PANSURAS is an institutional, local server-based, integrated decision-support program for preoperative risk assessment, teaching, as well as individual, local, and regional quality audit.

Perioperative assessment:
Perioperative assessment in PANSURAS is based upon the concept that a patient does not only undergo anesthesia or surgery, but undergoes anesthesia plus surgery. This means that preoperative risk assessment is an assessment of the risks of short-term effects of anesthesia combined with surgery, the risks associated with the longer-term effects of surgery, as well as the effects of any postoperative medication and therapy.

Three moments determine postoperative risk. Pre-, per-, and postoperative data are combined in proprietry algorithms to continually update the coefficients used in logistic equations providing clinical decision support to answer questions such as:

Assessment moments:
PANSURAS assesses patient profiles at four moments:

  1. Surgical / Anesthesiology Assessment Clinic: The initial risk-assessment. This is the moment when surgeons and anesthesiologists combine their knowledge to arrive at a total risk assessment. After all, no operation occurs without anesthesia, and no-one undergoes anesthesia without undergoing an operation. Both have their own unique effects upon the body during surgery. Initial risk assessment is where surgeons, anesthesiologists and patients determine whether the benefits of a planned operation outweigh the potential risks. PANSURAS provides decision support and advice for this assessment.(see example of WGBO related “Summary” used for discussions with patients about relative risk).
  2. Anesthesia planning: The anesthesia planning module / page includes standard LEMON and MOANS assessments, as well as a comment / blog whereby an anaesthesia status rergarding the preoperative preparation of the patient can be maintained as a sort of “paper trail”, both for efficient work-flow, as well as for subsequent analysis if required.
  3. In the holding area just before surgery: Most modern hospitals have a “holding area” where patients about to undergo a planned operation undergo last preparations for anesthesia and surgery. This is a moment when basic measurements are made of blood pressure, pulse, saturation, and ECG, as well as checking any recent laboratory values. PANSURAS includes a holding-area module enabling anesthesiologists and surgeons to determine whether the condition of a patient has significantly deteriorated between the initial assessment and arrival at the holding area.The chance of this happening increases with patient age. For example, some aged patients develop atrial fibrillation, or worsening lung function, between intial assessment and operation date, etc, etc. Some of these factors significantly increase postoperative risk to a degree that elective surgery should be cancelled until these problems are corrected. (see example of the effect of developing atrial fibrillation on the predicted outcomes in the screen “holding”. This module is used as a last check before surgery.)
  4. Postoperative data: Entry of basic operative data into PANSURAS enables more refined predictions of the postoperative course to be made. It is true that surgery and anesthesia have occurred, but these predictions can be used to guide postoperative management. Furthermore, these data are essential for generation of coefficients for existing predictive equations, as well as generating new algorithms, because these are all outcome-related.
  5. Follow-up data: Data from the PANSURAS database are absolutely standardised, making comparisons between institutions, individuals and regions possible. PANSURAS data, WHEN combined with the perioperative physiological and surgical data, AND coupled with individual, group practice, and regional data, TURN PANSURAS into a unique and powerful audit and quality control instrument fopr anesthesiologists and surgeons. This benefits patients, surgeons, and hospitals.

Teaching, Preoperative management & Research:
PANSURAS is also an integrated teaching, and research instrument. Multiple screens and pop-ups, (activated by clicking the many “info” buttons), provide information as well as advice on multiple context-related topics.

The simulation mode can be employed to demonstrate the effects of certain types of pathology upon perioperative morbidity of real, and example patients. At the same time, the simulation mode is a valable clinical tool with which to investigate the effects of any preoperative therapy directed to improving the condition of a specific patient.

The two-factor analytics on the analytics page reveal relationships between parameters: performs exponential, linear, logarithmic, and quadratic regressions, as well as generating the relevant equations to reveal relationships. This feature enables the expansion and formulation of new predictive algorithms.

Multiple factor logistic regression modules:
The analytics page of PANSURAS provides access to mutliple factor logistic regression modules which can be used to continually update the coefficients of the predictive equations used in the clinical page. The ability to perform continual multiple regresssions is a feature making PANSURAS unique in the field of preoperative assessment. No other perioperative predictive algorithms possess this feature. The ability to perform multiple regressions upon the local / regional patients actually treated in that locality / region means that PANSURAS generates accurate predictions for that locality / region. It also means that the predictive equations adjust for changing demography, socio-economic circumstances, and medical techniques. This means that PANSURAS is applicable in all world regions.

These same local / regional regressions can be used to benchmark performance between regions, as well as countries. (see the “Clinical logistical regression coefficients screen”)

The logistical analytical algorithms upon which much of PANSURAS is based are also powerful benchmarking and audit algorithms for regions, hospitals, and even individuals. A classic example of this use was published during 1993 for comparison of the vascular surgical units of two hospitals (Click here to read article by Copeland et al). This article reveals the power of physiological profiling. When physiological profiling is combined with postoperative follow-up data as revealed in the example “Clinical logistical regression coefficients screen”, then PANSURAS becomes a powerful quantitative, outcome-driven: individual, surgical unit, hospital, and regional, audit and benching tool. (example audit screens for an individual surgeon are shown as audit-1, audit-2, and audit-3 screens).

FINALLY — more information:
More information is provided by a Powerpoint presentation accessed by:

CLICKING THIS LINK to a presentation

(the link goes to a 2.5+ mb powerpoint presentation - may take a few seconds to load)

Some screenshots of PANSURAS

Opening screen:

Main clinical screen:

Summary screen for patient:

Anesthesia planning screen-1:

Anesthesia planning screen-2:

Holding screen - effect of atrial fibrillation:

Main analysis screen:

Clinical logistical regression coefficients screen:

2-factor regression start screen:

2-factor regression results screen:

Audit-1 screen:

Audit-2 screen:

Audit-3 screen:

Contact Woerlee Praktijk B.V.
Interested persons can contact the company represnting PANSURAS at the foloowing telephone number, or by email.
Telephone (mobile): +31 (0)6 53578402

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