
• Naproxen (H)
• Oxaprozin (H)
• Pentazocine (H)
• Piroxicam (H)
• Propoxyphene (low severity rating [L])
• Trimethobenzamide (H)

Antiarrhythmics

• Amiodarone (H)
• Dofetilide (H)
• Dronedarone
• Procainamide (H)
• Digoxin (L)
• Quinidine (H)
• Disopyramide (H)

Anticholinergics/antihistamines

• Brompheniramine (L)
• Chlorpheniramine (H)
• Cimetidine (L)
• Diphenhydramine (H)
• Hydroxyzine (H)
• Cyproheptadine (H)
• Clemastine (H)
• Promethazine (H)
• Tripelennamine (H)
• Dexchlorpheniramine (H)

Antidepressants

• Amitriptyline (H)
• Imipramine (H)
• Chlordiazepoxide-amitriptyline (H)
• Doxepin >6 mg/day (H)
• Fluoxetine (H)
• Perphenazine-amitriptyline (H)

Antihypertensive

• Clonidine (L)
• Guanfacine (L)
• Guanabenz (L)
• Cyclandelate (L)
• Dipyridamole (L)
• Doxazosin (L)
• Ethacrynic acid (L)
• Guanadrel (H)
• Guanethidine (H)
• Isoxsuprine (L)
• Methyldopa (H)
• Methyldopa-hydrochlorothiazide (H)
• Nifedipine (H)
• Nitrofurantoin (H)
• Reserpine (L)

Antiplatelet agents

• Ticlopidine (H)

Antipsychotics

• First-generation antipsychotics (H)
• Thioridazine (H)
• Mesoridazine (H)

Anxiolytics

• Alprazolam (H)
• Chlordiazepoxide (H)
• Chlordiazepoxide-amitriptyline (H)
• Clorazepate (H)
• Clidinium-chlordiazepoxide (H)
• Diazepam (H)
• Halazepam (H)
• Lorazepam (H)
• Meprobamate (H)
• Oxazepam (H)
• Quazepam (H)
• Rurazepam (H)
• Temazepam (H)
• Triazolam (H)

Dementia agents

• Anticholinergics (H)
• Benzodiazepines (H)
• Ergot mesyloids (L)
• Cyclandelate (L)....to be continued