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Bérubé M, Verret M, Bourque L, Côté C, Guénette L, Richard-Denis A, Ouellet S, Singer LN, Gauthier L, Gagnon MP, Gagnon MA, Martorella G. Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review. Pain 2024:00006396-990000000-00630. [PMID: 38888742 DOI: 10.1097/j.pain.0000000000003288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/28/2024] [Indexed: 06/20/2024]
Abstract
ABSTRACT Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.
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Affiliation(s)
- Mélanie Bérubé
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
| | - Michael Verret
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Medicine, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Bourque
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Andréane Richard-Denis
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Centre, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada
| | - Simon Ouellet
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Lesley Norris Singer
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Lynn Gauthier
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Quebec Pain Research Network, Sherbrooke, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
- Oncology Division, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Cancer Research Centre, Université Laval, Québec City, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- VITAM-Centre de Recherche en Santé durable, Université Laval, Québec, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit, Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, Tallahassee, FL, United States
- Florida State University Brain Science and Symptom Management Center, Tallahassee, FL, United States
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Swift CA, Fernstrum CJ, Howell HM, Phillips JB, Aultman RB, Baker KE, Thames CB, Bryant GC, Velazquez AE, Boydstun AG, Sullivan JM, Lebhar MS, Hecox EE, Humphries LS, Hoppe IC. Implementation of an Enhanced Recovery After Surgery Protocol for Cranial Vault Remodeling Procedures. Cleft Palate Craniofac J 2024:10556656241255940. [PMID: 38841797 DOI: 10.1177/10556656241255940] [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: 06/07/2024] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cranial vault remodeling for craniosynostosis. The authors aim to describe the implementation of an ERAS protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital. DESCRIPTION Institutional review board approval was received. All patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were collected (n = 168). Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and independent t-tests were employed to determine significance. A significance value of 0.05 was utilized. RESULTS During the time examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution - all of which were included in the analysis. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged. CONCLUSION This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for ways to maximize hospital reimbursement for these procedures, as well as potentially improve outcomes.
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Affiliation(s)
- Clarice A Swift
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Colton J Fernstrum
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Haven M Howell
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John B Phillips
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rebekah B Aultman
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Katherine E Baker
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Clay B Thames
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gidarell C Bryant
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Anna G Boydstun
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John M Sullivan
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Michael S Lebhar
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Emily E Hecox
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Laura S Humphries
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
| | - Ian C Hoppe
- Department of Surgery, Division of Plastic Surgery, University of Mississippi, Jackson, MS, USA
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Booker J, Penn J, Koh CH, Newall N, Rowland D, Sinha S, Hanrahan JG, Williams SC, Sayal P, Marcus HJ. Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey. BMJ Open Qual 2024; 13:e002810. [PMID: 38802270 PMCID: PMC11131119 DOI: 10.1136/bmjoq-2024-002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves. DESIGN A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey. SETTING A single surgical centre in the UK. PARTICIPANTS Fourteen members of the spinal multidisciplinary team were interviewed to develop the process map.This process map was validated using the EHR of 50 patients undergoing elective spine surgery between January and June 2022. Postprocedure, feedback was gathered from 25 patient surveys to identify which resources they used to learn about their spinal procedure. Patients below the age of 18 or who received emergency surgery were excluded. INTERVENTIONS Elective spine surgery and patient questionnaires given postoperatively either on the ward or in follow-up clinic. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. The secondary outcome was the percentage of the study cohort that used educational resources listed in the patient questionnaire. RESULTS There were 342 encounters which occurred across the cohort, with 16 discrete event categories identified. The initial surgical clinic (88%), anaesthetic preoperative assessment (96%) and admission for surgery (100%) were identified as key timepoints. Surveys identified that patients most used verbal information from their surgeon (100%) followed by written information from their surgeon (52%) and the internet (40%) to learn about their surgery. CONCLUSIONS Process mapping is an effective method of illustrating the patient pathway. The initial surgical clinic, anaesthetic preoperative assessment and surgical admission are key timepoints where patients receive information. This has future implications for guiding patient education interventions to focus at key timepoints.
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Affiliation(s)
- James Booker
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Jack Penn
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Chan Hee Koh
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Queen Square Institute of Neurology, University College London, London, UK
- Neurosciences Department, Cleveland Clinic London, London, UK
| | - Nicola Newall
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - David Rowland
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Siddharth Sinha
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - John G Hanrahan
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Simon C Williams
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Parag Sayal
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hani J Marcus
- Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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Licker M, El Manser D, Bonnardel E, Massias S, Soualhi IM, Saint-Leger C, Koeltz A. Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities. J Clin Med 2024; 13:2765. [PMID: 38792307 PMCID: PMC11121931 DOI: 10.3390/jcm13102765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient's comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative resection. Poor aerobic fitness, nutritional defects, sarcopenia and "toxic" behaviors such as sedentary behavior, smoking and alcohol consumption are modifiable risk factors for major postoperative complications. The process of enhancing patients' physiological reserve in anticipation for surgery is referred to as prehabilitation. Components of prehabilitation programs include optimization of medical treatment, prescription of structured exercise program, correction of nutritional deficits and patient's education to adopt healthier behaviors. All patients may benefit from prehabilitation, which is part of the enhanced recovery after surgery (ERAS) programs. Faster functional recovery is expected in low-risk patients, whereas better clinical outcome and shorter hospital stay have been demonstrated in higher risk and physically unfit patients.
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Affiliation(s)
- Marc Licker
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Diae El Manser
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Eline Bonnardel
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Sylvain Massias
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Islem Mohamed Soualhi
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Charlotte Saint-Leger
- Department of Cardiovascular & Thoracic Surgery, University Hospital of Martinique, F-97200 Fort-de-France, France;
| | - Adrien Koeltz
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
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Cammarota G, De Robertis E, Simonte R. Unexpected intensive care unit admission after surgery: impact on clinical outcome. Curr Opin Anaesthesiol 2024; 37:192-198. [PMID: 38390879 DOI: 10.1097/aco.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review is focused on providing insights into unplanned admission to the intensive care unit (ICU) after surgery, including its causes, effects on clinical outcome, and potential strategies to mitigate the strain on healthcare systems. RECENT FINDINGS Postoperative unplanned ICU admission results from a combination of several factors including patient's clinical status, the type of surgical procedure, the level of supportive care and clinical monitoring outside the ICU, and the unexpected occurrence of major perioperative and postoperative complications. The actual impact of unplanned admission to ICU after surgery on clinical outcome remains uncertain, given the conflicting results from several observational studies and recent randomized clinical trials. Nonetheless, unplanned ICU admission after surgery results a significant strain on hospital resources. Consequently, this issue should be addressed in hospital policy with the aim of implementing preoperative risk assessment and patient evaluation, effective communication, vigilant supervision, and the promotion of cooperative healthcare. SUMMARY Unplanned ICU admission after surgery is a multifactorial phenomenon that imposes a significant burden on healthcare systems without a clear impact on clinical outcome. Thus, the early identification of patient necessitating ICU interventions is imperative.
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Affiliation(s)
- Gianmaria Cammarota
- Department of Translational Medicine, Università del Piemonte Orientale, Novara
| | - Edoardo De Robertis
- Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
| | - Rachele Simonte
- Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
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de Souza RP, Lopes LB, Carmo ACN, Machado PM, de Andrade JML, Funez MI. Pain Neuroscience Education in elective surgery patients: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e078743. [PMID: 38553064 PMCID: PMC10982765 DOI: 10.1136/bmjopen-2023-078743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/04/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Pain Neuroscience Education (PNE) consists of an educational strategy that seeks to understand the biological processes of pain and how to control it. The main objective of this study will be to evaluate the impact of PNE on outcomes related to the postoperative period. The hypothesis is that the intervention may positively influence postoperative recovery, contributing to pain control, clinical indications, acceptance and consumption of analgesics and other pharmacological drugs that contribute to its control, as well as psychological aspects, such as anxiety, depression and pain catastrophising. METHODS AND ANALYSIS This will be an open, parallel, multicentre and randomised controlled clinical trial. A total of 100 participants aged between 18 and 59 years of age, of both genders, who are going to have elective general surgery will be evaluated. The intervention group will participate in a preoperative pain neuroscience educational session and also receive usual preoperative care, while the control group receives usual preoperative care as well. The educational session will last 30 min and consists of a video (5:20 min), a questionnaire about the content, time for participants to express their beliefs, thoughts and doubts. Participants will be evaluated preoperatively and there will be one postintervention evaluation. The intensity and characteristics of pain and anxiety are evaluated as primary outcomes. As secondary outcomes, pain catastrophising and depression are taken into account. ETHICS AND DISSEMINATION The project was approved by the Research Ethics Committee of the Faculty of Ceilandia, the Research Ethics Committee of the Institute of Strategic Health Management of the Federal District and the Research Council of the Hospital of Brasília-Rede Dasa (CAAE: 28572420.3.0000.8093). Recruitment began in June of 2023. All participants were included in the study only after their written consent. All data obtained will be analysed and distributed through publication in journals and at scientific events. TRIAL REGISTRATION NUMBER Brazilian Registry of Clinical Trials (ReBEC) (RBR-23mr7yy).
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McCormick JR, Harkin WE, Hodakowski AJ, Streepy JT, Khan ZA, Mowers CC, Urie BR, Jawanda HS, Jackson GR, Chahla J, Garrigues GE, Verma NN. Analysis of patient-directed search content and online resource quality for ulnar collateral ligament injury and surgery. JSES Int 2024; 8:384-388. [PMID: 38464434 PMCID: PMC10920115 DOI: 10.1016/j.jseint.2023.11.017] [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: 03/12/2024] Open
Abstract
Background Patients use the Internet to learn information about injuries, yet online content remains largely unstudied. This study analyzed patient questions posed online regarding ulnar collateral ligament (UCL) tears or UCL surgical management. Methods Three separate search strings about UCL tear and UCL surgery were queried on the Google search engine. The 300 most commonly asked questions were compiled for each topic and associated webpage information was collected from the "People also ask" section. Questions were categorized using the Rothwell classification and webpages by Journal of the American Medical Association (JAMA) benchmark criteria. Results The most frequent UCL tear questions were "how long does it take to heal a torn UCL?" and "what is nonsurgical treatment for the UCL?" The most frequent UCL surgery question was "can you retear your UCL after surgery?" The Rothwell classification of questions for UCL tear/UCL surgery was 55%/32% policy, 38%/57% fact, and 7%/11% value with highest subcategories being indications/management (46%/25%) and technical details (24%/25%). The most common webpages were academic (39%/29%) and medical practice (24%/26%). Mean JAMA score for all 600 webpages was low (1.2), with journals (mean = 3.4) having the highest score. Medical practice (mean = 0.5) and legal websites (mean = 0.0) had the lowest JAMA scores. Only 30% of webpages provided UCL-specific information. Conclusion Online UCL patient questions commonly pertain to technical details and injury management. Webpages suggested by search engines contain information specific to UCL tears and surgery only one-third of the time. The quality of most webpages provided to patients is poor, with minimal source transparency.
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Affiliation(s)
| | - William E. Harkin
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | | | - John T. Streepy
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Zeeshan A. Khan
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Colton C. Mowers
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Braedon R. Urie
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Harkirat S. Jawanda
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Garrett R. Jackson
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Jorge Chahla
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Grant E. Garrigues
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
| | - Nikhil N. Verma
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, IL, USA
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Skořepa P, Ford KL, Alsuwaylihi A, O'Connor D, Prado CM, Gomez D, Lobo DN. The impact of prehabilitation on outcomes in frail and high-risk patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clin Nutr 2024; 43:629-648. [PMID: 38306891 DOI: 10.1016/j.clnu.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND & AIMS Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this systematic review and meta-analysis was to determine the impact of prehabilitation on postoperative outcomes in frail and high-risk patients undergoing major abdominal surgery. METHODS Embase, Medline, CINAHAL and Cochrane databases were searched from January 2010 to January 2023 for randomised clinical trials (RCTs) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. Meta-analysis was limited to length of stay (primary end point), severe postoperative complications (Clavien-Dindo Classification ≥ Grade 3) and the 6-minute walk test (6MWT). The analysis was performed using RevMan v5.4 software. RESULTS Sixteen studies (6 RCTs, 10 observational) reporting on 3339 patients (1468 prehabilitation group, 1871 control group) were included. The median (interquartile range) age was 74.0 (71.0-78.4) years. Multimodal prehabilitation was applied in fifteen studies and unimodal in one. Meta-analysis of nine studies showed a reduction in hospital length of stay (weighted mean difference -1.07 days, 95 % CI -1.60 to -0.53 days, P < 0.0001, I2 = 19 %). Ten studies addressed severe complications and a meta-analysis suggested a decline in occurrence by up to 44 % (odds ratio 0.56, 95 % CI 0.37 to 0.82, P < 0.004, I2 = 51 %). Four studies provided data on preoperative 6MWT. The pooled weighted mean difference was 40.1 m (95 % CI 32.7 to 47.6 m, P < 0.00001, I2 = 24 %), favouring prehabilitation. CONCLUSION Given the significant impact on shortening length of stay and reducing severe complications, prehabilitation should be encouraged in frail, older and high-risk adult patients undergoing major abdominal surgery.
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Affiliation(s)
- Pavel Skořepa
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic; 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic. https://twitter.com/PavelSkorepa
| | - Katherine L Ford
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada; Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Canada. https://twitter.com/KathFord_RD
| | - Abdulaziz Alsuwaylihi
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dominic O'Connor
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK. https://twitter.com/Dom_OConnor1
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada. https://twitter.com/DrCarlaPrado
| | - Dhanny Gomez
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Young AM, Viktorsson SA, Strobel RJ, Rotar EP, Cramer C, Scott C, Carrott P, Blank RS, Martin LW. Five-Year Sustained Impact of a Thoracic Enhanced Recovery After Surgery Program. Ann Thorac Surg 2024; 117:422-430. [PMID: 37923241 DOI: 10.1016/j.athoracsur.2023.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Our thoracic enhanced recovery program (ERP) decreased the use of postoperative morphine equivalents and hospital costs 1 year after implementation at our tertiary center. The sustainability and potential increasing benefit of this program were evaluated. METHODS From 2015 to 2021, we prospectively analyzed the outcomes of patients who underwent elective pleural, pulmonary, or mediastinal operations at our institution. Patients were separated on the basis of the incision (video-assisted thoracoscopic surgery [VATS] or thoracotomy). The ERP protocol was initiated on May 1, 2016, and includes preoperative education, carbohydrate loading, opioid-sparing analgesia, conservative fluid management, protective ventilation, and early ambulation. Outcomes of patients before (2015, pre-VATS and pre-thoracotomy) and after (May 1, 2016, to December 31, 2021, ERP-VATS and ERP-thoracotomy) ERP implementation were compared. RESULTS The cohort included 1079 patients (pre-ERP era, n = 224 [21%]; ERP era, n = 855 [79%]). There was a median reduction of 1.5 hospital days per patient for ERP-thoracotomy and 1 hospital day per patient for ERP-VATS. Median postoperative morphine equivalents decreased in both groups (125 vs 45 mg, in ERP-thoracotomy; 84 vs 23 mg, ERP-VATS; P < .001), as did total admission cost ($32,118 vs $23,775, ERP-thoracotomy; $17,367 vs $11,560, ERP-VATS; P < .001). Median total fluid balance during the hospital stay decreased significantly. Rates of postoperative atrial fibrillation and urinary retention decreased across both subgroups. CONCLUSIONS ERP for thoracic surgery is sustainable and has been demonstrated to improve patient outcomes, to decrease opioid use, and to lower hospital costs. Therefore, it has the potential to become the standard of care.
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Affiliation(s)
- Andrew M Young
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Sindri A Viktorsson
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Raymond J Strobel
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Evan P Rotar
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Christopher Cramer
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Christopher Scott
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Phil Carrott
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Randal S Blank
- Department of Anesthesiology, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Linda W Martin
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia.
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10
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Stone AB, Gerner P, Bader AM, Soffin EM. We Need to Talk About Methadone: Adding Discussions With Patients to Our Care Pathways. Anesth Analg 2024; 138:e3-e4. [PMID: 38100811 DOI: 10.1213/ane.0000000000006770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Alexander B Stone
- Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts,
| | - Philipp Gerner
- Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts,
| | - Angela M Bader
- Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts,
| | - Ellen M Soffin
- Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts,
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11
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Machado PM, Carmo ACN, Leal LBLG, de Souza RP, Rocha PRS, Funez MI. A systematic review of the added value of perioperative pain neuroscience education. PATIENT EDUCATION AND COUNSELING 2023; 117:107984. [PMID: 37742593 DOI: 10.1016/j.pec.2023.107984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To identify and summarize evidence about the benefits of perioperative pain neuroscience education (PNE) on pain-related and psychosocial outcomes. METHODS Included were reports written in English that carried out PNE or its synonyms; perioperative period; aged ≥ 18 years; interventional studies and observational studies. Secondary studies, conference abstracts, and editorials were excluded. There was no time limitation. INFORMATION SOURCES PubMed, Virtual Health Library, Cochrane Library, and Science Direct. Search: June 20th 2023. The risk of bias was assessed using the Joanna Briggs Institute checklists, and synthesis followed the recommendations of the Synthesis Without Meta-analysis (SWiM) guideline. Register: Center for Open Science website (10.17605/OSF.IO/ZTNEJ). RESULTS The sample consisted of 18 reports. For pain outcomes, it was not possible to attribute PNE benefits because ten reports found improvements in both intervention and control groups. For psychosocial outcomes, fourteen reports found benefits for PNE groups. All the analyzed reports showed low risk of bias. CONCLUSION PNE had additional benefits beyond those obtained with conventional treatment for psychosocial outcomes. PRACTICAL IMPLICATIONS Due to the lack of evidence, it was not possible to indicate the clinical use of PNE. It is suggested that further studies are needed aimed at clarifying the possible benefits.
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Affiliation(s)
- Paula Muniz Machado
- University of Brasilia, School of Ceilândia, Graduate Program in Health Sciences and Technology, Federal District, Brasilia, Brazil.
| | - Anne Caroline Nunes Carmo
- University of Brasilia, School of Ceilândia, Collegiate of the Nursing Course, Federal District, Brasilia, Brazil.
| | | | - Raquel Pereira de Souza
- University of Brasilia, School of Ceilândia, Graduate Program in Health Sciences and Technology, Federal District, Brasilia, Brazil.
| | | | - Mani Indiana Funez
- University of Brasilia, School of Ceilândia, Graduate Program in Health Sciences and Technology and Collegiate of the Nursing Course, Federal District, Brasilia, Brazil.
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12
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Mithany RH, Daniel N, Shahid MH, Aslam S, Abdelmaseeh M, Gerges F, Gill MU, Abdallah SB, Hannan A, Saeed MT, Manasseh M, Mohamed MS. Revolutionizing Surgical Care: The Power of Enhanced Recovery After Surgery (ERAS). Cureus 2023; 15:e48795. [PMID: 38024087 PMCID: PMC10646429 DOI: 10.7759/cureus.48795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
The development of Enhanced Recovery After Surgery (ERAS) has brought about substantial transformations in perioperative care, substituting conventional methods with a patient-centric, evidence-based strategy. ERAS protocol adopts a holistic approach to patient care, which includes all stages preceding, during, and following the operation. These programs prioritize patient-specific therapies that are tailored to their specific requirements. Nutritional assessment and enhancement, patient education, minimally invasive procedures, and multimodal pain management are all fundamental components of ERAS. ERAS provides a multitude of advantages, including diminished postoperative complications, abbreviated hospital stays, heightened patient satisfaction, and healthcare cost reductions. This article examines the foundational tenets of ERAS, their incorporation into the field of general surgery, their suitability for diverse surgical specialties, the obstacles faced during implementation, and possible directions for further investigation, such as the integration of digital health technologies, personalized patient care, and the long-term viability of ERAS protocols.
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Affiliation(s)
- Reda H Mithany
- Department of General and Emergency Surgery, Kingston Hospital National Health Service (NHS) Foundation Trust, Kingston Upon Thames, GBR
| | - Nesma Daniel
- Medical Laboratory Science, Ain Shams University, Cairo, EGY
| | | | - Samana Aslam
- General Surgery, Lahore General Hospital, Lahore, PAK
| | - Mark Abdelmaseeh
- General Surgery, Faculty of Medicine, Assuit University, Assuit, EGY
| | - Farid Gerges
- Department of General and Emergency Surgery, Kingston Hospital National Health Service (NHS) Foundation Trust, London, GBR
| | - Muhammad Umar Gill
- Accident and Emergency, Kings College Hospital National Health Service (NHS) Foundation Trust, London, GBR
| | | | - Abdul Hannan
- Surgery, Glangwili General Hospital, Carmarthen, GBR
| | | | - Mina Manasseh
- General Surgery, Torbay and South Devon National Health Service (NHS) Foundation Trust, Torquay, GBR
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13
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Ong WH, Ashby J, Ellis J. Optometrist to Operation: Patients' Perspective on the Innovative Use of Quick Response (QR) Code-Linked Patient Information Video on Cataract Surgery. Cureus 2023; 15:e49336. [PMID: 38024095 PMCID: PMC10668533 DOI: 10.7759/cureus.49336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aimed to explore patients' subjective utility for a patient information video (PIV) on cataract surgery and analyse the use of a quick response (QR) code as a mode of delivery of the PIV. Methods A total of 500 patients were included in the study. All patients were given a paper form of the patient information leaflet (PIL) as the standard of care (SoC) in addition to a digital QR code to access a supplementary PIV. The questionnaire explored the patients' understanding of cataracts, the risks and benefits of cataract surgery, and their experience accessing and using the QR code. Results A total of 321 responses were collected (64% response rate). The majority were female (55%), with a mean age of 75 years. Among these, 69% (n = 222/321) managed to watch the video. A statistically significant association was reported between prior experience with QR codes and the ability to watch the video (p<0.001). The most common reason for not watching the video was no device (n=54/99, 54%). Ninety-one percent of the patients who watched the video expressed a desire for additional healthcare videos in the future. Overall, most patients (n=170/222, 76%) acknowledged that the PIV was easier to understand when compared to paper-format information, with a minority of patients reporting the PIV missing information that was covered on paper (n=2/222). Conclusions The provision of PIV supplementation as a part of the cataract surgery referral pathway is an innovative method of providing patient information in a more interactive way, with positive feedback from patients.
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Affiliation(s)
- Wei Han Ong
- Department of Ophthalmology, Ninewells Hospital, Dundee, GBR
| | - Joanna Ashby
- Department of Ophthalmology, Wolfson Medical School, University of Glasgow, Glasgow, GBR
| | - John Ellis
- Department of Ophthalmology, Ninewells Hospital, Dundee, GBR
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