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Self-Reported Smoking Compared to Serum Cotinine in Bariatric Surgery Patients: Smoking Is Underreported Before the Operation. Obes Surg 2020; 30:23-37. [PMID: 31512159 DOI: 10.1007/s11695-019-04128-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Smoking has been associated with postoperative complications and mortality in bariatric surgery. The evidence for smoking is based on self-report and medical charts, which can lead to misclassification and miscalculation of the associations. Determination of cotinine can objectively define nicotine exposure. We determined the accuracy of self-reported smoking compared to cotinine measurement in three phases of the bariatric surgery trajectory. METHODS Patients in the phase of screening (screening), on the day of surgery (surgery), and more than 18 months after surgery (follow-up) were consecutively selected. Self-reported smoking was registered and serum cotinine was measured. We evaluated the accuracy of self-reported smoking compared to cotinine, and the level of agreement between self-report and cotinine for each phase. RESULTS In total, 715 patients were included. In the screening, surgery, and follow-up group, 25.6%, 18.0%, and 15.5%, respectively, was smoking based on cotinine. The sensitivity of self-reported smoking was 72.5%, 31.0%, and 93.5% in the screening, surgery, and follow-up group, respectively (p < 0.001). The specificity of self-report was > 95% in all groups (p < 0.02). The level of agreement between self-report and cotinine was 0.778, 0.414, and 0.855 for the screening, surgery, and follow-up group, respectively. CONCLUSIONS Underreporting of smoking occurs before bariatric surgery, mainly on the day of surgery. Future studies on effects of smoking and smoking cessation in bariatric surgery should include methods taking into account the issue of underreporting.
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A review of the effects of tobacco smoking on the treatment of prostate cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Prostate cancer is the most commonly diagnosed malignancy and the third leading cause of death among Canadian men. The standard treatment modalities for prostate cancer include prostatectomy, radiation therapy, hormonal therapy and chemotherapy or any combination depending on the stage of the tumour. However, several studies have reported that tobacco smoking at the time of diagnosis and during treatment can potentially impact treatment efficacy, outcome and patients quality of life after treatment.Materials and methods:This narrative literature review elucidates the impacts of tobacco smoking on prostate cancer progression, treatment efficacy, including its effects on prostatectomy, radiation therapy and chemotherapy, risk of cancer recurrence and mortality and quality of life after treatment. Furthermore, we discuss the importance of integrating a smoking cessation programme into the treatment regimen for prostate cancer patients in order to yield more favourable treatment outcomes, reduce risk of recurrence and mortality and increase the quality of life after treatment for prostate cancer patients.Conclusions:Smoking cessation is one of the most important interventions to prevent cancer and it is also essential after the diagnosis of prostate cancer to improve clinical outcomes. All prostate cancer patients should be advised to quit tobacco use since it can potentially improve treatment response rates and survival, as well as reduce the risk of developing treatment complications and potentially improve the quality of life after treatment. There are several benefits to smoking cessation and it should become an important component of the cancer care continuum in all oncology programmes, starting from prevention of cancer through diagnosis, treatment, survivorship and palliative care. Evidence-based smoking cessation intervention should be sustainably integrated into any comprehensive cancer programme, and the information should be targeted to the specific benefits of cessation in cancer patients.
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53
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Durmusoğlu F, Attar E. Enhanced Recovery Pathways in Gynecology. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fatih Durmusoğlu
- Department of Obstetrics and Gynecology, Medipol University Medical School, Istanbul, Turkey
| | - Erkut Attar
- Department of Obstetrics and Gynecology, Yeditepe University Medical School, Istanbul, Turkey
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Bohlin KS, Löfgren M, Lindkvist H, Milsom I. Smoking cessation prior to gynecological surgery-A registry-based randomized trial. Acta Obstet Gynecol Scand 2020; 99:1230-1237. [PMID: 32170727 DOI: 10.1111/aogs.13843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/29/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Smoking cessation, both pre- and postoperatively, is important to reduce complications associated with surgery. Identifying feasible and effective means of alerting the patient before surgery to the importance of perioperative smoking cessation is a challenge to healthcare systems. MATERIAL AND METHODS A randomized registry-based trial using the web-version of the Swedish national quality register for gynecological surgery, GynOp, was performed (ClinicalTrials.gov NCT03942146). Current smokers scheduled for gynecological surgery were randomly assigned before surgery to group 1 (control group, no specific information), group 2 (web-based written information), group 3 (information to doctor that the woman was a smoker and should be recommended smoking cessation or group 4 (a combination of groups 2 and 3). Perioperative smoking habits were evaluated in a postoperative questionnaire 2 months after surgery. The treatment effect was estimated to be a 15% reduction in the number of smokers at the time of surgery. Thus, 94 women in each group were required, in total 376 women, using a one-sided test with an alpha level of 0.001 and a statistical power of 80%. RESULTS Participants (n = 1427) were recruited between 5 November 2015 and 6 December 2017. A total of 1137 smokers responded to the follow-up questionnaire (80%), with 486 women declining to participate, leaving 651 women eligible for analysis. Women who received both web-based information prior to surgery and information from a doctor, reported smoking cessation more often from 1 to 3 weeks preoperatively (Odds ratio [OR] 1.8, 95% confidence interval [CI] 1.0-3.3) and 1 to 3 weeks after surgery (OR 1.9, 95% CI 1.1-3.3) compared with the control group who received no specific information. CONCLUSIONS A combination of written information in the health declaration and a recommendation from a doctor regarding smoking cessation may be associated with higher odds of smoking cessation at 1-3 weeks pre- and postoperatively.
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Affiliation(s)
- Katja S Bohlin
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mats Löfgren
- Department of Obstetrics and Gynecology, Umeå University Hospital, Umeå, Sweden
| | - Håkan Lindkvist
- Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Raj AS, Cobain C, Abbott TE, Cron N. Abstinence from alcohol consumption and exercise capacity: A pre and post intervention cohort study. J Perioper Pract 2020; 31:89-95. [PMID: 31916909 DOI: 10.1177/1750458919889879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The benefits or harm associated with moderate levels of alcohol consumption on cardiorespiratory fitness are unclear. We hypothesised that in moderate drinkers, four weeks of abstinence could improve cardiorespiratory fitness. This was a single centre, prospective, pre and post intervention, experimental cohort study. Participants were recruited from healthy volunteers among hospital staff, who were non-smokers, over 25 years of age and regularly consumed ≥3 units of alcohol a day, ≥4 times a week for > 1 month. Cardiopulmonary exercise test was used to provide objective, quantifiable and reproducible data. In all, 30 participated, and data were analysed for 22 participants. Mean (SD) peak oxygen consumption and oxygen consumption at anaerobic threshold were similar before and after alcohol abstinence: 37.55 (10.89) and 39.66 (11.48) (P = 0.21) and 18.52 (5.43) and 16.82 (5.19) ml/kg/min (P = 0.1), respectively. It is concluded that this preliminary study did not establish a correlation between four weeks alcohol abstinence and cardiopulmonary fitness as measured by cardiopulmonary exercise test, among healthy volunteers self-reporting moderate alcohol consumption.
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Affiliation(s)
- Ashok S Raj
- Anaesthesia and Intensive Care Medicine, Croydon University Hospital, Croydon, UK
| | - Charlotte Cobain
- Anaesthesia and Intensive Care Medicine, Epsom and St Helier University Hospital NHS Trust, Epsom, UK
| | - Tom Ef Abbott
- William Harvey Research Institute, Critical Care and Perioperative Medicine Research Group, The Royal London Hospital, London, UK
| | - Nicholas Cron
- Department of Statistics, London School of Economics, London, UK
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Chan G, Iliopoulos E, Jain A, Turki M, Trompeter A. Infection after operative fixation of tibia plateau fractures. A risk factor analysis. Injury 2019; 50:2089-2092. [PMID: 31351672 DOI: 10.1016/j.injury.2019.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical fixation of tibial plateau fractures has been shown to improve long-term functional outcomes, but a major complication is that of postoperative infection which can be deleterious to long-term outcomes. This study aims to assess the impact of common comorbidities on the risk of postoperative infection. METHOD A retrospective study of 210 consecutive operatively treated patients, treated at two Level 1 Trauma Centres over a 27-month period was performed. Records were analysed to assess the presence of the study factors; smoking, alcohol intake >13 units/week, diabetes, and BMI > 30. The impact of these factors on infection was assessed with univariate and multivariate analyses. RESULTS 175 patients were included in the study, 56.6% male with a mean age of 46.9 years (± 18.2 years). Excessive alcohol consumption of >13 units/week was the only significant risk factor for postoperative infection (p = 0.05) on multivariate analysis. CONCLUSION This study has identified excessive alcohol consumption as the only independent risk factor for postoperative infection in patients with all types of tibial plateau fracture treated with operative fixation. No relationship between smoking, diabetes nor obesity was found for postoperative infection.
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Affiliation(s)
- G Chan
- Department of Trauma & Orthopaedics, St. Richards Hospital, Chichester, United Kingdom; Department of Trauma & Orthopaedics, Royal Sussex County Hospital, Brighton, United Kingdom.
| | - E Iliopoulos
- Department of Trauma & Orthopaedics, Royal Sussex County Hospital, Brighton, United Kingdom
| | - A Jain
- Department of Trauma & Orthopaedics, St. George's Hospital, London, United Kingdom
| | - M Turki
- St. George's Medical School, London, United Kingdom
| | - A Trompeter
- Department of Trauma & Orthopaedics, St. George's Hospital, London, United Kingdom
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Tam S, Weber RS, Liu J, Ting J, Hanson S, Lewis CM. Evaluating Unplanned Returns to the Operating Room in Head and Neck Free Flap Patients. Ann Surg Oncol 2019; 27:440-448. [PMID: 31410610 DOI: 10.1245/s10434-019-07675-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Head and neck oncologic surgery with reconstruction represents one of the most complex operations in otolaryngology. Unplanned return to the operating room represents an objective measure of postoperative complications. The purpose of this study was to identify reasons and risk factors for unplanned return to the operating room in patients undergoing head and neck surgery with reconstruction. METHODS This retrospective cohort study of 467 patients undergoing head and neck surgery with free flap reconstruction used a previously-developed Head and Neck-Reconstructive Surgery-specific National Surgical Quality Improvement Program. Disease and site-specific preoperative, intraoperative, and postoperative data were gathered. Comparisons between those with and without an unexpected return to the operating room were completed with univariate and multiple logistic regression models. RESULTS The rate of unexpected return to the operating room was 18.8% (88 patients). Most common reasons for URTOR were flap compromise (24 patients, 5.1%), postoperative infection (21 patients, 4.5%), and hematoma (20 patients, 4.3%). Two risk factors were identified by multivariate analysis: coagulopathy (ORadjusted = 2.83, 95% CI = 1.24-6.19, P = 0.010), and use of alcohol (ORadjusted = 1.9, 95% CI = 1.14-3.33, P = 0.025). CONCLUSIONS Preexisting coagulopathy and increased alcohol consumption were associated with increased risk of unexpected return to the operating room. These findings can aid physicians in preoperative patient counseling and medical optimization and can inform more precise risk stratification of patients undergoing head and neck surgery with reconstruction. Strategies to prevent and mitigate unexpected returns to the operating room will improve patient outcomes, decrease resource utilization, and facilitate successful integration into alternative payment models.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jun Liu
- Department of Plastic and Reconstructive Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose Ting
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Summer Hanson
- Department of Plastic and Reconstructive Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol M Lewis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, Roselli EE, Khoynezhad A, Gerdisch M, Levy JH, Lobdell K, Fletcher N, Kirsch M, Nelson G, Engelman RM, Gregory AJ, Boyle EM. Guidelines for Perioperative Care in Cardiac Surgery. JAMA Surg 2019; 154:755-766. [DOI: 10.1001/jamasurg.2019.1153] [Citation(s) in RCA: 347] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel T. Engelman
- Heart and Vascular Program, Baystate Medical Center, Springfield, Massachusetts
| | | | | | | | - V. Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rakesh C. Arora
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
- Now with Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Ali Khoynezhad
- MemorialCare Heart and Vascular Institute, Los Angeles, California
| | - Marc Gerdisch
- Franciscan Health Heart Center, Indianapolis, Indiana
| | | | - Kevin Lobdell
- Atrium Health, Department of Cardiovascular and Thoracic Surgery, North Carolina
| | - Nick Fletcher
- St Georges University of London, London, United Kingdom
| | - Matthias Kirsch
- Centre Hospitalier Universitaire Vaudois Cardiac Surgery Centre, Lausanne, Switzerland
| | | | | | | | - Edward M. Boyle
- Department of Cardiac Surgery, St Charles Medical Center, Bend, Oregon
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Barrett S, Begg S, Sloane A, Kingsley M. Surgeons and preventive health: a mixed methods study of current practice, beliefs and attitudes influencing health promotion activities amongst public hospital surgeons. BMC Health Serv Res 2019; 19:358. [PMID: 31170990 PMCID: PMC6555744 DOI: 10.1186/s12913-019-4186-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/28/2019] [Indexed: 01/17/2023] Open
Abstract
Background Little is known about the participation of surgeons in preventative health activities in the non-admitted hospital care setting. The aim of this study was to identify which preventive health activities surgeons practice and to explore their attitudes towards preventive health. Methods A mixed methods study was conducted using a sequential explanatory design. Quantitative results were obtained from a self-reported clinician survey (n = 16) and a Generalized Estimating Equation was used to assess the relationship between dependent (preventive health practice) and independent (confidence and knowledge in preventive health practice, years of practice, and attitudinal factors) variables. Using a building approach to integration, results from the quantitative analyses informed design of the interview guide. Surgeons’ beliefs and attitudes were explored using in-depth, semi structured interviews with a purposeful sample of surgeons (n = 14). Responses were collected, independently coded and analysed using a qualitative descriptive approach. Results In accordance with a contiguous narrative approach to integration, the quantitative and qualitative findings are reported separately. The clinician survey found that the surgeons carried out preventive health activities at low levels. Preventive health advice was predominantly verbal in nature, and few surgeons provided written material or referred patients to additional services. The GEE analyses indicated that the following factors best predicted the tendency to undertake preventive health activities: years of clinical practice (p = 0.041), and the perceived work priority placed on preventive health (p = 0.008). Interviews generated four themes that influenced the tendency of surgeons to undertake preventive health activities: perceptions of their role in preventive health, perceived motivation of patients, hospital structure, and facilitating factors. In regards to enabling factors that are likely to increase preventive health practice, surgeons unanimously advocated for referral pathways into specialist behaviour change programs that they could facilitate within their relatively brief consulting time. Conclusions The findings suggests that the majority of public hospital surgeons engage in routine preventive health advice at a low level. The high volume of non-admitted surgical consultations undertaken annually, coupled with medium to high self-reported knowledge and confidence in addressing behavioural risk factors, support an increased involvement of surgeons in preventive health practice. Electronic supplementary material The online version of this article (10.1186/s12913-019-4186-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | | | - Michael Kingsley
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.
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Abstract
Optimization of the nutritional and metabolic state prior to major surgery leads to improved surgical outcomes and is increasingly seen as an important part of oncology disease management. For locally advanced esophageal cancer the treatment is multimodal, including neoadjuvant chemoradiotherapy or perioperative chemotherapy in combination with esophageal resection. Patients undergoing such a multimodal treatment have a higher risk for progressive decline in their nutritional status. Preoperative malnutrition and loss of skeletal muscle mass has been reported to correlate with unfavorable outcomes in patients who undergo esophageal cancer surgery. Decline in nutritional status is most likely caused by insufficient nutritional intake, reduced physical activity, systemic inflammation and the effects of anticancer therapy. To ensure an optimal nutritional status prior to surgery, it is key to assess the nutritional status in all preoperative esophageal cancer patients, preferable early in the treatment trajectory, and to apply nutritional interventions accordingly. Nutritional management of esophageal cancer can be challenging, the optimal nutritional therapy is still under debate, and warrants more nutritional scientific research. In this review, the most recent findings regarding preoperative nutrition associated with outcomes in patients with esophageal cancer will be explored.
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Affiliation(s)
- Elles Steenhagen
- Internal Medicine and Dermatology, Department of Dietetics, University Medical Center Utrecht, The Netherlands
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61
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Kaka AS, Zhao S, Ozer E, Agrawal A, Kang S, Rocco J, Carrau R, Teknos T, Clapp JD, Weed H, Old MO. Comparison of Clinical Outcomes Following Head and Neck Surgery Among Patients Who Contract to Abstain From Alcohol vs Patients Who Abuse Alcohol. JAMA Otolaryngol Head Neck Surg 2019; 143:1181-1186. [PMID: 28447103 DOI: 10.1001/jamaoto.2017.0553] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Azeem S Kaka
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Songzhu Zhao
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Enver Ozer
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Amit Agrawal
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Stephen Kang
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - James Rocco
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Ricardo Carrau
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - Theodoros Teknos
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
| | - John D Clapp
- The Ohio State University College of Social Work, Columbus
| | - Harrison Weed
- Division of General Medicine, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus
| | - Matthew O Old
- The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus.,Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
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Budworth L, Prestwich A, Lawton R, Kotzé A, Kellar I. Preoperative Interventions for Alcohol and Other Recreational Substance Use: A Systematic Review and Meta-Analysis. Front Psychol 2019; 10:34. [PMID: 30778307 PMCID: PMC6369879 DOI: 10.3389/fpsyg.2019.00034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Preoperative alcohol and other recreational substance use (ORSU) may catalyze perioperative complications. Accordingly, interventions aiming to reduce preoperative substance use are warranted. Methods: Studies investigating interventions to reduce alcohol and/or ORSU in elective surgery patients were identified from: Cochrane Library; MEDLINE; PSYCINFO; EMBASE; and CINAHL. In both narrative summaries of results and random effects meta-analyses, effects of interventions on perioperative alcohol/ORSU, complications, mortality and length of stay were assessed. Primary Results: Nine studies (n = 903) were included. Seven used behavioral interventions only, two provided disulfiram in addition. Pooled analyses found small effects on alcohol use (d: 0.34; 0.05-0.64), though two trials using disulfiram (0.71; 0.36-1.07) were superior to two using behavioral interventions (0.45; -0.49-1.39). No significant pooled effects were found for perioperative complications, length of hospital stay or mortality in studies solely targeting alcohol/ORSU. Too few interventions targeting ORSU (n = 1) were located to form conclusions regarding their efficacy. Studies were generally at high risk-of-bias and heterogeneous. Conclusions: Preoperative interventions were beneficial in reducing substance use in some instances, but more high-quality studies targeting alcohol/ORSU specifically are needed. The literature to date does not suggest that such interventions can reduce postoperative morbidity, length of hospital stay or mortality. Limitations in the literature are outlined and recommendations for future studies are suggested.
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Affiliation(s)
- Luke Budworth
- School of Psychology, University of Leeds, Leeds, United Kingdom.,Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Andrew Prestwich
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, United Kingdom.,Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Alwyn Kotzé
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
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McLennan E, Oliphant R, Moug SJ. Limited preoperative physical capacity continues to be associated with poor postoperative outcomes within a colorectal ERAS programme. Ann R Coll Surg Engl 2019; 101:261-267. [PMID: 30644323 DOI: 10.1308/rcsann.2018.0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIM Enhanced recovery after surgery (ERAS) programmes aim to standardise perioperative care leading to optimal patient outcomes. Despite these programmes, variation in outcomes still persists. This study aimed to assess the influence of lifestyle factors on short-term outcomes after colorectal surgery within this optimal recovery programme. METHODS Consecutive patients enrolled on an ERAS pathway who underwent elective colorectal surgery (June 2013 to July 2014) at one site were included. We used data routinely collected by ERAS nurse specialists and during preassessment to analyse association between patient and lifestyle factors and likelihood of developing postoperative complications or having an increased length of stay. RESULTS A total of 199 patients were included: mean age 61.8 years (range 17-90 years) and 53.8% male. Age, sex, deprivation, smoking status, alcohol intake, body mass index or level of comorbidity were not associated with postoperative complications. Patients reporting limited preoperative physical capacity (unable to climb two flights of stairs) were more than four times as likely to have a postoperative complication on univariate analysis and were found to still have increased risk of postoperative complications on multivariate analysis. Patients reporting limited preoperative physical capacity were shown to have significantly longer hospital stay on univariate analysis. In the multivariate analysis, limited physical capacity was not associated with prolonged length of stay due to confounding factors of age and deprivation. CONCLUSIONS Limited physical capacity was the only patient and lifestyle factor associated with poorer postoperative complications and prolonged hospital stay after elective colorectal surgery within an ERAS programme. Consideration should be given to individualised prehabilitation that aims to increase physical capacity pre-operatively to improve patient outcomes.
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Affiliation(s)
- E McLennan
- Department of Surgery, Royal Alexandra Hospital , Paisley , UK
| | - R Oliphant
- Department of Surgery, Raigmore Hospital , Inverness , UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital , Paisley , UK
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65
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Zhao S, Chen F, Wang D, Wang H, Han W, Zhang Y. Effect of preoperative smoking cessation on postoperative pain outcomes in elderly patients with high nicotine dependence. Medicine (Baltimore) 2019; 98:e14209. [PMID: 30653178 PMCID: PMC6370016 DOI: 10.1097/md.0000000000014209] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the effect of smoking cessation before surgery on postoperative pain and analgesic consumption after thoracoscopic radical resection of lung cancer in elderly patients with high nicotine dependence. METHODS A total of 107 male patients, ages 60 to 70 years, undergoing elective thoracoscopic radical lung cancer surgery from July 2017 to July 2018 were enrolled into 3 groups: group A (highly nicotine-dependent and discontinued smoking <3 weeks before surgery, n = 36), group B (highly nicotine-dependent and discontinued smoking >3 weeks before surgery, n = 38), and group C (nonsmokers, n = 33). Postoperative sufentanil consumption, visual analog scale (VAS) pain scores at rest and during cough, rescue analgesia, opioid-related adverse events, and patient satisfaction were assessed from 0 to 48 h postoperatively. RESULTS Patient characteristics were comparable among the 3 groups. Sufentanil consumption and VAS pain scores from postoperative 0 to 48 h were significantly higher in groups A and B than in group C. In addition, group B had lower sufentanil consumption and pain scores than group A. No differences in the need for rescue analgesia, patient satisfaction, or occurrence of postoperative adverse events, including nausea, vomiting, respiratory depression, and oversedation, were observed among the 3 groups. CONCLUSION Compared with nonsmokers, highly nicotine-dependent male patients who were deprived of cigarettes experienced more severe pain and required treatment with more sufentanil after thoracoscopic radical lung cancer surgery. Moreover, preoperative smoking cessation at least 3 weeks before surgery led to better postoperative pain outcomes than smoking cessation within 3 weeks of surgery.
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Affiliation(s)
| | - Fan Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | | | | | - Wei Han
- Department of Anesthesiology
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Schonborn JL, Anderson H. Perioperative medicine: a changing model of care. BJA Educ 2018; 19:27-33. [PMID: 33456851 DOI: 10.1016/j.bjae.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - H Anderson
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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Egholm JWM, Pedersen B, Møller AM, Adami J, Juhl CB, Tønnesen H. Perioperative alcohol cessation intervention for postoperative complications. Cochrane Database Syst Rev 2018; 11:CD008343. [PMID: 30408162 PMCID: PMC6517044 DOI: 10.1002/14651858.cd008343.pub3] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures.Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system. Stopping consumption of alcohol can normalize these organ systems to some degree and may reduce the occurrence of complications after surgery.This review was first published in 2012 and was updated in 2018. OBJECTIVES To assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. SEARCH METHODS We searched the following databases up until 21 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; CINAHL via EBSCOhost; and two trials registers. We scanned the reference lists and citations of included trials and any identified relevant systematic reviews for further references to additional trials. When necessary, we contacted trial authors to ask for additional information. SELECTION CRITERIA We included all randomized controlled trials (RCTs) that evaluated the effects of perioperative alcohol cessation interventions on postoperative complications and alcohol consumption. We included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered a perioperative alcohol cessation intervention or no intervention.We defined 'risky drinking' as alcohol consumption equivalent to more than 3 alcoholic units (AU)/d or 21 AU/week (with 1 AU containing 12 grams of ethanol) with or without symptoms of alcohol abuse or dependency. This corresponds to the amount of alcohol associated with increased postoperative complication rates in most clinical studies. DATA COLLECTION AND ANALYSIS We used guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. We presented main outcomes as dichotomous variables in a meta-analysis. When data were available, we conducted subgroup and sensitivity analyses to explore the risk of bias. Primary outcome measures were postoperative complications and in-hospital and 30-day mortality. Secondary outcomes were successful quitting at the end of the programme, postoperative alcohol use, and length of hospital stay. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included in this updated review one new study (70 participants), resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study.Overall, 53 of the 122 participants from three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate.In-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low.Investigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.All three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the standard deviation (SD). We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term. AUTHORS' CONCLUSIONS This systematic review assessed the efficacy of perioperative alcohol cessation interventions for postoperative complications and alcohol consumption. All three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.Included studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomized controlled trials is needed. Once published and assessed, the one 'ongoing' study identified may alter the conclusions of this review.
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Affiliation(s)
- Julie WM Egholm
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
| | - Bolette Pedersen
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
| | - Ann Merete Møller
- Herlev and Gentofte Hospital, University of CopenhagenCochrane Anaesthesia, Critical and Emergency Care GroupHerlev RingvejHerlevDenmark2730
| | - Johanna Adami
- Sophiahemmet UniversityLindstedtsvägen 8StockholmSweden
| | - Carsten B Juhl
- University of Southern DenmarkSEARCH (Research group for synthesis of evidence and research), Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical BiomechanicsCampusvej 55Odense MDenmark5230
| | - Hanne Tønnesen
- Hospital of Southern Jutland, University of Southern DenmarkOrthopaedic DepartmentAabenraaDenmark6200
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenWHO‐CC, Clinical Health Promotion CentreCopenhagenDenmark
- Lund UniversityDepartment of Health SciencesLundSweden
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Gagné S, McIsaac DI. Modifiable risk factors for patients undergoing lung cancer surgery and their optimization: a review. J Thorac Dis 2018; 10:S3761-S3772. [PMID: 30505563 DOI: 10.21037/jtd.2018.10.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Enhanced recovery after surgery (ERAS) programs include a variety of pre-, intra- and post-operative interventions that seek to decrease the stress response to surgery and facilitate the recovery of surgical patients. There are a number of patient factors that may increase the risk of postoperative complications (POC) after lung cancer surgery and delay recovery. Some of these factors may be amenable to optimization preoperatively and potentially decrease the incidence of these complications. We have chosen to discuss the incidence and complications associated with factors we felt were both relatively common and significant contributors to POCs. For each of these factors we discuss potential avenues for optimization and the evidence for the resulting decrease in complications.
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Affiliation(s)
- Sylvain Gagné
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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69
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ACOG Committee Opinion No. 750: Perioperative Pathways: Enhanced Recovery After Surgery. Obstet Gynecol 2018; 132:e120-e130. [DOI: 10.1097/aog.0000000000002818] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kheir MM, Tan TL, Kheir M, Maltenfort MG, Chen AF. Postoperative Blood Glucose Levels Predict Infection After Total Joint Arthroplasty. J Bone Joint Surg Am 2018; 100:1423-1431. [PMID: 30106824 DOI: 10.2106/jbjs.17.01316] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Perioperative hyperglycemia has many etiologies, including medication, impaired glucose tolerance, uncontrolled diabetes mellitus, or stress, the latter of which is common in patients postoperatively. Our study investigated the influence of postoperative blood glucose levels on periprosthetic joint infection after elective total joint arthroplasty to determine a threshold for glycemic control for which surgeons should strive during a patient's hospital stay. METHODS A single-institution retrospective review was conducted on 24,857 primary total joint arthroplasties performed from 2001 to 2015. Of these, 13,196 had a minimum follow-up of 1 year (mean, 5.9 years). Postoperative day 1 morning blood glucose levels were utilized and were correlated with periprosthetic joint infection, as defined by the International Consensus Group on Periprosthetic Joint Infection. Multivariable analysis was used to determine the influence of several important covariates on infection. An alpha level of 0.05 was used to determine significance. RESULTS The rate of periprosthetic joint infection increased linearly from blood glucose levels of ≥115 mg/dL. Multivariable analysis revealed that blood glucose levels were significantly associated with periprosthetic joint infection (p = 0.028). The optimal blood glucose threshold to reduce the likelihood of periprosthetic joint infection was 137 mg/dL. The periprosthetic joint infection rate in the entire cohort was 1.59% (1.46% in patients without diabetes compared with 2.39% in patients with diabetes; p = 0.001). There was no significant association between blood glucose level and periprosthetic joint infection in patients with diabetes (p = 0.276), although there was a linear trend. CONCLUSIONS The relationship between postoperative blood glucose levels and periprosthetic joint infection increased linearly, with an optimal cutoff of 137 mg/dL. Immediate and strict postoperative glycemic control may be critical in reducing postoperative complications, as even mild hyperglycemia was significantly associated with periprosthetic joint infection. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael M Kheir
- Indiana University Department of Orthopaedic Surgery, Indianapolis, Indiana
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Kheir
- University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Antonia F Chen
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
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71
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Li X, Tang L, Lin YF, Xie GF. Role of vitamin C in wound healing after dental implant surgery in patients treated with bone grafts and patients with chronic periodontitis. Clin Implant Dent Relat Res 2018; 20:793-798. [PMID: 30039526 DOI: 10.1111/cid.12647] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postoperative wound healing is an important part of the success of the dental implant surgery. However, in case of complex surgery or unfavorable factors, wound healing is often unsatisfactory. OBJECTIVE The aim of this study was to explore the effects of vitamin C supplementation in wound healing, following the placement of dental implants with or without bone grafts and patients with chronic periodontitis. METHODS This randomized controlled clinical trial included 128 patients requiring dental implants to replace missing teeth. Patients were divided into four groups, group A received dental implants supported by guided bone regeneration (GBR) technique, group B received dental implants with Bio-Oss Collagen, group C received dental implants in patients with chronic periodontitis, and group D received dental implants without any bone grafting or periodontal disease. Each group was divided into an experimental subgroup, who received vitamin C, and a control subgroup. Follow-up appointments were performed at day 3, day 7, and day 14 postsurgery, during which soft tissue healing and pain response scores were evaluated using the Landry index and visual analogue scale, respectively. RESULTS The experimental subgroups had significantly higher healing indices than the controls (P < .05) at day 7 postsurgery for group B and day 14 postsurgery for groups A, B, and C. Group D displayed no difference between the experimental and control groups at any time point. In reference to vitamin C for pain relief, there were no statistically significant differences between the study groups. CONCLUSION Using vitamin C supplementation improves postoperative healing following dental implant surgery in patients with chronic periodontitis and patients treated with GBR or Bio-Oss Collagen grafts. However, vitamin C supplementation does not decrease the postoperative pain associated with dental implant surgery.
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Affiliation(s)
- Xiao Li
- Department of Implant Dentistry, Stomatology Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Tang
- Department of Implant Dentistry, Stomatology Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Yong Feng Lin
- Department of Implant Dentistry, Stomatology Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Gui Fang Xie
- Department of Implant Dentistry, Stomatology Hospital, Guangxi Medical University, Nanning, Guangxi, China
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Watanabe M, Okamura A, Toihata T, Yamashita K, Yuda M, Hayami M, Fukudome I, Imamura Y, Mine S. Recent progress in perioperative management of patients undergoing esophagectomy for esophageal cancer. Esophagus 2018; 15:160-164. [PMID: 29951987 DOI: 10.1007/s10388-018-0617-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/17/2018] [Indexed: 02/03/2023]
Abstract
Esophagectomy remains the mainstay of curative intent treatment for esophageal cancer. Oncologic esophagectomy is a highly invasive surgery and both morbidity and mortality rates still remain high. Recently, it has been revealed that multidisciplinary perioperative management can decrease the postoperative complications after esophagectomy. In this review, we summarized the recent progress in each component of multidisciplinary perioperative care bundle, including oral hygiene, cessation of smoking and alcohol, respiratory training, measurement of physical fitness, swallowing evaluation and rehabilitation, nutritional support, pain control and management of delirium. The accumulation of evidence and the popularization of knowledge will increase safety of esophagectomy and thus improve the outcome of patients with esophageal cancer.
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Affiliation(s)
- Masayuki Watanabe
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Akihiko Okamura
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tasuku Toihata
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kotaro Yamashita
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masami Yuda
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ian Fukudome
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinji Mine
- Esophageal Cancer Division, Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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73
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Grotz TE, Fournier KF, Mansfield PF. Patient Selection for Cytoreductive Surgery. Surg Oncol Clin N Am 2018; 27:443-462. [DOI: 10.1016/j.soc.2018.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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74
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Vukovic N, Dinic L. Enhanced Recovery After Surgery Protocols in Major Urologic Surgery. Front Med (Lausanne) 2018; 5:93. [PMID: 29686989 PMCID: PMC5900414 DOI: 10.3389/fmed.2018.00093] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/23/2018] [Indexed: 01/31/2023] Open
Abstract
The purpose of the review The analysis of the components of enhanced recovery after surgery (ERAS) protocols in urologic surgery. Recent findings ERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%. Several clinical pathways were introduced to improve perioperative course and reduce the length of hospital stay. These protocols differ from ERAS modalities in other surgeries. The reasons for this are longer operative time, increased risk of perioperative transfusion and infection, and urinary diversion achieved using transposed intestinal segments. Previous studies in this area analyzed the need for mechanical bowel preparation, postoperative nasogastric tube decompression, as well as the duration of urinary drainage. Furthermore, the attention has also been drawn to perioperative fluid optimization, pain management, and bowel function. Summary Notwithstanding partial resemblance between the pathways in major urologic surgery and other pelvic surgeries, there are still scarce guidelines for ERAS protocols in urology, which is why further studies should assess the importance of preoperative medical optimization, implementation of thoracic epidural anesthesia and analgesia, and perioperative nutritional management.
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Affiliation(s)
- Natalija Vukovic
- Anesthesiology and Reanimation Center, Clinical Center Nis, Nis, Serbia
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75
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Graf SA, Zeliadt SB, Rise PJ, Backhus LM, Zhou XH, Williams EC. Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection. J Thorac Dis 2018; 10:1648-1656. [PMID: 29707317 DOI: 10.21037/jtd.2018.02.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Lung resections carry a significant risk of complications necessitating the characterization of peri-operative risk factors. Unhealthy alcohol use represents one potentially modifiable factor. In this retrospective cohort study, the largest to date of lung resections in the Veterans Health Administration (VHA), we examined the association between unhealthy alcohol use and postoperative complications and mortality. Methods Veterans Affairs Surgical Quality Improvement Program data recorded at 86 medical centers between 2007 and 2011 were used to identify 4,715 patients that underwent lung resection. Logistic regression models, adjusted for demographics and comorbidities, were fit to assess the association between unhealthy alcohol use (report of >2 drinks per day in the 2 weeks preceding surgery) and 30-day outcomes. Results Among 4,715 patients that underwent pulmonary resection, 630 (13.4%) reported unhealthy alcohol use (>2 drinks/day). Overall, postoperative complications occurred in 896 (19.0%) patients, including pneumonia in 524 (11.1%). The rate of mortality was 2.6%. In adjusted analyses, complications were significantly more common among patients with unhealthy alcohol use [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.15-1.74] including, specifically, pneumonia (OR, 1.69; 95% CI, 1.32-2.15). No statistically significant association was identified between unhealthy alcohol use and mortality (OR, 1.27; 95% CI, 0.75-2.02). In secondary analyses that stratified by smoking status at the time of surgery, drinking more than 2 drinks per day was associated with post-operative complications in patients reporting current smoking (OR, 1.51; 95% CI, 1.18-1.91) and was not identified in those reporting no current smoking at the time of surgery (OR, 1.23; 95% CI, 0.79-1.85). Conclusions In this large VHA study, 13% of patients undergoing lung resection reported drinking more than 2 drinks per day in the preoperative period, which was associated with increased risk of post-operative complications. Unhealthy alcohol use may be an important target for perioperative risk-mitigation interventions, particularly in patients who report current smoking.
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Affiliation(s)
- Solomon A Graf
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA, USA
| | - Steven B Zeliadt
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Peter J Rise
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Leah M Backhus
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Xiao-Hua Zhou
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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Lee KH, Qiu M, Sun J. Current practice in provision of alcohol assessment and support for patients following alcohol related facial fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:S2212-4403(18)30056-7. [PMID: 29506915 DOI: 10.1016/j.oooo.2018.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/20/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The algorithm for maxillofacial trauma management is well defined; however, provision of alcohol assessment for patients after trauma is not widely practiced. This study aims to investigate the rate of alcohol assessment achieved within the demographic characteristics of patients with facial trauma and the circumstances where this intervention was implemented. STUDY DESIGN This study retrospectively examined the Victorian Admitted Episodes Data Set (VAED) from 2004 to 2013. RESULTS Of a total of 54,730 presentations with facial fractures to all Victorian hospitals, 0.9% in the non-alcohol-involved group and 4.3% in the alcohol-involved group received alcohol assessment during their inpatient stay (P < .001). Among patients with alcohol involvement, the likelihood of assessment was significantly different with regard to length of stay, age, trauma mechanism, and gender. Positive blood alcohol test did not relate to probability of assessment. Those with acute alcohol intoxication were less likely to be assessed (P < .001), whereas those with harmful alcohol use, alcohol dependence, or alcohol withdrawal state were much more likely to be assessed (P < .001). CONCLUSIONS This study found no consistent practice of alcohol support to patients following alcohol-related facial fractures. Post-trauma alcohol support may optimize perioperative management of patients and education regarding alcohol harm and may reduce future trauma risk. Development and refinement of such practice is an area for further research.
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Affiliation(s)
- Kai H Lee
- Consultant Oral & Maxillofacial Surgeon, Western Health, Melbourne, Australia.
| | | | - Jiandong Sun
- Adjunct Research Fellow, School of Public Health and Social Work, Queensland University of Technology, Brisbane City, Australia
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Affiliation(s)
- Erika L Brinson
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Kevin C Thornton
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
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Silecchia G, Iossa A. Complications of staple line and anastomoses following laparoscopic bariatric surgery. Ann Gastroenterol 2017; 31:56-64. [PMID: 29333067 PMCID: PMC5759613 DOI: 10.20524/aog.2017.0201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022] Open
Abstract
With over 600 million people being obese, and given the scientific demonstration of the advantages of surgical treatment, bariatric surgery is on the rise. The promising long-term results in terms of weight loss, and particularly in relation to comorbidities and the control/cure rate, mean that the number of procedures performed in all countries remains high. However, the risk of potentially complex or fatal complications, though small, is present and is related to the procedures per se. This review is a guide for bariatric and/or general surgeons, offering a complete overview of the pathogenesis of anastomosis and staple line following the most common laparoscopic bariatric procedures: sleeve gastrectomy, gastric bypass, and mini-gastric bypass. The review is divided according to the procedure and the complications (leak, bleeding and stenosis), and evaluates all the factors that can potentially improve or worsen the complication rate, representing a “unicum” in the present literature on bariatric surgery.
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Affiliation(s)
- Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
| | - Angelo Iossa
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, University of Rome "La Sapienza", Rome, Italy
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Kingma BF, Steenhagen E, Ruurda JP, van Hillegersberg R. Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction. J Surg Oncol 2017; 116:623-629. [PMID: 28968919 DOI: 10.1002/jso.24827] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) aims to accelerate recovery by a set of multimodality management strategies. For esophagectomy, several nutritional elements of ERAS can be safely introduced and are advised in routine practice, including preadmission counseling to screen and treat for potential malnutrition, shortened preoperative fasting, and carbohydrate loading. However, the timing of oral intake and the use of routine nasogastric decompression remain matter of debate after esophagectomy. Furthermore, more research is needed on future developments such as perioperative immunonutrition.
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Affiliation(s)
- B Feike Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elles Steenhagen
- Department of Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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81
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Kennedy ND, Winter DC. Impact of alcohol & smoking on the surgical management of gastrointestinal patients. Best Pract Res Clin Gastroenterol 2017; 31:589-595. [PMID: 29195679 DOI: 10.1016/j.bpg.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/24/2017] [Accepted: 10/20/2017] [Indexed: 01/31/2023]
Abstract
Alcohol and smoking are repeatedly described as modifiable risk factors in clinical studies across all surgical specialities. These lifestyle choices impart a sub-optimal physiology via multiple processes and play an important role in the surgical management of the gastrointestinal patient. Cessation is imperative to optimise the patient's fitness for surgery with surgery itself being a prime opportunity for sustained cessation. A consistent, planned and integrated management involving surgical, anaesthetic, medical, and primary care facets will aid in successful cessation and perioperative care. This review highlights the pathological processes which contribute to perioperative complications and details the current practices to detect, predict and appropriately manage the perioperative gastrointestinal patient who smokes and consumes alcohol.
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Affiliation(s)
- Niall D Kennedy
- St Vincents University Hospital, Elm Park, Dublin 4, Ireland.
| | - Des C Winter
- St Vincents University Hospital, Elm Park, Dublin 4, Ireland
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Elsamadicy AA, Adogwa O, Vuong VD, Sergesketter A, Reddy G, Cheng J, Bagley CA, Karikari IO. Impact of alcohol use on 30-day complication and readmission rates after elective spinal fusion (≥2 levels) for adult spine deformity: a single institutional study of 1,010 patients. JOURNAL OF SPINE SURGERY 2017; 3:403-410. [PMID: 29057350 DOI: 10.21037/jss.2017.08.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol use has been shown to affect surgical outcomes. However, it is unknown what effect alcohol use has on postoperative complications or readmission rates in spinal fusion surgery. The aim of this study is to determine the impact of preoperative alcohol use on 30-day readmission rates or the complications profile after adult elective spinal fusion for deformity correction (≥2 levels). METHODS The medical records of 1,010 adult patients undergoing elective spinal fusion (≥2 levels) for spinal deformities at a major academic institution from 2005 to 2015 were reviewed. We identified 317 (31.4%) patients who had a history of alcohol prior to surgery and 693 (68.6%) patients who had no history of pre-operative alcohol consumption. The demographics, comorbidities, intra- and 30-day post-operative complication and readmission rates were collected for each patient. The primary outcome investigated in this study was the rate of 30-day readmissions and postoperative complication rates. RESULTS Baseline characteristics were similar between both cohorts. Intraoperative variables and the immediate postoperative complications profile were mostly similar between both cohorts. Overall, there was no significant difference between the 30-day readmission rates or complications profile between the two cohorts. CONCLUSIONS Our study suggests there is no significant difference in 30-day readmission or complication rates among adult patients with or without preoperative alcohol use undergoing elective correction of spinal deformities.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Victoria D Vuong
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Amanda Sergesketter
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Gireesh Reddy
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph Cheng
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Carlos A Bagley
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Karaman K, Aziret M, Ercan M, Ebiloglu T, Karadeniz U, Bostanci EB. A Preventive Strategy for Staple Line Bleeding in Morbidly Obese Patients Undergoing Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2017; 27:1015-1021. [PMID: 28829225 DOI: 10.1089/lap.2017.0386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Risk factors for staple line bleeding (SLB) during and after sleeve gastrectomy (SG) are various, including patient related factors, perioperative medications, and surgical technique, although there is little clarification in the literature of the role played by blood pressure during the stapling phase. The aim of the present retrospective cohort study was to identify possible risk factors liable to cause SLB. MATERIALS AND METHODS Data collected prospectively from 120 consecutive patients who underwent SG were analyzed retrospectively according to age, gender, body mass index (BMI), international normalized ratio (INR) value, intraoperative systolic blood pressure (SBP), and mean arterial blood pressure (MABP). RESULTS In univariate analysis, age, stapling phase SBP and MABP, and the duration of surgery were all significantly higher in patients with SLB than those without (P < .05). In distinguishing patients with SLB from those without, the cutoff threshold for SBP during the stapling phase was 120 mmHg with a 78.9% sensitivity, 97.6% specificity, 93.8% positive predictive value, 90.9% negative predictive value, and 91.7% accuracy (AUC = 0.908, 95% CI: 0.839-0.976, and P < .001). In multivariate logistic regression analysis, independent of age and operation time, SBP >120 mmHg significantly maintained its predictive power on SLB (95% CI: 32.410-1457.896, P < .001). CONCLUSION A SBP >120 mmHg during the division of the stomach is an independent risk factor for SLB. Maintaining intraoperative SBP ≤120 mmHg during the stapling phase does not only decrease the risk of SLB but also the need for homeostatic agents such as clips and sutures, which in turn prolong the operative time and increase cost.
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Affiliation(s)
- Kerem Karaman
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Mehmet Aziret
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Metin Ercan
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Tugce Ebiloglu
- 2 Department of Anesthesiology, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Umit Karadeniz
- 2 Department of Anesthesiology, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
| | - Erdal Birol Bostanci
- 1 Department of Gastroenterological Surgery, Sakarya University Teaching and Research Hospital , Sakarya, Turkey
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Mörgeli R, Scholtz K, Kurth J, Treskatsch S, Neuner B, Koch S, Kaufner L, Spies C. Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia. Visc Med 2017; 33:267-274. [PMID: 29034255 DOI: 10.1159/000475611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. METHODS We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities. RESULTS Especially in combination with advanced age, the effects of malignancies can be devastating, bringing new health challenges, exacerbating preexisting conditions, and exerting severe psychological strain. An interdisciplinary assessment and process planning provide an ideal setting to identify and prevent potential complications, especially in regards to frailty and cardiovascular risk. In addition, important perioperative considerations are presented, such as malnutrition, fasting, intraoperative neuromonitoring, and hemodynamic control, as well as postoperative early mobilization, pain, and delirium management. CONCLUSION The decisions and interventions made in the perioperative stage can positively influence many intra- and postoperative factors, significantly improving the chances of successful treatment of elderly cancer patients. Appropriate management can help prevent or mitigate complications, secure a quick recovery, and improve short- and long-term outcomes.
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Affiliation(s)
- Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kathrin Scholtz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Kurth
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bruno Neuner
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanne Koch
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lutz Kaufner
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Reduced Impact of Smoking Status on 30-Day Complication and Readmission Rates After Elective Spinal Fusion (≥3 Levels) for Adult Spine Deformity: A Single Institutional Study of 839 Patients. World Neurosurg 2017; 107:233-238. [PMID: 28790002 DOI: 10.1016/j.wneu.2017.07.174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smoking status has been shown to affect postoperative outcomes after surgery. The aim of this study was to determine whether patients' smoking status impacts 30-day complication and readmission rates after elective complex spinal fusion (≥3 levels). METHODS The medical records of 839 adult spinal deformity patients undergoing elective complex spinal fusion (≥3 levels) at a major academic institution from 2005 to 2015 were reviewed. We identified 124 (14.8%) smokers and 715 (85.2%) nonsmokers. Patient demographics, comorbidities, intraoperative and postoperative complications, and 30-day readmission rates were collected for each patient. The primary outcome investigated in this study was the rate of 30-day postoperative complication and readmission rates. RESULTS Patient demographics and comorbidities were similar between both groups, including age, sex, and body mass index. Median [interquartile] number of fusion levels and operative time were similar between the cohorts (smoker: 5 [4-7] vs. nonsmoker: 5 [4-8], P = 0.58) and (smoker: 309.6 ± 157.9 minutes vs. nonsmoker: 287.5 ± 131.7 minutes, P = 0.16), respectively. Both cohorts had similar postoperative complication rates and lengths of hospital stay. There was no significant difference in 30-day readmission between the cohorts (smoker: 12.9% vs. nonsmoker: 10.8%, P = 0.48). There were no observed differences in 30-day complication rates, including pain (P = 0.46), UTI (P = 0.54), hardware failure (P = 0.36), wound dehiscence (P = 0.29), and wound drainage (P = 0.86). Smokers had greater rates of 30-day cellulitis (smoker: 1.6% vs. nonsmoker: 0.3%, P = 0.05) and DVT (smoker: 0.8% vs. nonsmoker: 0.0%, P = 0.02). CONCLUSIONS Our study suggests that smoking does not significantly affect 30-day readmission rates after complex spinal surgery requiring ≥3 levels of fusion. Further studies are necessary to corroborate our findings.
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Thorarinsson A, Fröjd V, Kölby L, Lidén M, Elander A, Mark H. Patient determinants as independent risk factors for postoperative complications of breast reconstruction. Gland Surg 2017; 6:355-367. [PMID: 28861376 DOI: 10.21037/gs.2017.04.04] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Breast reconstruction is an essential component in the treatment of breast cancer. Postoperative complications after breast reconstruction are common and affect patient satisfaction. Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. METHODS We retrospectively enrolled 623 consecutive patients who underwent reconstruction with a deep inferior epigastric perforator flap (DIEP), latissimus dorsi flap (LD), lateral thoracodorsal flap (LTDF), or tissue expander with a secondary implant (EXP) in this study. Information on demographic and perioperative factors was collected, as well as information on all postoperative complications. Logistic regression was used to analyze associations between possible patient-related risk factors and postoperative complications. RESULTS Smoking was associated with the highest number of early overall complications [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially. CONCLUSIONS Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.
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Affiliation(s)
- Andri Thorarinsson
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Victoria Fröjd
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lauridsen SV, Thomsen T, Thind P, Tønnesen H. STOP smoking and alcohol drinking before OPeration for bladder cancer (the STOP-OP study), perioperative smoking and alcohol cessation intervention in relation to radical cystectomy: study protocol for a randomised controlled trial. Trials 2017; 18:329. [PMID: 28716147 PMCID: PMC5513198 DOI: 10.1186/s13063-017-2065-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/26/2017] [Indexed: 01/16/2023] Open
Abstract
Background To evaluate the effect of a smoking-, alcohol- or combined-cessation intervention starting shortly before surgery and lasting 6 weeks on overall complications after radical cystectomy. Secondary objectives are to examine the effect on types and grades of complications, smoking cessation and alcohol cessation, length of hospital stay, health-related quality of life and return to work or habitual level of activity up to 12 months postoperatively. Methods/design The study is a multi-institutional randomised clinical trial involving 110 patients with a risky alcohol intake and daily smoking who are scheduled for radical cystectomy. Patients will be randomised to the 6-week Gold Standard Programme (GSP) or treatment as usual (control). The GSP combines patient education and pharmacologic strategies. Smoking and alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly meetings and at follow-up. Discussion Herein, we report the design of the STOP-OP study, objectives and accrual up-date. This study will provide new knowledge about how to prevent smoking and alcohol-related postoperative complications at the time of bladder cancer surgery. Till now 77 patients have been enrolled. Patient accrual is expected to be finalised before the end of 2017 and data will be published in 2018. Trial registration ClinicalTrials.gov, ID: NCT02188446. Registered on 28 May 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2065-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, 2112, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital, Rigshospitalet and University of Copenhagen, Health and Medical Sciences, Copenhagen, Denmark
| | - Peter Thind
- Department of Urology, Copenhagen University Hospital, Rigshospitalet, 2112, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospitals, Copenhagen, Denmark.,Clinical Health Promotion Centre, Health Sciences, Lund University, Lund, Sweden.,Health Science, University of Southern Denmark, Odense, Denmark
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Van Schayck OCP, Williams S, Barchilon V, Baxter N, Jawad M, Katsaounou PA, Kirenga BJ, Panaitescu C, Tsiligianni IG, Zwar N, Ostrem A. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG. NPJ Prim Care Respir Med 2017; 27:38. [PMID: 28600490 PMCID: PMC5466643 DOI: 10.1038/s41533-017-0039-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/29/2017] [Accepted: 05/09/2017] [Indexed: 11/12/2022] Open
Abstract
Tobacco smoking is the world's leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it recognises that clinical decisions should be tailored to the individual's circumstances and attitudes and be influenced by the availability and affordability of drugs and specialist services. Finally it argues that the role of the International Primary Care Respiratory Group is to improve the confidence as well as the competence of primary care and, therefore, makes recommendations about clinical education and evaluation. We also advocate for an update to the WHO Model List of Essential Medicines to optimise each primary-care intervention. This International Primary Care Respiratory Group statement has been endorsed by the Member Organisations of World Organization of Family Doctors Europe.
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Affiliation(s)
- O C P Van Schayck
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - S Williams
- International Primary Care Respiratory Group, Aberdeen, UK
| | - V Barchilon
- Andalusian Health Service (SAS), Tobacco group of GRAP (Primary Care Respiratory Group), Andalusia, Spain
| | - N Baxter
- International Primary Care Respiratory Group, Aberdeen, UK
- Southwark Clinical Commissioning Group, London, UK
| | - M Jawad
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - P A Katsaounou
- Pulmonary Medicine, Medical School, National and Kapodistran University of Athens, Evaggelismos Hospital, Athens, Greece
| | - B J Kirenga
- Lung Institute and Division of Pulmonary Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - C Panaitescu
- Family Medicine Solo Practice, RespiRo- Romanian Primary Care Respiratory Group, Bucharest, Romania
| | - I G Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - N Zwar
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - A Ostrem
- General Practitioner, Gransdalen Legesenter, Oslo, Norway
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Kim JH, Patel S. Is It Worth Discriminating Against Patients Who Smoke? A Systematic Literature Review on the Effects of Tobacco Use in Foot and Ankle Surgery. J Foot Ankle Surg 2017; 56:594-599. [PMID: 28476393 DOI: 10.1053/j.jfas.2017.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 02/03/2023]
Abstract
Although numerous studies have linked smoking with lower extremity wound and bone healing complications, a comprehensive study on the effects of smoking in foot and ankle surgery has not yet been reported. The purpose of the present study was to report the results of our systemic literature review, identifying the effects of tobacco use on common foot and ankle procedures. The systematic literature review was performed according to guidelines set by the PRIMSA statement (Preferred Reporting Items for Systematic Review and Meta-Analyses). Smoking, as a single risk factor, was analyzed and used to compare adverse outcomes in the postoperative setting of foot and ankle surgery. We reviewed 528 abstracts that met our initial identification criteria. After an extensive review process, 46 of the articles (8.71%) met the eligibility requirements to be included in the present study. Distal bunionectomy with osteotomy, first metatarsophalangeal joint arthrodesis, Lapidus bunionectomy, toe amputation, transmetatarsal amputation, Syme's amputation, open reduction internal fixation (ORIF) of calcaneal fractures, ankle fracture ORIF, pilon fracture ORIF, subtalar arthrodesis, rearfoot arthrodesis, tibiocalcaneal arthrodesis, ankle arthrodesis, total ankle arthroplasty, and plastic surgery procedures and their respective negative association with smoking was identified and described in our review. Our systematic literature review revealed that procedures involving arthrodesis, fracture ORIF, and plastic surgery were associated with negative outcomes in smokers. Procedures that did not involve osseous unions such as total ankle arthroplasty and amputations did not appear to have negative outcomes associated with smoking.
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Affiliation(s)
- Jason H Kim
- Resident Physician, Kaiser San Francisco Bay Area Foot and Ankle Residency, Oakland, CA.
| | - Sandeep Patel
- Attending Physician, Kaiser San Francisco Bay Area Foot and Ankle Residency, Antioch, CA
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A score to estimate 30-day mortality after intensive care admission after cardiac surgery. J Thorac Cardiovasc Surg 2017; 153:1118-1125.e4. [DOI: 10.1016/j.jtcvs.2016.11.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 10/07/2016] [Accepted: 11/04/2016] [Indexed: 01/25/2023]
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Rotevatn TA, Bøggild H, Olesen CR, Torp-Pedersen C, Mortensen RN, Jensen PF, Overgaard C. Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty - A register-based cohort study. PLoS One 2017; 12:e0173083. [PMID: 28306737 PMCID: PMC5357001 DOI: 10.1371/journal.pone.0173083] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/15/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the implications of low and moderate preoperative alcohol consumption on postoperative mortality and morbidity after primary hip and knee arthroplasty. Methods A total of 30,799 patients who underwent primary hip or knee arthroplasty between January 1st, 2005 and October 8th, 2011 with information on preoperative alcohol consumption (0 grams of pure alcohol/week, >0–168 g/week, >168–252 g/week, and >252 g/week) were identified through the Danish Anesthesia Database. The 90-day and 1-year risks of mortality (primary outcomes), 1-year risk of prosthetic infection, and 30-day risks of cardiovascular disease and deep venous thrombosis (secondary outcomes) were estimated by Cox regression analysis. Results We identified 285 (0.9%) deaths within the first 90 days and 694 (2.3%) within the first year. Within the first 30 days, 209 (0.7%) and 270 (0.9%) patients had acquired cardiovascular disease and deep venous thrombosis, respectively, and 514 (1.7%) patients developed prosthetic infection within the first year. The adjusted mortality models yielded hazard ratios of 0.55 (95% confidence interval [CI] 0.41 to 0.74) at 90 days and 0.61 (95% CI 0.51 to 0.73) at 1 year for the group consuming >0–168 g/week when compared to abstainers. Adjusted hazard ratios showed that the group consuming >0–168 g/week had a 0.91 (95% CI 0.75 to 1.11) risk of prosthetic infection, 0.68 (95% CI 0.50 to 0.92) risk of cardiovascular disease and 0.88 (95% CI 0.67 to 1.15) risk of deep venous thrombosis when compared to abstainers. Conclusions This study demonstrates that low-to-moderate alcohol consumption prior to primary hip or knee arthroplasty is associated with lower risks of mortality at both 90 days and 1 year after surgery and of cardiovascular disease after 30 days. More research from longitudinal studies is needed to identify specific causal relations and explanations.
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Affiliation(s)
- Torill A. Rotevatn
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- * E-mail:
| | - Henrik Bøggild
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Christinna R. Olesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke N. Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Per F. Jensen
- Department of Anesthesia, Næstved Hospital, Næstved, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Olsen LL, Møller AM, Brorson S, Hasselager RB, Sort R. The impact of lifestyle risk factors on the rate of infection after surgery for a fracture of the ankle. Bone Joint J 2017; 99-B:225-230. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0344.r1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/04/2016] [Indexed: 11/05/2022]
Abstract
Aims Lifestyle risk factors are thought to increase the risk of infection after acute orthopaedic surgery but the evidence is scarce. We aimed to investigate whether smoking, obesity and alcohol overuse are risk factors for the development of infections after surgery for a fracture of the ankle. Patients and Methods We retrospectively reviewed all patients who underwent internal fixation of a fracture of the ankle between 2008 and 2013. The primary outcome was the rate of deep infection and the secondary outcome was any surgical site infection (SSI). Associations with the risk factors and possible confounding variables were analysed univariably and multivariably with backwards elimination. Results A total of 1043 patients were included; 64 (6.1%) had a deep infection and 146 (14.0%) had SSI. Obesity was strongly associated with both outcomes (odds ratio (OR) 2.21, p = 0.017 and OR 1.68, p = 0.032) in all analyses. Alcohol overuse was similarly associated, though significant only in unadjusted analyses. Surprisingly, smoking did not yield statistically significant associations with infections. Conclusion These findings suggest that obesity and possibly alcohol overuse are independent risk factors for the development of infection following surgery for a fracture of the ankle. This large study brings new evidence concerning these common risk factors; although prospective studies are needed to confirm causality. Cite this article: Bone Joint J 2017;99-B:225–30.
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Affiliation(s)
- L. L. Olsen
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - A. M. Møller
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - S. Brorson
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - R. B. Hasselager
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
| | - R. Sort
- Herlev and Gentofte Hospital, Herlev
Ringvej 75, 2730 Herlev, Denmark
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Laser Surgery of the Airway. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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94
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Sureshchandra S, Rais M, Stull C, Grant K, Messaoudi I. Transcriptome Profiling Reveals Disruption of Innate Immunity in Chronic Heavy Ethanol Consuming Female Rhesus Macaques. PLoS One 2016; 11:e0159295. [PMID: 27427759 PMCID: PMC4948771 DOI: 10.1371/journal.pone.0159295] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/30/2016] [Indexed: 12/12/2022] Open
Abstract
It is well established that heavy ethanol consumption interferes with the immune system and inflammatory processes, resulting in increased risk for infectious and chronic diseases. However, these processes have yet to be systematically studied in a dose and sex-dependent manner. In this study, we investigated the impact of chronic heavy ethanol consumption on gene expression using RNA-seq in peripheral blood mononuclear cells isolated from female rhesus macaques with daily consumption of 4% ethanol available 22hr/day for 12 months resulting in average ethanol consumption of 4.3 g/kg/day (considered heavy drinking). Differential gene expression analysis was performed using edgeR and gene enrichment analysis using MetaCore™. We identified 1106 differentially expressed genes, meeting the criterion of ≥ two-fold change and p-value ≤ 0.05 in expression (445 up- and 661 down-regulated). Pathway analysis of the 879 genes with characterized identifiers showed that the most enriched gene ontology processes were "response to wounding", "blood coagulation", "immune system process", and "regulation of signaling". Changes in gene expression were seen despite the lack of differences in the frequency of any major immune cell subtype between ethanol and controls, suggesting that heavy ethanol consumption modulates gene expression at the cellular level rather than altering the distribution of peripheral blood mononuclear cells. Collectively, these observations provide mechanisms to explain the higher incidence of infection, delay in wound healing, and increase in cardiovascular disease seen in subjects with Alcohol use disorder.
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Affiliation(s)
- Suhas Sureshchandra
- Graduate Program in Genetics, Genomics and Bioinformatics, University of California Riverside, Riverside, California, United States of America
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, United States of America
| | - Maham Rais
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, United States of America
| | - Cara Stull
- Division of Neurosciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, United States of America
| | - Kathleen Grant
- Division of Neurosciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, United States of America
| | - Ilhem Messaoudi
- Graduate Program in Genetics, Genomics and Bioinformatics, University of California Riverside, Riverside, California, United States of America
- Division of Biomedical Sciences, School of Medicine, University of California Riverside, Riverside, California, United States of America
- Division of Neurosciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, United States of America
- * E-mail:
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95
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Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study. Eur J Anaesthesiol 2016; 32:458-70. [PMID: 26020123 DOI: 10.1097/eja.0000000000000223] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN A prospective observational study of a multicentre cohort. SETTING Sixty-three hospitals across Europe. PATIENTS Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO2) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO2; at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes.The study was registered at ClinicalTrials.gov (identifier NCT01346709).
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96
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Iossa A, Abdelgawad M, Watkins BM, Silecchia G. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbecks Arch Surg 2016; 401:757-66. [PMID: 27301373 DOI: 10.1007/s00423-016-1464-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/08/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Leak is the second most common cause of death after bariatric surgery. The leak rate after laparoscopic sleeve gastrectomy (LSG) ranges between 1.1 and 5.3 %. The aim of the paper is to provide an overview of the current pathogenic and promoting factors of leakage after LSG on the basis of recent literature review and to report the evidence based preventive measures. METHODS Risk factors and pathogenesis of leakage after LSG were examined based on an extensive review of literature and evidence based analysis of the most recent published studies using Oxford centre for evidence-based medicine, 2011, levels of evidence. RESULTS Pathogenesis of leakage after LSG can be attributed to mechanical or ischemic causes. Many factors can predispose to leakage after LSG which are either technically related or patient related. Awareness of these predisposing factors and technical tips may decrease the incidence of leakage. CONCLUSIONS This review reports factors promoting leak and gives technical recommendations to avoid leak after LSG based on the available evidence and expert consensus which encompasses: (1) use a bougie size ≥40 Fr, EL:1, (2) begin the gastric transection 5-6 cm from the pylorus, EL:2-3, (3) use appropriate cartridge colors from antrum to fundus, EL:1, (4) reinforce the staple line with buttress material, EL:1, (5) follow a proper staple line, (6) remove the crotch staples, EL:4, (7) maintain proper traction on the stomach before firing, (8) stay away from the angle of His at least 1 cm, EL:1, (9) check the bleeding from the staple line, (10) perform an intraoperative methylene blue test, EL:4.
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Affiliation(s)
- Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
| | - Mohamed Abdelgawad
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.,Gastroenterology Surgical Center (GEC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Brad Michael Watkins
- Division of General Surgery and Weight loss Center, West Chester Hospital, University of Cincinnati, Cincinnati, OH, USA
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence, La Sapienza University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy
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97
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Levett DZ, Edwards M, Grocott M, Mythen M. Preparing the patient for surgery to improve outcomes. Best Pract Res Clin Anaesthesiol 2016; 30:145-57. [DOI: 10.1016/j.bpa.2016.04.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/01/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022]
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99
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The Implications of Tobacco Smoking on Acute Postoperative Pain: A Prospective Observational Study. Pain Res Manag 2016; 2016:9432493. [PMID: 27445634 PMCID: PMC4904603 DOI: 10.1155/2016/9432493] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/16/2015] [Indexed: 12/02/2022]
Abstract
Background. The clinical importance of cigarette smoking on acute postoperative pain perception is not fully understood. Methods. To determine whether smokers who underwent major surgery need more postoperative opiate than do nonsmokers. We prospectively enrolled 407 male and 441 female participants who underwent in-hospital surgery. Current-smokers were compared with nonsmokers and past-smokers about opiate use during the first 72 h after surgery. Results. A greater proportion of males had more smoking history than females. The average age of male current-smokers is smaller than both nonsmokers and past-smokers. The surgical type (upper abdomen, lower abdomen, extremities, spine, and others) and duration of surgery have no differences between current-smokers, past-smokers, and nonsmokers. Statistically, the male current-smokers required more opiate analgesics during the first 72 h following surgery compared with the male nonsmokers and past-smokers; furthermore, the male current-smokers reported higher pain intensity when moving and at rest on day 1 after surgery. Conclusions. In this study, the male current-smokers required more morphine in the first 72 h after surgery than did the nonsmokers and past-smokers. Furthermore, smoking was more prevalent among the males than the females. Health care providers must be aware of the potential for increased narcotic requirements in male current-smokers.
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100
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Steenhagen E. Enhanced Recovery After Surgery: It's Time to Change Practice! Nutr Clin Pract 2015; 31:18-29. [PMID: 26703956 DOI: 10.1177/0884533615622640] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Perioperative surgical care is undergoing a paradigm shift. Traditional practices such as prolonged preoperative fasting (nil by mouth from midnight), bowel cleaning, and reintroduction of oral nutrition 3-5 days after surgery are being shunned. These and other similar changes have been formulated into a protocol called Enhanced Recovery After Surgery (ERAS) pathway. It is a multimodal perioperative care pathway designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of an ERAS protocol include preoperative counseling, optimization of nutrition, standardized analgesic and anesthetic regimes, and early mobilization. The recent literature is heavily influenced by colorectal surgery, but the principles are now being applied to a wide range of disciplines. As they challenge traditional surgical doctrine, the implementation of ERAS guidelines has been slow, despite the significant body of evidence indicating that ERAS guidelines may lead to improved outcomes.
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Affiliation(s)
- Elles Steenhagen
- Internal Medicine and Dermatology, Department of Dietetics, University Medical Center Utrecht, the Netherlands
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