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The game theory in thoracic surgery: from the intuitions of Luca Pacioli to the operating rooms management.

ABSTRACT: Game theory is a formal way to analyze the interactions among groups of subjects who behave each other. It has historically been of great interest in the economic fields in which decisions are made in a competitive environment. Game theory has fascinating potential if applied in the medical science. Few papers have been written about the application of game theory in surgery. The majority of scenarios of game theory in surgery fall into two main groups: cooperative and no cooperative games.

SUBMITTER: Ciocci A

PROVIDER: S-EPMC4669275 | biostudies-other | 2015 Nov

REPOSITORIES: biostudies-other

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The game theory in thoracic surgery: from the intuitions of Luca Pacioli to the operating rooms management.

Ciocci Argante A Viti Andrea A Terzi Alberto A Bertolaccini Luca L

Journal of thoracic disease 20151101 11

Game theory is a formal way to analyze the interactions among groups of subjects who behave each other. It has historically been of great interest in the economic fields in which decisions are made in a competitive environment. Game theory has fascinating potential if applied in the medical science. Few papers have been written about the application of game theory in surgery. The majority of scenarios of game theory in surgery fall into two main groups: cooperative and no cooperative games. ...[more]

PMID: 26716049

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Project description:ObjectivesOur Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures.MethodsA retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records.ResultsThree hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) (P < .00001) with median schedule II opioids prescribed = 0.ConclusionsSmall modifications to our protocol for pain management strategies are safe and associated with significant decrease of opioid requirements, particularly schedule II narcotics, during the postoperative period without influencing acute pain levels.

Dataset Information

The game theory in thoracic surgery: from the intuitions of Luca Pacioli to the operating rooms management.

Publications

The game theory in thoracic surgery: from the intuitions of Luca Pacioli to the operating rooms management.

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