Perioperative medicine encompasses the period between the initial consideration for surgery and long-term recovery outcomes. Specialists, alongside personnel across hospital departments, seek to create a safe, personalized care experience tailored to each patient’s unique physiological and social needs. This differs from primary surgery, which only fixes the immediate physiological problem or addresses the disease. Practitioners do not define surgery as only the window when the patient is under anesthesia; instead, they approach it like a gradual process, with the actual surgery comprising just one component.
The most pressing concern distinguishing perioperative care from the duties of a surgical team is complication reduction. Professionals in this emerging field acknowledge that patients at greater risk for complications after surgery demand more rigorous observation and treatment. Therefore, they design a surgical plan that addresses more medical challenges than a normal surgical team and strive to make the medical treatments for post-surgical complications safer.
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Dr. Elliott Bennett-Guerrero is a professor and a Department of Anesthesiology vice chair at the Stony Brook School of Medicine in Stony Brook, New York. Dr. Elliott Bennett-Guerrero also serves Stony Brook as medical director of perioperative quality and patient safety.
The medical term “perioperative” refers to the entire process and experience of a surgical procedure, which includes the preoperative (before the procedure), intraoperative (during the procedure), and postoperative (after the procedure) phases. While it generally refers to all clinical activities and patient stages that occur between medical center arrival and release, perioperative care can also encompass long periods of outpatient preparation and recovery. Historically, surgical preoperative and postoperative care have been given lesser attention. Medical practitioners with a perioperative focus are dedicated to enhancing these care phases and seamlessly integrating them with intraoperative procedures to create a unified approach. This holistic approach strives to improve overall patient experience and medical outcomes in areas ranging from cost of care to recovery times. An accomplished medical doctor with a perioperative focus, Dr. Elliott Bennett-Guerrero has been a professor and vice chair for clinical research at the Stony Brook School of Medicine’s Department of Anesthesiology since 2015. Building on a history in clinical research that spans well over three decades, Dr. Elliott Bennett-Guerrero worked with several colleagues to release a 2023 evaluative study of a novel feeding tube placement platform.
Coauthored by Thomas A. Sorrentino, MD, Saheel Sutaria, MSb, Patrick Butler, PhD, Daniel Burnett, MD, and Elliott Bennett-Guerrero, MD, Evaluation of a Novel Platform for Placement Confirmation of Enteral Feeding Tubes in Adults appeared in the scholarly journal Nutrition on June 30, 2023. This study tested the validity of a unique platform for guiding the correct placement of feeding tubes in healthy adult patients. This platform uses an impedance-based and temperature algorithm to determine the safest and most effective feeding tube insertion depth. Following 10 patients, the study determined that the novel platform accurately determined the location of all 60 feeding tube insertions. Elliott Bennett-Guerrero is a professor and the vice chairman of Stony Brook Medicine's Department of Anesthesiology in Stony Brook, New York. He has been involved in many quality improvement initiatives like diabetes, sepsis, and mortality. Elliott Bennett-Guerrero has many research interests, including blood transfusion, cancer recurrence after surgery, and convalescent plasma.
Most people who contracted COVID-19 developed antibodies after they recovered from the virus. Convalescent plasma therapy was a proposed treatment that involves using blood from people who have recovered from an illness to help give a boost to the immune system of patients currently battling the virus. The donated blood is processed and separated into antibodies and plasma. After this, the remaining components of the donated blood are returned to the donor. This potential treatment was tested in many patients with severe COVID-19. During the procedure, a plasma bag is connected to an IV line for about one to three hours. After the procedure has been completed, a medical professional monitors the patient’s reaction to the treatment. As a professor and researcher at New York’s Stony Brook University, Dr. Elliott Bennett-Guerrero’s work has involved participating in Stony Brook Medicine’s response to the COVID-19 pandemic. Involving patients and health care workers (HCW), Dr. Elliott Bennett-Guerrero’s team compared the development of antibodies in different HCW roles.
Conducted at Stony Brook University Hospital, the seven-person research team collected participants in the first two-and-a-half weeks of April 2020. 474 employees agreed to participate, providing not only demographic information and their work classification, but the results of any COVID-19 polymerase chain reaction (PCR) tests since February 2020. To measure antibody prevalence, each participant gave a sample of blood using a Nucleocapsid based COVID-19 Assay, and researchers compared the antibody readings from that test to blood and plasma samples of patients with active COVID-19 infections. The team sorted participants into categories like frontline HCW, nurses, miscellaneous physicians, and hospital staff in advisory and other roles. The worker groups, frontline or not did not display significantly different prevalence of COVID-19 antibodies. While those workers with a positive PCR test did have higher antibody rates, the study found that the rate was not out of proportion with the general population – suggesting that they likely became infected in the community and not necessarily just because of their jobs. A professor and vice chairman at Stony Brook Medicine's Department of Anesthesiology, Elliott Bennett-Guerrero has been with the institution since 2015. Involved in the facility’s response to the COVID-19 pandemic in the area, he worked in the intensive care unit taking care of critically ill patients. In addition, Elliott Bennett-Guerrero researched whether blood plasma might benefit patients infected with the disease.
A team of 18 researchers sought to determine whether convalescent plasma sourced from patients who had recovered from COVID-19 produced better patient outcomes than standard plasma. The double-blind study occurred in this New York hospital and consisted of 74 patients with confirmed COVID-19 infections. Physicians monitored antibody counts, amount of time spent on a ventilator, and other standardized health outcomes. Though patients injected with the convalescent plasma experienced heightened antibody levels, they did not experience statistically significant better health outcomes in fighting COVID-19. The team published their findings in the journal Critical Care Medicine in April 2021. Dr. Elliott Bennett-Guerrero serves as professor and vice chairman with Stony Brook Medicine's Department of Anesthesiology and pursues research in the field of anesthesiology, with a focus on patient safety and perioperative quality. In 2022, Dr. Elliott Bennett-Guerrero led an observational study that was published in Anesthesia & Analgesia “Thrombin Generation in Cardiac Versus Noncardiac Surgical Cohorts.”
Bleeding is a serious issue following cardiac surgery, and patients who have had mechanical valve implantation will often have anticoagulation and may have delayed prophylaxis for venous thromboembolism (VTE). A particular concern is thrombin generation, which is an essential step in the formation of blood clots (independent of hemostatic processes such as fibrin cross-linking, platelet activation, and fibrinolysis). The calibrated automated thrombin (CAT) generation assay is a standard way of assessing thrombin generation, and it also has an emerging use in examining hemorrhagic and thrombotic outcomes. The study was the first to employ this assay in comparing the thrombin generation profiles displayed by noncardiac and cardiac surgical patients. A cohort study looked at blood samples from 100 patients, evenly divided between cardiac and noncardiac care. CAT measurements were used to evaluate the blood samples, while characteristics of the surgical procedure and patient were analyzed as well. The results indicated that cardiac patients exhibited a significant thrombin generation decrease after surgery, while noncardiac surgical patients did not. The hypothesized reasons for this lowered thrombin generation included coagulation factor depletion and hemodilution. An experienced doctor currently serving Stony Brook Medicine, Dr. Elliott Bennett-Guerrero specializes in clinical trials and has done several in the field of blood transfusion and coronavirus. Elliott Bennett-Guerrero has also studied the prevention of surgical site infection with gentamicin-collagen sponges.
Gentamicin-collagen sponges are antibiotic agents that have been approved in over 54 countries. Dr. Bennett-Guerrero led two clinical trials conducted in the United States that were supposed to be the basis for regulatory approval in the United States. One of these phase 3 clinical trials involved over 600 patients undergoing open or laparoscopically-assisted colorectal surgeries. This study, which was published in the New England Journal of Medicine, found that insertion of the sponge did not reduce surgical site infections. Similarly, another phase 3 trial in the United States involving 1500 patients undergoing cardiac surgeries found that insertion of the sponge did not reduce surgical site infections. This trial was published in the Journal of the American Medical Association. An experienced doctor specializing in clinical trials, Dr. Elliott Bennett-Guerrero is a professor at Stony Brook Medicine. Dr. Elliott Bennett-Guerrero also provides and supports scholarships at the University of Colorado Law School for students that want to become public defenders.
Public defenders are attorneys that are assigned to people that cannot afford legal representation at a trial. Public defenders can be assigned for a wide range of issues ranging from civil matters to crimes. While some people wonder if public defenders do not represent their clients effectively, a study from the American Bar Association revealed that they are as effective as private lawyers. The study also concluded that public defenders are associated with improved outcomes in trials. One of the benefits of using a public defender is that they typically work with the same staff, eg. judges, frequently. This means that they can learn the preferences of the judges and opposing legal counsel and know what to do in certain situations. A Stony Brook, New York resident, Dr. Elliott Bennett-Guerrero, is an alumnus of the Harvard Medical School, where he obtained a doctor of medicine. Dr. Elliott Bennett-Guerrero currently serves as the Medical Director for Perioperative Quality and Patient Safety for Stony Brook Medicine. He has led a few clinical studies dedicated to understanding the coronavirus disease.
In 2020, Stony Brook Medicine designed a clinical trial to aid the speedy recovery of patients from the coronavirus disease. In the first phase, Stony Brook Medicine gathered many convalescent plasma donations from Long Island residents who had tested positive for coronavirus in the past. The renowned healthcare facility hypothesized that the antibodies present in the convalescent plasma of former coronavirus patients could be useful to stop the infection of patients battling the virus. The clinical trial was randomized, and 80 percent of the participants were injected with convalescent plasma, while 20 percent were injected with standard plasma. The trial showed that convalescent plasma administration increased antibodies to the virus that causes COVID-19 (SARS-CoV-2) by 14.4% whereas standard plasma administration led to an 8.6% decrease (p=0.005) in these antibody levels. The study did not show an improvement in clinical outcomes such as time on the ventilator, although it may have been too small to show a small improvement. |
AuthorDr. Elliott Bennett-Guerrero is both an educator and a vice chairman at Stony Brook Medicine. Archives
June 2022
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