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Falade IO, Wilson JC, Mehari ME, Soroudi D, Song S, Kim EA. The complexity of online patient education materials for wound care strategies: A readability analysis. Surgery 2024; 176:324-330. [PMID: 38769036 DOI: 10.1016/j.surg.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/13/2024] [Accepted: 04/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND In the United States, over 6 million people are affected by chronic wounds. Patients often rely on the Internet for treatment information; however, these educational materials typically exceed the average eighth-grade health literacy level. This study aimed to assess the readability and language accessibility of online patient education materials on wound care strategies. METHODS A search was conducted on Google for articles related to wound care strategies. The first 12 unique websites from each search strategy were selected for further analysis. Readability was assessed using 11 tests, with the mean scores calculated for each. RESULTS A total of 66 articles pertaining to wound care strategies were retrieved from 43 websites. All articles had an average reading grade level of 13.5 ± 2.5 and an average reading age of 18.7 ± 2.5 years. Websites were categorized by the following sources: academic (34.9%), reagent/biologic manufacturers (27.9%), wound care (18.6%), news media organizations (14%), and other (4.7%). Flesch Reading Ease Score, graded from 0 for most difficult to 100 for least difficult, was found to be highest for academic websites (44.2, P = .01) and lowest for news media websites (24.9, P = .01). Academic websites were available in the more languages compared to all other website categories (P < .01). CONCLUSION Online materials related to wound care strategies often exceed the National Institute of Health recommended eighth-grade reading level. This study emphasizes the need for healthcare providers to create more accessible educational materials to address the gap in health literacy and optimize patient care.
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Affiliation(s)
- Israel O Falade
- School of Medicine, University of California San Francisco, San Francisco, CA. https://www.twitter.com/israelfal
| | - Jasmin C Wilson
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Mulki E Mehari
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Daniel Soroudi
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Siyou Song
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA
| | - Esther A Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA.
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da Silveira CAB, Rasador AC, Lima DL, Kasmirski J, Kasakewitch JPG, Nogueira R, Malcher F, Sreeramoju P. The impact of smoking on ventral and inguinal hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03122-9. [PMID: 39085514 DOI: 10.1007/s10029-024-03122-9] [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: 04/09/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Individual studies indicate poorer outcomes for smokers after hernia repair. Previous meta-analyses have examined the impact of smoking on specific outcomes such as recurrence and surgical site infection, but there has been a lack of comprehensive consensus or systematic review on this subject. Addressing this gap, our study undertakes a systematic review and meta-analysis to assess the impact of smoking on the outcomes of ventral hernia repair (VHR) and inguinal hernia repair. SOURCE A thorough search of Cochrane Central, Scopus, SciELO, and PubMed/MEDLINE, focusing on studies that examined the effect of smoking on inguinal and VHR outcomes was conducted. Key outcomes evaluated included recurrence, reoperation, surgical site occurrences (SSO), surgical site infection (SSI), and seroma. PRINCIPAL FINDINGS Out of 3296 screened studies, 42 met the inclusion criteria. These comprised 25 studies (69,295 patients) on VHR and 17 studies (204,337 patients) on inguinal hernia repair. The analysis revealed that smokers had significantly higher rates of recurrence (10.4% vs. 9.1%; RR 1.48; 95% CI [1.15; 1.90]; P < 0.01), SSO (13.6% vs. 12.7%; RR 1.44; 95% CI [1.12; 1.86]; P < 0.01) and SSI (6.6% vs. 4.2%; RR 1.64; 95% CI [1.38; 1.94]; P < 0.01) following VHR. Additionally, smokers undergoing inguinal hernia repair showed higher recurrence (9% vs. 8.7%; RR 1.91; 95% CI [1.21; 3.01]; P < 0.01), SSI (0.6% vs. 0.3%; RR 1.6; 95% CI [1.21; 2.0]; P < 0.001), and chronic pain (9.9% vs. 10%; RR 1.24; 95% CI [1.06; 1.45]; P < 0.01) rates. No significant differences were observed in seroma (RR 2.63; 95% CI [0.88; 7.91]; P = 0.084) and reoperation rates (RR 1.48; 95% CI [0.77; 2.85]; P = 0.236) for VHR, and in reoperation rates (RR 0.99; 95% CI [0.51; 1.91]; P = 0.978) for inguinal hernias between smokers and non-smokers. Analysis using funnel plots and Egger's test showed the absence of publication bias in the study outcomes. CONCLUSION This comprehensive meta-analysis found statistically significant increases in recurrence rates, and immediate postoperative complications, such as SSO and SSI following inguinal and VHR. Also, our subgroup analysis suggests that the MIS approach seems to be protective of adverse outcomes in the smokers group. However, our findings suggest that these findings are not of clinical relevance, so our data do not support the necessity of smoking cessation before hernia surgery. More studies are needed to elucidate the specific consequences of smoking in both inguinal and ventral hernia repair. PROSPERO REGISTRATION ID CRD42024517640.
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Affiliation(s)
| | | | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
| | | | - João P G Kasakewitch
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Flavio Malcher
- Division of General Surgery, NYU Langone, New York, NY, USA
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Shields LBE, Clark L, Reed J, Tichenor S. Implementing a nurse-led prehabilitation program for patients undergoing spinal surgery. Nursing 2024; 54:42-50. [PMID: 38913927 DOI: 10.1097/nsg.0000000000000025] [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: 06/26/2024]
Abstract
ABSTRACT Prehabilitation, or "prehab," helps patients optimize strength, function, and nutrition before surgery. This evidence-based practice project presents strategies for implementing a prehab program to prepare patients for spinal surgery. Nurses play an integral role in educating patients preoperatively about the myriad lifestyle changes associated with spinal surgery.
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Affiliation(s)
- Lisa B E Shields
- Lisa Shields is a medical research associate at Norton Neuroscience Institute, Norton Healthcare. Lisa Clark is the program manager for Neurosurgery at Norton Healthcare. Jenna Reed is the rehabilitation supervisor at the Norton Neurosciences and Spine Rehabilitation Center. Stephanie Tichenor is a neurosurgery nurse practitioner at the Norton Neuroscience Institute
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McKechnie T, Jessani G, Bakir N, Lee Y, Sne N, Doumouras A, Hong D, Eskicioglu C. Evaluating frailty using the modified frailty index for colonic diverticular disease surgery: analysis of the national inpatient sample 2015-2019. Surg Endosc 2024; 38:4031-4041. [PMID: 38874611 DOI: 10.1007/s00464-024-10965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease. METHODS We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015-December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit. RESULTS Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38-3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65-2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46-2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001). CONCLUSION In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Ghazal Jessani
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Noor Bakir
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Niv Sne
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Michael G. DeGroote School of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Walsh M, Martindale R. A review of perioperative immune-modulating and metabolic-modulating nutrition strategies for bowel resection surgery. JPEN J Parenter Enteral Nutr 2024; 48:538-545. [PMID: 38689534 DOI: 10.1002/jpen.2634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/17/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
Focused perioperative nutrition strategies have proven benefits on the outcomes for patients undergoing major abdominal surgery. In this brief article, we will review these strategies and the evidence to support them with a focus on gastrointestinal anastomotic healing. We will elaborate the risks and benefits of enteral feeds, immune- and metabolic-modulating formulas, prebiotics and probiotics, and prehabilitation in preparation for surgery. Additionally, we will discuss the role of fish oils (eicosapentaenoic acid and docosahexaenoic acid) in the surgical patient and new data on specialized proresolving mediators in inflammation resolution. Finally, this article will consider the harmful impact surgical trauma has on the microbiome and the potential for perioperative dietary modulation to attenuate these negative effects.
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Affiliation(s)
- Maura Walsh
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Robert Martindale
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon, USA
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Pérez-Sáez MJ, Pascual J. Unmet Questions About Frailty in Kidney Transplant Candidates. Transplantation 2024:00007890-990000000-00795. [PMID: 38886883 DOI: 10.1097/tp.0000000000005093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Frailty occurs frequently among patients with advanced chronic kidney disease, especially among women. Assessing frailty in kidney transplant (KT) candidates is crucial for informing them about associated risks. However, there is poor agreement between frailty scales and research on their correlation with transplant outcomes. Being prefrail significantly impacts both graft and patient survival, often beginning with just 1 Fried criterion. Rather than viewing frailty as a categorical state, it should be regarded as a spectrum ranging from 1 to 5 criteria, with the risk of adverse outcomes escalating as frailty worsens. Frailty status fluctuates during the waiting period for KT; hence, a 1-time frailty evaluation is insufficient to determine risks and implement strategies for improving functional status. Further research should investigate the components of frailty that most frequently change during this waiting period and establish strategies to prevent or reverse frailty. Although careful evaluation of frail KT candidates is necessary to prevent early complications and mortality, exclusion based solely on a frailty score is unwarranted. Instead, efforts should focus on timely interventions to enhance their condition before transplantation. Although evidence is limited, exercise programs appear feasible and yield positive results. A pretransplant clinical framework encompassing multimodal prehabilitation-comprising physical therapy, nutritional measures, and psychological support-during the waiting list period may help alleviate the effects of frailty and poor fitness after KT, ultimately improving key outcomes. Despite logistical challenges, there is a pressing need for interventional trials in this area.
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Affiliation(s)
- María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Julio Pascual
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Institute for Research i+12, Madrid, Spain
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Jia L, Navare S, Hoyler M. Lingering effects of COVID-19 in the care of perioperative patients. Curr Opin Anaesthesiol 2024; 37:308-315. [PMID: 38573196 DOI: 10.1097/aco.0000000000001364] [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: 04/05/2024]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to organ dysfunction and clinical symptoms beyond the acute infection phase. These effects may have significant implications for the management of perioperative patients. The purpose of this article is to provide a systems-based approach to the subacute and chronic effects of SARS-CoV-2 that are most relevant to anesthesiology practice. RECENT FINDINGS In 2024, COVID-19 remains a concern for anesthesiologists due ongoing new infections, evolving viral strains, and relatively low rates of booster vaccination in the general population. A growing body of literature describes the post-COVID-19 syndrome in which patients experience symptoms more than 12 weeks after acute infection. Recent literature describes the lingering effects of SARS-CoV-2 infection on all major organ systems, including neurologic, pulmonary, cardiovascular, renal, hematologic, and musculoskeletal, and suggests an increased perioperative mortality risk in some populations. SUMMARY This review offers anesthesiologists an organ system-based approach to patients with a history of COVID-19. Recognizing the long-term sequelae of SARS-CoV-2 infection can help anesthesiologists to better evaluate perioperative risk, anticipate clinical challenges, and thereby optimize patient care.
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Affiliation(s)
- Linjia Jia
- NewYork-Presbyterian Hospital - Weill Cornell, Department of Anesthesiology
| | - Sagar Navare
- Weill Cornell Medicine, Department of Anesthesiology, New York, New York, USA
| | - Marguerite Hoyler
- Weill Cornell Medicine, Department of Anesthesiology, New York, New York, USA
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Jack S, Andritsch E, Joaquim A, Kreissl M, Locati L, Netea-Maier R, Reverter J, Elisei R. Current landscape and support for practical initiation of oncological prehabilitation translatable to thyroid cancer: A position paper. Heliyon 2024; 10:e30723. [PMID: 38813200 PMCID: PMC11133508 DOI: 10.1016/j.heliyon.2024.e30723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Despite a growing body of evidence for the effectiveness of prehabilitation, the uptake of prehabilitation in Europe remains low. Contributing factors range from limited awareness and understanding of prehabilitation to a lack of supporting infrastructure and reimbursement challenges. In this position paper, the authors propose a new comprehensive definition of prehabilitation and identify differentiated thyroid cancer as a type of cancer particularly well-suited for prehabilitation. To support clinicians with the implementation of prehabilitation programs in their clinics, the authors discuss the following practical solutions: a) find the most appropriate prehabilitation program for each patient; b) raise awareness among peers; c) develop evidence to demonstrate the effectiveness of prehabilitation; d) expand the interdisciplinary team; e) expand your network and make use of existing assets; f) utilize learnings from the COVID-19 pandemic.
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Affiliation(s)
- S. Jack
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - E. Andritsch
- Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036, Graz, Austria
| | - A. Joaquim
- ONCOMOVE®, Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
| | - M.C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Universitatsplätz 2, 39106, Magdeburg, Germany
| | - L. Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, S. da Nuova, 65, 27100, Pavia, PV, Italy
- Medical Oncology Unit, IRCCS ICS, Maugeri, Via Salvatore Maugeri, 10, 27100 Pavia PV, Italy
| | - R.T. Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 28, 6525, GA, Nijmegen, the Netherlands
| | - J.L. Reverter
- Endocrinology and Nutrition Department, Germans Trias i Pujol University Hospital, Universidad Autónoma de Barcelona, Placa Civica, 08193, Bellaterra, Barcelona, Spain
| | - R. Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126, Pisa, PI, Italy
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Talwar G, McKechnie T, Patel J, Qiu R, Wu K, Lee Y, Hong D, Doumouras A, Bogach J, Eskicioglu C. Assessing the Modified Frailty Index and Post-Operative Outcomes in Adhesive Small Bowel Obstruction: A Retrospective Cohort Study. J Surg Res 2024; 297:71-82. [PMID: 38447338 DOI: 10.1016/j.jss.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/18/2023] [Accepted: 12/16/2023] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Studies identifying predictors of postoperative outcomes in adhesive small bowel obstruction are limited. This study investigates the efficacy of the modified frailty index (mFI)to predict postoperative morbidity and mortality among patients undergoing surgery for adhesive small bowel obstruction. METHODS A multicentre retrospective cohort study including patients undergoing surgery for adhesive small bowel obstruction after failed trial of nonoperative management between January 2015 and December 2020 was performed. Impact of frailty status using the mFI, stratified as frail (≥0.27) and robust (<0.27), on postoperative morbidity, mortality, length of stay, and discharge destination was evaluated using multiple logistic regression. RESULTS Ninety-two robust patients (mean age 62.4 y, 68% female) and 41 frail patients (mean age 81.7 y, 63% female) were included. On simple stratification, frail patients had significantly increased 30-d morbidity (overall morbidity 80% versus 49%) and need for higher level of care on discharge (41% versus 9%). However, on multiple regression, functional dependence but not the mFI, was independently associated with worse 30-d overall morbidity (odds ratio [OR] 3.97, confidence interval [CI] 1.29-12.19) and lower likelihood of returning to preoperative disposition (OR 0.21, CI 0.05-0.91). The delay in operation beyond 5 d was independently associated with worse 30-d outcomes including overall morbidity and mortality (OR 7.54, CI 2.13-26.73) and decreased return to preoperative disposition (OR 0.14, CI 0.04-0.56). CONCLUSIONS The mFI, although promising, was not independently predictive of outcomes following surgery for adhesive small bowel obstruction. Further adequately powered studies are required.
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Affiliation(s)
- Gaurav Talwar
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Janhavi Patel
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Reva Qiu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Wu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jessica Bogach
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, Juravinski Hospital, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
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Shen C, Gu L, Li N, Wang R, Yang X, Chu Z. Attitudes and perceptions of cancer patients and healthcare providers towards prehabilitation: A thematic synthesis. Br J Health Psychol 2024; 29:395-429. [PMID: 37985361 DOI: 10.1111/bjhp.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Prehabilitation, which is the process of enhancing functional capacity before undergoing surgery or other treatments, has been shown to improve cancer patients' outcomes. Patient and healthcare provider attitudes and perceptions are essential factors in the successful implementation of prehabilitation. The purpose of this systematic review is to synthesize qualitative evidence and explore the barriers and facilitators to prehabilitation implementation. METHODS From the earliest available date to October 2023, 7 databases (PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE) were searched for a systematic review. Data were extracted, thematically analysed, and mapped onto the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). The Critical Appraisal Skills Programme (CASP) tool was used to assess the quality of the studies. RESULTS A total of 26 studies were included, involving 377 patients, 51 caregivers, and 156 healthcare providers. 16 factors were identified and mapped onto the COM-B model: reflective/automatic motivation, physical/social opportunity, physical/ psychological capability. CONCLUSIONS Patients and healthcare provides identified a lack of reflective motivation and physical opportunities as the most significant barriers to engagement in prehabilitation. Personalized approaches, social support, and healthcare providers' engagement are key factors for prehabilitation. Future research should focus on developing effective interventions to enhance the uptake and sustainability of prehabilitation.
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Affiliation(s)
- Chen Shen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Lianqi Gu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Na Li
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rao Wang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Yang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiping Chu
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Sliwinski S, Faqar-Uz-Zaman SF, Heil J, Mohr L, Detemble C, Dreilich J, Zmuc D, Bechstein WO, Becker S, Chun F, Derwich W, Schreiner W, Solbach C, Fleckenstein J, Filmann N, Schnitzbauer AA. Predictive value of a novel digital risk calculator to determine early patient outcomes after major surgery: a proof-of-concept pilot study. Patient Saf Surg 2024; 18:13. [PMID: 38610002 PMCID: PMC11010393 DOI: 10.1186/s13037-024-00395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND A structured risk assessment of patients with validated and evidence-based tools can help to identify modifiable factors before major surgeries. The Protego Maxima trial investigated the value of a new digitized risk assessment tool that combines tools which can be easily used and implemented in the clinical workflow by doctors and qualified medical staff. The hypothesis was that the structured assessment and risk-grouping is predictive of short-term surgical quality reflected by complications and overall survival. METHODS The Protego Maxima Trial was a prospective cohort analysis of patients undergoing major surgery (visceral, thoracic, urology, vascular and gynecologic surgeries) as key inclusion criterion and the absence of an acute or acute on chronically decompensated pulmo-cardiovascular decompensation. Patients were risk-scored with the software (The Prehab App) that includes a battery of evidence-based risk assessment tools that allow a structured risk assessment. The data were grouped to predefined high and low risk groups and aggregate and individual scores. The primary outcome was to validate the predictive value of the RAI score and the TUG for overall survival in the high and low risk groups. Secondary outcomes were surgical outcomes at 90-days after surgery (overall survival, Clavien-Dindo (CD) 1-5 (all complications), and CD 3-5 (major complications)). The study was carried out in accordance with the DIN ISO 14,155, and the medical device regulation (MDR) at Frankfurt University Hospital between March 2022 and January 2023. RESULTS In total 267 patients were included in the intention to treat analysis. The mean age was 62.1 ± 12.4 years. Patients with a RAI score > 25 and/or a timed up and go (TUG) > 8 s had a higher risk for mortality at 90 days after surgery. The low-risk group predicted beneficial outcome and the high-risk group predicted adverse outcome in the ROC analysis (Area Under the Curve Receiver Operator Characteristics: AUROC > 0.800; p = 0.01). Risk groups (high vs. low) showed significant differences for 90-day survival (99.4% vs. 95.5%; p = 0.04) and major complications (16.4% vs. 32.4%; p < 0.001). CONCLUSION The proof-of-concept trial showed that a risk assessment with 'The Prehab App' may be viable to estimate the preoperative risk for mortality and major complications before major surgeries. The overall performance in this initial set of data indicated a certain reliability of the scoring and risk grouping, especially of the RAI score and the TUG. A larger data set will be required to proof the generalizability of the risk scoring to every subgroup and may be fostered by artificial intelligence approaches. TRIAL REGISTRATION Ethics number: 2021-483-MDR/MPDG-zuständig monocentric; The Federal Institute for Pharmaceuticals and Medical Devices/BfArM, reference number: 94.1.04-5660-13655; Eudamed: CIV-21-07-0307311; German Clinical Trial Registry: DRKS 00026985.
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Affiliation(s)
- Svenja Sliwinski
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Sara Fatima Faqar-Uz-Zaman
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Jan Heil
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Lisa Mohr
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Charlotte Detemble
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Julia Dreilich
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Dora Zmuc
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Wolf O Bechstein
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Sven Becker
- Department for Gynecology, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Felix Chun
- Department for Urology, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Wojciech Derwich
- Department for Vascular Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Waldemar Schreiner
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Christine Solbach
- Department for Gynecology, Frankfurt University Hospital, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Johannes Fleckenstein
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Pain Center, Hospital Landsberg am Lech, Landsberg am Lech, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University Frankfurt, Frankfurt/Main, Germany
| | - Andreas A Schnitzbauer
- Department for General, Visceral, Transplant and Thoracic Surgery, Frankfurt University Hospital, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
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12
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Bajawi M, Corral S, Blázquez J, Die J, Muñoz P, Barranquero AG, Juez L, Nisa FGM. Impact of CT-measured sarcopenic obesity on postoperative outcomes following colon cancer surgery. Langenbecks Arch Surg 2024; 409:42. [PMID: 38231409 PMCID: PMC10794372 DOI: 10.1007/s00423-024-03231-0] [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: 10/01/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE This study aimed to investigate the influence of sarcopenic obesity on anastomotic leak following elective colon resection for non-metastatic colon cancer. Secondary outcomes included overall morbidity, mortality and length of hospital stay. METHODS This retrospective observational study, conducted at a colorectal surgery referral centre, spanned from January 1, 2015, to January 1, 2020. A total of 544 consecutive patients who underwent elective colon resection were included in the analysis, excluding patients with rectal cancer, urgent surgery, absence of anastomosis, lack of imaging, multivisceral resections and synchronic tumours. RESULTS Postoperative complications were observed in 177 (32.3%) patients, with 51 (9.31%) classified as severe (Clavien-Dindo > II). Sarcopenic obesity was identified in 9.39% of the sample and emerged as an independent predictor of increased overall morbidity [OR 2.15 (1.14-3.69); p = 0.016] and 30-day mortality [OR 5.07 (1.22-20.93); p = 0.03] and was significantly associated with the development of anastomotic leak [OR 2.95 (1.41-6.18); p = 0.007]. Furthermore, it increased the risk of reoperation and was linked to a prolonged length of hospital stay. CONCLUSIONS CT-measured sarcopenic obesity demonstrates a discernible correlation with an elevated risk of postoperative morbidity and mortality in the context of colon cancer surgery.
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Affiliation(s)
| | - Sara Corral
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Javier Blázquez
- Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Javier Die
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Paula Muñoz
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Luz Juez
- Department of General Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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13
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She KY, Huang L, Zhang HT, Gao Y, Yao KR, Luo Q, Tang X, Li L, Zhao L, Wang ZH, Yang XJ, Yin XH. Effect of prehabilitation on postoperative outcomes in the frail older people: A systematic review and meta-analysis. Geriatr Nurs 2024; 55:79-88. [PMID: 37976559 DOI: 10.1016/j.gerinurse.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The study investigates the impact of preoperative rehabilitation on the surgical prognosis of frail older patients. METHOD The effect sizes of all studies retrieved and included by the nine databases were analyzed and expressed as RR and WMD. RESULTS 8 studies with 902 participants met the criteria for inclusion. A significant reduction in total complications (RR = 0.84, 95 % CI = 0.73 to 0.97, P = 0.021) and the 6MWT after surgery (WMD = 74.76, 95 % CI = 44.75 to 104.77, P = 0.000) was observed in the prehabilitation group. But it had no differences in mortality(RR = 1.89, 95 % CI = 0.75 to 4.72, P = 0.176), readmission rates(RR = 1.04, 95 % CI = 0.56 to 1.91, P = 0.906) and LOS(WMD = -0.24, 95 % CI = -1.00 to 0.52, P = 0.540). CONCLUSIONS Prehabilitation had positive effect on postoperative complications and functional recovery in frail older patients.
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Affiliation(s)
- Ke-Yi She
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Li Huang
- The Second Hospital, University of South China, Hengyang, Hunan, China
| | - Hong-Tao Zhang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Yue Gao
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Ke-Ru Yao
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Qin Luo
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Xi Tang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Lu Li
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Lu Zhao
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Zhi-Han Wang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Xin-Jun Yang
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Xin-Hong Yin
- School of Nursing, University of South China, Hengyang, Hunan, China.
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14
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Ehlers AP, Nham W, Vitous CA, Hosea F, Palazzolo KP, Howard R, Delaney L, Shao JM, Rubyan M, Telem DA. Life after "no": barriers to behavior change for persons declined hernia repair due to high-risk features. Surg Endosc 2023; 37:8663-8669. [PMID: 37500919 DOI: 10.1007/s00464-023-10283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Delaying an elective operation to mitigate risk factors improves patient outcomes. Elective ventral hernia repair is one such example. To address this issue, we developed a pre-operative optimization clinic to support high-risk patients seeking elective ventral hernia repair. Unfortunately, few patients progressed to surgery. Within this context, we sought to understand the barriers to behavior change among these patients with the goal of improving care for patients undergoing elective surgery. METHODS We performed semi-structured, qualitative interviews with 20 patients who were declined ventral hernia repair due to either active tobacco use or obesity. Patients were recruited from a pre-operative optimization clinic at an academic hospital. Interviews sought to characterize patients' perceived barriers to behavior change. Interviews were concluded once thematic saturation was reached. We used an inductive thematic analysis to analyze the data. All data analysis was performed using MAXQDA software. RESULTS Among 20 patients (mean age 50, 65% female, 65% White), none had yet undergone ventral hernia repair. While most patients had a positive experience in the clinic, among those who did not, we found three dominant themes around behavior change: (1) Patient's role in behavior change: how the patient perceived their role in making behavior changes optimize their health for surgery; (2) Obtainability of offered resources: the need for more support for patients to access the recommended healthcare; and (3) Patient-provider concordance: the extent to which patients and providers agree on the relative importance of different attributes of their care. CONCLUSION Behavior change prior to elective surgery is complex and multifaceted. While improving access to tobacco cessation resources and obesity management may improve outcomes for some, patients may benefit from increased on-site facilitation to promote access to resources as well as the use of patient-facing decision support tools to promote patient-provider concordance.
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Affiliation(s)
- Anne P Ehlers
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA.
- Henry Ford Health, Detroit, MI, USA.
| | - Wilson Nham
- Michigan Medicine Emergency Medicine Research, Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Forrest Hosea
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Krisinda P Palazzolo
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Ryan Howard
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Lia Delaney
- Henry Ford Health, Detroit, MI, USA
- Department of Surgery, Stanford University, Palo Alto, CA, USA
| | - Jenny M Shao
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
| | - Michael Rubyan
- Henry Ford Health, Detroit, MI, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Surgical Quality Collaborative-Core Optimization Health Registry (MSQC-COHR), Ann Arbor, MI, USA
- Henry Ford Health, Detroit, MI, USA
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15
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Steffens D, Denehy L, Solomon M, Koh C, Ansari N, McBride K, Carey S, Bartyn J, Lawrence AS, Sheehan K, Delbaere K. Consumer Perspectives on the Adoption of a Prehabilitation Multimodal Online Program for Patients Undergoing Cancer Surgery. Cancers (Basel) 2023; 15:5039. [PMID: 37894406 PMCID: PMC10605909 DOI: 10.3390/cancers15205039] [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: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to explore patients' perspectives on the adoption of a prehabilitation multimodal online program. Patients recovering from gastrointestinal cancer surgery at a tertiary hospital between October 2021 and November 2022 were invited to participate. An e-Health program including intensity exercises, nutrition and psychological counselling was used. Patients were instructed to navigate the e-Health program over 24 h using an iPad and then complete the study survey. Patients' characteristics, use of technology, views and minimal expected outcomes from a preoperative online program were collected. Of the 30 patients included, most were female, most reported confidence in the use of technology, most considered the online program safe and most agreed it would be beneficial for their health. "Poor preoperative health" and "lack of motivation and encouragement" were identified as the main barriers to the uptake of a preoperative online program, while program 'simplicity' and perceived 'benefits' were the main facilitators. Significant improvement in postoperative outcomes is perceived to influence patients' willingness to participate in a preoperative multimodal e-Health program. Gastrointestinal cancer patients perceived the adoption of a preoperative multimodal e-Health application as safe to be performed at home and of potential benefit to their health. A range of patient's characteristics, barriers and facilitators to the uptake of an online program were identified. These should be considered in future preoperative multimodal online programs to enhance patient experience, adherence and efficacy. The safety and efficacy of the online prehabilitation program will need to be determined in a larger randomized controlled trial.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
| | - Linda Denehy
- Department of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia;
- Department of Health Services Research: Allied Health, Peter MacCallum Cancer Centre, Melbourne 3052, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
- Colorectal Department, Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
- Colorectal Department, Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
- Colorectal Department, Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
| | - Kate McBride
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
| | - Sharon Carey
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
| | - Jenna Bartyn
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
| | - Aaron Sean Lawrence
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
| | - Kym Sheehan
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia; (M.S.); (C.K.); (N.A.); (K.M.); (S.C.); (J.B.); (A.S.L.); (K.S.)
| | - Kim Delbaere
- Neuroscience Research Australia, Sydney, NSW 2031, Australia;
- School of Population Health, University of New South Wales, Kensington, NSW 2052, Australia
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16
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Boeding JRE, Cuperus IE, Rijken AM, Crolla RMPH, Verhoef C, Gobardhan PD, Schreinemakers JMJ. Postponing surgery to optimise patients with acute right-sided obstructing colon cancer - A pilot study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106906. [PMID: 37061403 DOI: 10.1016/j.ejso.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Right-sided obstructing colon cancer is most often treated with acute resection. Recent studies on right-sided obstructing colon cancer report higher mortality and morbidity rates than those in patients without obstruction. The aim of this study is to retrospectively analyse whether it is possible to optimise the health condition of patients with acute right-sided obstructing colon cancer, prior to surgery, and whether this improves postoperative outcomes. METHOD All consecutive patients with high suspicion of, or histologically proven, right-sided obstructing colon cancer, treated with curative intent between March 2013 and December 2019, were analysed retrospectively. Patients were divided into two groups: optimised group and non-optimised group. Pre-operative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. RESULTS In total, 54 patients were analysed in this study. Twenty-four patients received optimisation before elective surgery, and thirty patients received emergency surgery, without optimisation. Scheduled surgery was performed after a median of eight days (IQR 7-12). Postoperative complications were found in twelve (50%) patients in the optimised group, compared to twenty-three (77%) patients in the non-optimised group (p = 0.051). Major complications were diagnosed in three (13%) patients with optimisation, compared to ten (33%) patients without optimisation (p = 0.111). Postoperative in-hospital stay, 30-day mortality, as well as primary anastomosis were comparable in both groups. CONCLUSION This pilot study suggests that pre-operative optimisation of patients with obstructing right sided colonic cancer may be feasible and safe but is associated with longer in-patient stay.
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Affiliation(s)
- Jeske R E Boeding
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Iris E Cuperus
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Arjen M Rijken
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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17
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Tao Y, Cata JP, Zeng W, Tian J. Editorial: Perioperative management and cancer outcome. Front Oncol 2023; 13:1251728. [PMID: 37614508 PMCID: PMC10444207 DOI: 10.3389/fonc.2023.1251728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/21/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Yiying Tao
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Key Laboratory of Anesthesiology (Shanghai Jiaotong University), Ministry of Education, Shanghai, China
| | - Juan P. Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, United States
| | - Weian Zeng
- Department of Anesthesiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie Tian
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Key Laboratory of Anesthesiology (Shanghai Jiaotong University), Ministry of Education, Shanghai, China
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18
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Lussiez A, Zondlak A, Hsu PJ, Delaney L, Vitous CA, Telem D, Rubyan M. Surgeon behaviors related to engaging patients in smoking cessation at the time of elective surgery. Am J Surg 2023; 226:218-226. [PMID: 37105853 DOI: 10.1016/j.amjsurg.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Despite the abundance of evidence supporting smoking cessation before elective surgery, there is wide variation in surgeon adherence to these best practices. METHODS This qualitative study used convenience sampling to recruit General Surgery trained surgeons. Surgeons participated in semi-structured interviews based on domains from the Theoretical Domains Framework (TDF). Content analysis was guided by the TDF. RESULTS Of the 14 TDF domains, social or professional role/identity, memory, attention and decision processes, environmental context and resources, and beliefs about consequences emerged most frequently. Mapping these domains to the Behavior Change Wheel identified education, enablement, and incentivization as effective intervention functions. CONCLUSIONS Using the TDF, this study identified a widespread sense of responsibility among surgeons to engage patients in perioperative smoking cessation despite workplace barriers and lacking resources. These findings provide valuable insight to facilitate surgeon participation in health promotion through targeted, theory-based interventions informed by surgeon identified barriers to perioperative smoking cessation.
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Affiliation(s)
- Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Allyse Zondlak
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Phillip J Hsu
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Lia Delaney
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - C Ann Vitous
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Dana Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael Rubyan
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Rombey T, Eckhardt H, Kiselev J, Silzle J, Mathes T, Quentin W. Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations. BMC Med 2023; 21:265. [PMID: 37468923 PMCID: PMC10354976 DOI: 10.1186/s12916-023-02977-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Prehabilitation aims at enhancing patients' functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care. METHODS We searched PubMed, Embase, the CRD database, ClinicalTrials.gov, the WHO ICTRP and the dissertation databases OADT and DART. Studies comparing prehabilitation for patients with elective surgery to usual preoperative care were included if they reported cost outcomes. All types of economic evaluations (EEs) were included. The primary outcome of the review was cost-effectiveness based on cost-utility analyses (CUAs). The risk of bias of trial-based EEs was assessed with the Cochrane risk of bias 2 tool and the ROBINS-I tool and the credibility of model-based EEs with the ISPOR checklist. Methodological quality of full EEs was assessed using the CHEC checklist. The EEs' results were synthesised narratively using vote counting based on direction of effect. RESULTS We included 45 unique studies: 25 completed EEs and 20 ongoing studies. Of the completed EEs, 22 were trial-based and three model-based, corresponding to four CUAs, three cost-effectiveness analyses, two cost-benefit analyses, 12 cost-consequence analyses and four cost-minimization analyses. Three of the four trial-based CUAs (75%) found prehabilitation cost-effective, i.e. more effective and/or less costly than usual care. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective. When excluding studies of insufficient credibility/critical risk of bias, this number reduced to 14/23 (60.9%). In 8/25 (32.0%), cost-effectiveness was unclear, e.g. because prehabilitation was more effective and more costly, and in one EE prehabilitation was not cost-effective. CONCLUSIONS We found some evidence that prehabilitation for patients awaiting elective surgery is cost-effective compared to usual preoperative care. However, we suspect a relevant risk of publication bias, and most EEs were of high risk of bias and/or low methodological quality. Furthermore, there was relevant heterogeneity depending on the population, intervention and methods. Future EEs should be performed over a longer time horizon and apply a more comprehensive perspective. TRIAL REGISTRATION PROSPERO CRD42020182813.
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Affiliation(s)
- Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, 10623, Germany.
| | - Helene Eckhardt
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, 10623, Germany
| | - Jörn Kiselev
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Julia Silzle
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, 10623, Germany
| | - Tim Mathes
- Department for Medical Statistics, University Medical Centre Goettingen, Goettingen, Germany
| | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, 10623, Germany
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Sliwinski S, Werneburg E, Faqar-Uz-Zaman SF, Detemble C, Dreilich J, Mohr L, Zmuc D, Beyer K, Bechstein WO, Herrle F, Malkomes P, Reissfelder C, Ritz JP, Vilz T, Fleckenstein J, Schnitzbauer AA. A toolbox for a structured risk-based prehabilitation program in major surgical oncology. Front Surg 2023; 10:1186971. [PMID: 37435472 PMCID: PMC10332323 DOI: 10.3389/fsurg.2023.1186971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/17/2023] [Indexed: 07/13/2023] Open
Abstract
Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients' resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3-6 weeks with 3-4 exercises per week that take 30-60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo-Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of $8 for treatment for $1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards.
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Affiliation(s)
- Svenja Sliwinski
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Elisabeth Werneburg
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Sara Fatima Faqar-Uz-Zaman
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Charlotte Detemble
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Julia Dreilich
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Lisa Mohr
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Dora Zmuc
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Katharina Beyer
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
| | - Wolf O. Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Florian Herrle
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Romed Klinik Prien am Chiemsee, Klinik für Allgemein- und Viszeralchirurgie, Prien am Chiemsee, Germany
| | - Patrizia Malkomes
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Christoph Reissfelder
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joerg P. Ritz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Helios Clinics Schwerin, Department for General and Visceral Surgery, Schwerin, Germany
| | - Tim Vilz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Johannes Fleckenstein
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Department of Pain Medicine, Hospital Landsberg am Lech, Landsberg am Lech, Germany
| | - Andreas A. Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
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Howard R, Englesbe M. Leveraging the perioperative period to improve population health. Perioper Med (Lond) 2023; 12:21. [PMID: 37277869 DOI: 10.1186/s13741-023-00311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/12/2023] [Indexed: 06/07/2023] Open
Abstract
Although surgical care has become safer, cheaper, and more efficient, it has only a modest impact on the overall health of society, which is driven primarily by health behaviors such as smoking, alcohol use, poor diet, and physical inactivity. Given the ubiquity of surgical care in the population, it represents a critical opportunity to screen for and address the health behaviors that drive premature mortality at a population level. Patients are especially receptive to behavior change around the time of surgery, and many health systems already have programs in place to address these issues. In this commentary, we present the case for integrating health behavior screening and intervention into the perioperative pathway as a novel and impactful way to improve the health of society.
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Affiliation(s)
- Ryan Howard
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, Floor 1, Ann Arbor, MI, 48109, USA
| | - Michael Englesbe
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, Floor 1, Ann Arbor, MI, 48109, USA.
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22
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Vu JV, Lussiez A. Smoking Cessation for Preoperative Optimization. Clin Colon Rectal Surg 2023; 36:175-183. [PMID: 37113283 PMCID: PMC10125302 DOI: 10.1055/s-0043-1760870] [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: 04/29/2023]
Abstract
Cigarette smoking is associated with pulmonary and cardiovascular disease and confers increased postoperative morbidity and mortality. Smoking cessation in the weeks before surgery can mitigate these risks, and surgeons should screen patients for smoking before a scheduled operation so that appropriate smoking cessation education and resources can be given. Interventions that combine nicotine replacement therapy, pharmacotherapy, and counseling are effective to achieve durable smoking cessation. When trying to stop smoking in the preoperative period, surgical patients experience much higher than average cessation rates compared with the general population, indicating that the time around surgery is ripe for motivating and sustaining behavior change. This chapter summarizes the impact of smoking on postoperative outcomes in abdominal and colorectal surgery, the benefits of smoking cessation, and the impact of interventions aimed to reduce smoking before surgery.
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Affiliation(s)
- Joceline V. Vu
- Department of Surgery, Temple University Hospital System, Philadelphia, Pennsylvania
| | - Alisha Lussiez
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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23
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Faqar-Uz-Zaman SF, Sliwinski S, Detemble C, Filmann N, Zmuc D, Mohr L, Dreilich J, Bechstein WO, Fleckenstein J, Schnitzbauer AA. Study protocol for a pilot trial analysing the usability, validity and safety of an interventional health app programme for the structured prehabilitation of patients before major surgical interventions: the PROTEGO MAXIMA trial. BMJ Open 2023; 13:e069394. [PMID: 37019492 PMCID: PMC10439343 DOI: 10.1136/bmjopen-2022-069394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Major surgery is associated with a high risk for postoperative complications, leading to an increase in mortality and morbidity, particularly in frail patients with a reduced cardiopulmonary reserve. Prehabilitation, including aerobic exercise training, aims to improve patients' physical fitness before major surgery and reduce postoperative complications, length of hospital stay and costs. The purpose of the study is to assess the usability, validity and safety of an app-based endurance exercise software in accordance with the Medical Device Regulation using wrist-worn wearables to measure heart rate (HR) and distance. METHODS AND ANALYSIS The PROTEGO MAXIMA trial is a prospective, interventional study with patients undergoing major elective surgery, comprising three tasks. Tasks I and II aim to assess the usability of the app, using evaluation questionnaires and usability scenarios. In Task IIIa, patients will undergo a structured risk assessment by the Patronus App, which will be correlated with the occurrence of postoperative complications after 90 days (non-interventional). In Task IIIb, healthy students and patients will perform a supervised 6 min walking test and a 37 min interval training on a treadmill based on HR reserve, wearing standard ECG limb leads and two smartwatches, which will be driven by the test software. The aim of this task is to assess the accuracy of HR measurement by the wearables and the safety, using specific alarm settings of the devices and lab testing of the participants (interventional). ETHICS AND DISSEMINATION Ethical approval was granted by the Institutional Review Board of the University Hospital of Frankfurt and by the Federal Institute for Pharmaceuticals and Medical Products (BfArM, reference number 94.1.04-5660-13655) on 7 February 2022. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBERS European Database on Medical Devices (CIV-21-07-037311) and German Clinical Trial Registry (DRKS00026985).
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Affiliation(s)
- Sara Fatima Faqar-Uz-Zaman
- Department for General, Visceral, Transplant and Thoracic Surgery, Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Germany
| | - Svenja Sliwinski
- Department for General, Visceral, Transplant and Thoracic Surgery, Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Germany
| | - Charlotte Detemble
- Department for General, Visceral, Transplant and Thoracic Surgery, Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Dora Zmuc
- MCL Medical Center Ljubljana, Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lisa Mohr
- Department of Sports Medicine and Exercise Physiology, Institute for Sports Science, Goethe University Frankfurt, Frankfurt, Germany
| | - Julia Dreilich
- Department of Sports Medicine and Exercise Physiology, Institute for Sports Science, Goethe University Frankfurt, Frankfurt, Germany
| | - Wolf O Bechstein
- Department for General, Visceral, Transplant and Thoracic Surgery, Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Germany
| | - Johannes Fleckenstein
- Department of Sports Medicine and Exercise Physiology, Institute for Sports Science, Goethe University Frankfurt, Frankfurt, Germany
- Pain Centre, Klinikum Landsberg am Lech, Landsberg am Lech, Germany
| | - Andreas A Schnitzbauer
- Department for General, Visceral, Transplant and Thoracic Surgery, Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Germany
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24
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Kalt F, Mayr H, Gero D. Classification of Adverse Events in Adult Surgery. Eur J Pediatr Surg 2023; 33:120-128. [PMID: 36720250 DOI: 10.1055/s-0043-1760821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Successful surgery combines quality (achievement of a positive outcome) with safety (avoidance of a negative outcome). Outcome assessment serves the purpose of quality improvement in health care by establishing performance indicators and allowing the identification of performance gaps. Novel surgical quality metric tools (benchmark cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes in a subgroup of well-defined low-risk patients, with the aim of setting realistic and best achievable goals for surgeons and centers, as well as supporting unbiased comparison of surgical quality between centers and periods of time. Validated classification systems have been deployed to grade adverse events during the surgical journey: (1) the ClassIntra classification for the intraoperative period; (2) the Clavien-Dindo classification for the gravity of single adverse events; and the (3) Comprehensive Complication Index (CCI) for the sum of adverse events over a defined postoperative period. The failure to rescue rate refers to the death of a patient following one or more potentially treatable postoperative adverse event(s) and is a reliable proxy of the institutional safety culture and infrastructure. Complication assessment is undergoing digital transformation to decrease resource-intensity and provide surgeons with real-time pre- or intraoperative decision support. Standardized reporting of complications informs patients on their chances to realize favorable postoperative outcomes and assists surgical centers in the prioritization of quality improvement initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the enhancement of clinical standards.
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Affiliation(s)
- Fabian Kalt
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
| | - Hemma Mayr
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Switzerland
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25
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Lussiez A, Eton R, Anderson M, Valbuena V, Campbell D, Englesbe M, Howard R. Heterogeneity in Surgical Quality Improvement in Michigan. Ann Surg 2023; 277:612-618. [PMID: 35129495 DOI: 10.1097/sla.0000000000005282] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate changes in 30-day postoperative outcomes and individual hospital variation in outcomes from 2012 to 2019 in a collaborative quality improvement network. SUMMARY BACKGROUND DATA Collaborative quality improvement efforts have been shown to improve postoperative outcomes overall; however, heterogeneity in improvement between participating hospitals remains unclear. Understanding the distribution of individual hospital-level changes is necessary to inform resource allocation and policy design. METHODS We performed a retrospective cohort study of 51 hospitals in the Michigan Surgical Quality Collaborative (MSQC) from 2012 to 2019. Risk-and reliability-adjusted hospital rates of 30-day mortality, complications, serious complications, emergency department (ED) visits, readmissions, and reoperations were calculated for each year and compared between the last 2 years and the first 2 years of the study period. RESULTS There was a significant decrease in the rates of all 5 adverse outcomes across MSQC hospitals from 2012 to 2019. Of the 51 individual hospitals, 31 (61%) hospitals achieved a decrease in mortality (range -1.3 percentage points to +0.6 percentage points), 40 (78%) achieved a decrease in complications (range -8.5 percentage points to +2.9 percentage points), 26 (51%) achieved a decrease in serious complications (range -3.2 percentage points to +3.0 percentage points), 29 (57%) achieved a decrease in ED visits (range 5.0 percentage points to +2.2 percentage points), 46 (90%) achieved a decrease in readmissions (range -3.1 percentage points to +0.4 percentage points) and 39 (76%) achieved a decrease in reoperations (range 3.3 percentage points to +1.0 percentage points). CONCLUSIONS Despite overall improvement in surgical outcomes across hospitals participating in a quality improvement collaborative, there was substantial variation in improvement between hospitals, highlighting opportunities to better understand hospital-level barriers and facilitators to surgical quality improvement.
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Affiliation(s)
- Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Ryan Eton
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Maia Anderson
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Valeria Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI
| | - Darrell Campbell
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Surgical Quality Collaborative, Ann Arbor, MI
| | - Michael Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Surgical Quality Collaborative, Ann Arbor, MI
| | - Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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26
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Ho VP, Bensken WP, Flippin JA, Santry HP, Claridge JA, Towe CW, Koroukian SM. Functional Status is Key to Long-term Survival in Emergency General Surgery Conditions. J Surg Res 2023; 283:224-232. [PMID: 36423470 PMCID: PMC9923717 DOI: 10.1016/j.jss.2022.10.034] [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: 02/28/2022] [Revised: 06/29/2022] [Accepted: 10/17/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Emergency General Surgery (EGS) conditions in older patients constitutes a substantial public health burden due to high morbidity and mortality. We sought to utilize a supervised machine learning method to determine combinations of factors with the greatest influence on long-term survival in older EGS patients. METHODS We identified community dwelling participants admitted for EGS conditions from the Medicare Current Beneficiary Survey linked with claims (1992-2013). We categorized three binary domains of multimorbidity: chronic conditions, functional limitations, and geriatric syndromes (such as vision or hearing impairment, falls, incontinence). We also collected EGS disease type, age, and sex. We created a classification and regression tree (CART) model to identify groups of variables associated with our outcome of interest, three-year survival. We then performed Cox proportional hazards analysis to determine hazard ratios for each group with the lowest risk group as reference. RESULTS We identified 1960 patients (median age 79 [interquartile range [IQR]: 73, 85], 59.5% female). The CART model identified the presence of functional limitations as the primary splitting variable. The lowest risk group were patient aged ≤81 y with biliopancreatic disease and without functional limitations. The highest risk group was men aged ≥75 y with functional limitations (hazard ratio [HR] 11.09 (95% confidence interval [CI] 5.91-20.83)). Notably absent from the CART model were chronic conditions and geriatric syndromes. CONCLUSIONS More than the presence of chronic conditions or geriatric syndromes, functional limitations are an important predictor of long-term survival and must be included in presurgical assessment.
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Affiliation(s)
- Vanessa P Ho
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.
| | - Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - J Alford Flippin
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Heena P Santry
- Department of Surgery, Kettering Hospital, Columbus, Ohio
| | - Jeffrey A Claridge
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
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de Jong DLC, Wegdam JA, Berkvens EBM, Nienhuijs SW, de Vries Reilingh TS. The influence of a multidisciplinary team meeting and prehabilitation on complex abdominal wall hernia repair outcomes. Hernia 2023; 27:609-616. [PMID: 36787034 PMCID: PMC9926435 DOI: 10.1007/s10029-023-02755-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Surgical site occurrences after transversus abdominis release in ventral hernia repair are still reported up to 15%. Evidence is rising that preoperative improvement of risk factors might contribute to optimal patient recovery. A reduction of complication rates up to 40% has been reported. The aim of this study was to determine whether prehabilitation has a favorable effect on the risk on wound and medical complications as well as on length of stay. METHODS A retrospective cohort study was performed in a tertiary referral center for abdominal wall surgery. All patients undergoing ventral hernia repair discussed at multidisciplinary team (MDT) meetings between 2015 and 2019 were included. Patients referred for a preconditioning program by the MDT were compared to patients who were deemed fit for operative repair by the MDT, without such a program. Endpoints were patients, hernia, and procedure characteristics as well as length of hospital stay, wound and general complications. RESULTS A total of 259 patients were included of which 126 received a preconditioning program. Baseline characteristics between the two groups were statistically significantly different as the prehabilitated group had higher median BMI (28 vs 30, p < 0.001), higher HbA1c (41 vs 48, p = 0.014), more smokers (4% vs 25%, p < 0.001) and higher HPW classes due to more patient factors (14% vs 48%, p < 0.001). There were no significant differences in intra-operative and postoperative outcome measures. CONCLUSIONS This study showed prehabilitation facilitates patients with relevant comorbidities achieving the same results as patients without those risk factors. The indication of a preconditioning program might be effective at the discretion of an MDT meeting. Further research could focus on the extent of such program to assess its value.
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28
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Parsons RF, Tantisattamo E, Cheungpasitporn W, Basu A, Lu Y, Lentine KL, Woodside KJ, Singh N, Scalea J, Alhamad T, Dunn TB, Rivera FHC, Parajuli S, Pavlakis M, Cooper M. Comprehensive review: Frailty in pancreas transplant candidates and recipients. Clin Transplant 2023; 37:e14899. [PMID: 36591953 DOI: 10.1111/ctr.14899] [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: 09/02/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Well-selected patients with kidney disease and diabetes mellitus who undergo simultaneous kidney-pancreas transplantation often experience dramatic improvements in quality of life and long-term survival compared to those who remain on medical therapy. Over the past several years the importance of frailty in the pancreas transplant candidate and recipient populations has grown. More patients with advanced age have entered the waitlist, and complications from prolonged diabetes, even in younger patients, have created increased evidence of risk for frailty. Given these concerns, and the broad challenges facing pancreas transplantation volumes overall, we generated this review to help establish the impact and implications. We summarize the interplay of immunological factors, aging, environmental factors, diabetes mellitus, and chronic kidney disease that put these patients at risk for frailty. We discuss its measurement and recommend a combination of two instruments (both well-validated and one entirely objective). We describe the outcomes for patients before and after pancreas transplantation who may have frailty, and what interventions can be taken to mitigate its effects. Broader investigation into frailty in the pancreas transplant population is needed to better understand how to select patients for pancreas transplantation and to how manage its consequences thereafter.
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Affiliation(s)
| | | | | | | | - Yee Lu
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Neeraj Singh
- John C. McDonald Regional Transplant Center, Shreveport, Los Angeles, USA
| | - Joseph Scalea
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tarek Alhamad
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ty B Dunn
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Martha Pavlakis
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington DC, USA
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Roy I, Huang K, Bhakta A, Marquez E, Spangenberg J, Jayabalan P. Relationship Between Cachexia and the Functional Progress of Patients With Cancer in Inpatient Rehabilitation. Am J Phys Med Rehabil 2023; 102:99-104. [PMID: 35383593 PMCID: PMC9532459 DOI: 10.1097/phm.0000000000002024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Although inpatient rehabilitation can improve functional independence in patients with cancer, the role of cachexia in this population is unknown. Our objectives were to:1) Establish prevalence of cachexia in a cohort of cancer patients receiving inpatient rehabilitation and its association with demographic and oncological history.2) Determine the relationship between the presence of cachexia and functional recovery and whether these patients in inpatient rehabilitation have a distinct prognosis. METHODS This is a retrospective cohort study of 250 patients over 330 admissions to an inpatient rehabilitation facility. Body weight loss threshold and Weight Loss Grading Scale identified patients with and without cachexia. Main outcomes were functional independence measure scores, discharge destination, and 6-mo survival. RESULTS Prevalence of cachexia in inpatient rehabilitation was 59% using consensus body weight loss criteria, and 77% of cancer patients had a Weight Loss Grading Scale score greater than 0. Patients with and without cachexia had similar motor and cognitive gains, although patients with severe cachexia had more limited functional gains ( P < 0.05) and increased odds of acute care return ( P < 0.01). Patients with a Weight Loss Grading Scale score of 4 had decreased survival at 6 mos ( P < 0.05) compared with noncachectic patients. CONCLUSIONS These data suggest that there is a relationship between cachexia and recovery for cancer patients that should be further studied in rehabilitation settings.
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Affiliation(s)
- Ishan Roy
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
| | - Kevin Huang
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Akash Bhakta
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily Marquez
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Prakash Jayabalan
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Whelan MJ, Roos R, Fourie M, van Aswegen H. Preoperative physiotherapy education for patients undergoing colorectal cancer resection. S Afr Fam Pract (2004) 2023; 65:e1-e10. [PMID: 36744482 PMCID: PMC9983287 DOI: 10.4102/safp.v65i1.5614] [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] [Received: 07/28/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Surgical resection is a common treatment for patients with colorectal cancer. Patients undergoing surgery are at risk of functional deterioration as a response to surgical stress. Furthermore, patients with cancer often present with systemic problems as well as a functional decline. The study aimed to create a framework for preoperative education for patients undergoing colorectal cancer resection. METHODS Five databases were utilised to find intervention-based studies describing the content, mode, setting and timing of delivery of preoperative education for patients undergoing abdominal surgery. Physiotherapists were purposively sampled to participate in a focus group session using a seven-step nominal group technique (NGT) with the goal to reach consensus on the proposed content of a preoperative patient education programme. RESULTS Seventeen studies were reviewed. Results indicate that the mode and timing of the education provided are heterogenous. Content included in the education programs described were breathing exercises, coughing techniques, verbal advice, physical exercises, surgical information, postoperative pain management, nutritional support, relaxation techniques and information about postoperative complications. Six physiotherapists participated in the focus group discussion. Ideas generated in the focus group were similar to those described in the literature. CONCLUSION Results from both the narrative review and the focus group session assisted the authors to develop a framework for the content, timing, setting and mode of delivery of physiotherapy preoperative education for patients undergoing surgical resection for colorectal cancer.Contribution: The framework can be used to inform a physiotherapy preoperative education programme for patients undergoing surgery for colorectal cancer.
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Affiliation(s)
- Megan J. Whelan
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marelee Fourie
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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31
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Jain SR, Kandarpa VL, Yaow CYL, Tan WJ, Ho LML, Sivarajah SS, Ng JL, Chong CXZ, Aw DKL, Foo FJ, Koh FHX. The Role and Effect of Multimodal Prehabilitation Before Major Abdominal Surgery: A Systemic Review and Meta-Analysis. World J Surg 2023; 47:86-102. [PMID: 36184673 DOI: 10.1007/s00268-022-06761-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND For patients undergoing abdominal surgery, multimodal prehabilitation, including nutrition and exercise interventions, aims to optimize their preoperative physical and physiological capacity. This meta-analysis aims to explore the impact of multimodal prehabilitation on surgical and functional outcomes of abdominal surgery. METHODS Medline, Embase and CENTRAL were searched for articles about multimodal prehabilitation in major abdominal surgery. Primary outcomes were postoperative complications with a Clavien-Dindo score ≥3, and functional outcomes, measured by the 6-Minute Walking Test (6MWT). Secondary outcome measures included the quality-of-life measures. Pooled risk ratio (RR) and 95% confidence interval (CI) were estimated, with DerSimonian and Laird random effects used to account for heterogeneity. RESULTS Twenty-five studies were included, analysing 4,210 patients across 13 trials and 12 observational studies. Patients undergoing prehabilitation had significantly fewer overall complications (RR = 0.879, 95% CI 0.781-0.989, p = 0.034). There were no significant differences in the rates of wound infection, anastomotic leak and duration of hospitalization. The 6MWT improved preoperatively in patients undergoing prehabilitation (SMD = 33.174, 95% CI 12.674-53.673, p = 0.005), but there were no significant differences in the 6MWT at 4 weeks (SMD = 30.342, 95% CI - 2.707-63.391, p = 0.066) and 8 weeks (SMD = 24.563, 95% CI - 6.77-55.900, p = 0.104) postoperatively. CONCLUSIONS As preoperative patient optimization shifts towards an interdisciplinary approach, evidence from this meta-analysis shows that multimodal prehabilitation improves the preoperative functional capacity and reduces postoperative complication rates, suggesting its potential in effectively optimizing the abdominal surgery patient. However, there is a large degree of heterogenicity between the prehabilitation interventions between included articles; hence results should be interpreted with caution.
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Affiliation(s)
- Sneha Rajiv Jain
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Vasundhara Lakshmi Kandarpa
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Clyve Yu Leon Yaow
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Winson JianHong Tan
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Leonard Ming Li Ho
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Sharmini Su Sivarajah
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jia Lin Ng
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Cheryl Xi Zi Chong
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Darius Kang Lie Aw
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Frederick Hong Xiang Koh
- Department of General Surgery, Sengkang General Hospital, SingHealth, 110 Sengkang East Way, Singapore, 544886, Singapore.
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Brodersen F, Wagner J, Uzunoglu FG, Petersen-Ewert C. Impact of Preoperative Patient Education on Postoperative Recovery in Abdominal Surgery: A Systematic Review. World J Surg 2023; 47:937-947. [PMID: 36641521 PMCID: PMC9971074 DOI: 10.1007/s00268-022-06884-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patient education is recommended as an essential component of Enhanced Recovery after Surgery (ERAS) protocols. However, there are many uncertainties regarding content and methodological criteria, which may have a significant impact on the effectiveness of the intervention. The aim of this review is to assess the effect of preoperative patient education on postoperative recovery in abdominal surgery and to examine different patient education strategies for their effectiveness. METHODS We performed a systematic review according to the PRISMA guidelines. PubMed, CINAHL, and Cochrane were searched from 2011 to 2022. All studies investigating the effect of preoperative patient education on postoperative recovery in abdominal surgery were included. A critical quality assessment of all included studies was performed. RESULTS We identified 826 potentially suitable articles via a database search and included 12 studies in this review. The majority of the included studies reported a reduction in the length of hospital stay (LOS) and even a reduction in postoperative complications and adverse events. Patients with preoperative education seemed to have lower psychological stress and experience less anxiety. However, the contents, delivery, and general conditions were implemented differently, making comparison difficult. Moreover, the majority of the included studies were weak in quality. CONCLUSION With this review, we report potential effects, current implementations, and frameworks of patient education. However, the results must be interpreted with caution and are not directly transferable to clinical practice. Further studies in this field are necessary to make concrete recommendations for clinical practice.
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Affiliation(s)
- Freya Brodersen
- Department of General-, Visceral-and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Jonas Wagner
- Department of General-, Visceral-and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Faik Güntac Uzunoglu
- Department of General-, Visceral-and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Corinna Petersen-Ewert
- Department Nursing and Management, University of Applied Sciences, Alexanderstrasse 1, 20099, Hamburg, Germany
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Reese L, Wagner JC, Germer CT. [Older patients in abdominal surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:3-9. [PMID: 36319746 DOI: 10.1007/s00104-022-01740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aging society imposes special challenges on operative medicine. OBJECTIVE Characteristics in the perioperative treatment of older patients. Consequences for the daily practice. MATERIAL AND METHODS Evaluation and summary of existing literature including recommendations for the (peri)operative management of older patients. RESULTS Despite the growing relevance there are only few studies focusing on older patients. The altered (patho)physiology and comorbidities are challenging and can lead to complications. CONCLUSION The evaluation of the indications for surgery should meticulously take the improvement to be expected into account by weighing up the individual wishes of patients and special risks. The adequate perioperative care including early mobilization and sufficient analgesia are decisive.
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Affiliation(s)
- L Reese
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
| | - J C Wagner
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland
| | - C T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland
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Coderre D, Brahmbhatt P, Hunter TL, Baima J. Cancer Prehabilitation in Practice: the Current Evidence. Curr Oncol Rep 2022; 24:1569-1577. [PMID: 35788874 DOI: 10.1007/s11912-022-01304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This article serves to describe recent controversies in cancer prehabilitation including efficacy, dose, cost effectiveness, stakeholder input, and international implementation. RECENT FINDINGS Appropriate frequency, type, and timing have yet to be determined, but high intensity exercise is recommended. Costs are favorable when modeled and information on costs of real-world application are forthcoming. Patients are interested in and willing to attend cancer prehabilitation. Cancer prehabilitation research is spreading throughout the world. Cancer prehabilitation includes assessment of a newly diagnosed cancer patient's baseline fitness and targeted interventions to improve their health before surgery, chemotherapy, or radiation. Cancer prehabilitation improves fitness as measured preoperatively and improves outcomes postoperatively.
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Affiliation(s)
- Danielle Coderre
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Priya Brahmbhatt
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- Department of Anesthesiology, Toronto General Hospital, Toronto, Canada
| | - Tracey Louise Hunter
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jennifer Baima
- Department of Orthopedics and Physical Rehabilitation, University Massachusetts Chan Medical School, Worcester, MA, USA
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Intérêt de l’évaluation pré-opératoire et prise en charge post opératoire du patient âgé. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022. [DOI: 10.1016/j.banm.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lussiez A, Hallway A, Lui M, Perez-Escolano J, Sukhon D, Palazzolo W, Elhady H, Englesbe M, Howard R. Evaluation of an Intervention to Address Smoking and Food Insecurity at Preoperative Surgical Clinic Appointments. JAMA Netw Open 2022; 5:e2238677. [PMID: 36301545 PMCID: PMC9614576 DOI: 10.1001/jamanetworkopen.2022.38677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The health of the US population is decreasing, and novel strategies are needed to reverse the trajectory. The surgical episode may be an opportune time to screen for poor health behaviors and social needs, yet little is known about the feasibility or acceptability of such efforts. OBJECTIVE To assess the feasibility and acceptability of a pilot program that engages patients in health behavior change and addresses unmet social needs at the time of surgery. DESIGN, SETTING, AND, PARTICIPANTS This quality improvement study was conducted among 10 338 patients seen in a preoperative clinic for elective surgery between February 8 and August 31, 2021. Patients who received a referral for institutional resources were contacted via telephone to complete follow-up surveys 30 to 90 days after surgery and between July 1, 2021, and March 31, 2022. INTERVENTIONS Implementation of a tool to screen patients for smoking and food insecurity in a preoperative clinic. Those who screened positive were offered referrals for institutional resources. Telephone surveys were conducted with patients who accepted referrals to understand attitudes toward addressing health behaviors and social needs. MAIN OUTCOMES AND MEASURES Screening and referral rates, patient-perceived acceptability of addressing health behaviors and social needs at the time of surgery, smoking cessation rates, and resolution of food insecurity. RESULTS A total of 10 338 patients (6052 women [58.5%]; mean [SD] age, 56.5 [17.9] years) were evaluated in the preoperative clinic. Of the 10 338 patients, 7825 (75.7%) were successfully screened. Of the 641 identified smokers, 152 (23.7%) accepted a referral for smoking cessation counseling. Of the 181 identified patients with food insecurity, 121 (66.9%) accepted a referral for nonmedical needs assistance. On follow-up surveys, 64 of 78 smokers (82.1%) agreed that the preoperative appointment was an appropriate time to discuss smoking cessation, and 34 of 78 smokers (43.6%) reported quitting smoking. Similarly, 69 of 84 patients with food insecurity (82.1%) agreed it was a good or very good idea for health systems to address nonmedical needs at the time of surgery, and 27 patients (32.1%) reported no longer being insecure about food since their preoperative visit. CONCLUSIONS AND RELEVANCE This study suggests that it is feasible to address patients' foundational health at the time of surgery. Most patients agreed that these interventions were appropriate during the perioperative period. These results support using the surgical episode as an opportunity to address foundational health.
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Affiliation(s)
| | - Alexander Hallway
- Department of Surgery, Michigan Medicine, Ann Arbor
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor
| | - Maxine Lui
- Center for Healthcare Engineering and Patient Safety, University of Michigan, Ann Arbor
| | - Jose Perez-Escolano
- Center for Healthcare Engineering and Patient Safety, University of Michigan, Ann Arbor
| | - Deena Sukhon
- Department of Surgery, Michigan Medicine, Ann Arbor
| | | | - Hatim Elhady
- Department of Surgery, Michigan Medicine, Ann Arbor
| | | | - Ryan Howard
- Department of Surgery, Michigan Medicine, Ann Arbor
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Zhang X, Wang S, Ji W, Wang H, Zhou K, Jin Z, Bo L. The effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery: A systematic review and meta-analysis. Front Oncol 2022; 12:958261. [PMID: 35965591 PMCID: PMC9372464 DOI: 10.3389/fonc.2022.958261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
Study objective Prehabilitation is analogous to marathon training and includes preoperative preparation for exercise, as well as nutrition and psychology. However, evidence-based recommendations to guide prehabilitation before colorectal surgery are limited. We aimed to evaluate the effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery. Design This study is a systematic review and meta-analysis. Methods The PubMed, Embase, and Cochrane databases were searched for studies reporting the effect of prehabilitation strategies versus standard care or rehabilitation in patients undergoing colorectal surgery. The primary outcomes were overall postoperative complications and length of hospital stay (LOS), and the secondary outcome was functional capacity (measured using the 6-min walk test [6MWT]) at 4 and 8 weeks after surgery. Main results Fifteen studies with 1,306 participants were included in this meta-analysis. The results showed no significant reduction in the number of overall postoperative complications (risk ratio = 1.02; 95% confidence interval [CI] = 0.79–1.31; p = 0.878) or LOS (standardized mean difference = 0.04; 95% CI = −0.11 to 0.20; p = 0.589) in patients who underwent colorectal surgery with or without prehabilitation strategy. Additionally, there were no significant differences in the functional capacity estimated using the 6MWT at 4 and 8 weeks postoperatively. Conclusions Prehabilitation did not significantly affect the number of postoperative complications, LOS, or functional capacity of patients undergoing colorectal surgery. Whether prehabilitation should be recommended deserves further consideration. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290108, identifier CRD42021290108
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Affiliation(s)
- Xiaoting Zhang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shaokang Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wentao Ji
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Huixian Wang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Keqian Zhou
- College of Basic Medicine, Naval Medical University, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, Naval Medical University, Shanghai, China
- *Correspondence: Lulong Bo, ; Zhichao Jin,
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Lulong Bo, ; Zhichao Jin,
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Bolshinsky V, Ismail H, Li M, Basto J, Schier R, Hagemeier A, Ho KM, Heriot A, Riedel B. Clinical covariates that improve surgical risk prediction and guide targeted prehabilitation: an exploratory, retrospective cohort study of major colorectal cancer surgery patients evaluated with preoperative cardiopulmonary exercise testing. Perioper Med (Lond) 2022; 11:20. [PMID: 35614461 PMCID: PMC9134693 DOI: 10.1186/s13741-022-00246-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preoperative risk stratification is used to derive an optimal treatment plan for patients requiring cancer surgery. Patients with reversible risk factors are candidates for prehabilitation programmes. This pilot study explores the impact of preoperative covariates of comorbid disease (Charlson Co-morbidity Index), preoperative serum biomarkers, and traditional cardiopulmonary exercise testing (CPET)-derived parameters of functional capacity on postoperative outcomes after major colorectal cancer surgery. METHODS Consecutive patients who underwent CPET prior to colorectal cancer surgery over a 2-year period were identified and a minimum of 2-year postoperative follow-up was performed. Postoperative assessment included: Clavien-Dindo complication score, Comprehensive Complication Index, Days at Home within 90 days (DAH-90) after surgery, and overall survival. RESULTS The Charlson Co-morbidity Index did not discriminate postoperative complications, or overall survival. In contrast, low preoperative haemoglobin, low albumin, or high neutrophil count were associated with postoperative complications and reduced overall survival. CPET-derived parameters predictive of postoperative complications, DAH-90, and reduced overall survival included measures of VCO2 kinetics at anaerobic threshold (AT), peakVO2 (corrected to body surface area), and VO2 kinetics during the post-exercise recovery phase. Inflammatory parameters and CO2 kinetics added significant predictive value to peakVO2 within bi-variable models for postoperative complications and overall survival (P < 0.0001). CONCLUSION Consideration of modifiable 'triple low' preoperative risk (anaemia, malnutrition, deconditioning) factors and inflammation will improve surgical risk prediction and guide prehabilitation. Gas exchange parameters that focus on VCO2 kinetics at AT and correcting peakVO2 to body surface area (rather than absolute weight) may improve CPET-derived preoperative risk assessment.
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Affiliation(s)
- Vladimir Bolshinsky
- General Surgery, Peninsula Health, Frankston, VIC, Australia. .,Surgical Health Specialists, Frankston, VIC, Australia.
| | - Hilmy Ismail
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael Li
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jarrod Basto
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Robert Schier
- Universität zu Köln Medizinische Fakultät, Koln, Nordrhein-Westfalen, Germany
| | - Anna Hagemeier
- Universität zu Köln Medizinische Fakultät, Koln, Nordrhein-Westfalen, Germany
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Advocating for prehabilitation for patients undergoing gynecology-oncology surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1875-1881. [DOI: 10.1016/j.ejso.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 12/18/2022]
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Saur NM, Davis BR, Montroni I, Shahrokni A, Rostoft S, Russell MM, Mohile SG, Suwanabol PA, Lightner AL, Poylin V, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Perioperative Evaluation and Management of Frailty Among Older Adults Undergoing Colorectal Surgery. Dis Colon Rectum 2022; 65:473-488. [PMID: 35001046 DOI: 10.1097/dcr.0000000000002410] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nicole M Saur
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Isacco Montroni
- Department of Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Armin Shahrokni
- Department of Medicine/Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vitaliy Poylin
- Division of Gastrointestinal and Oncologic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
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Høydahl Ø, Edna TH, Xanthoulis A, Lydersen S, Endreseth BH. Octogenarian patients with colon cancer - postoperative morbidity and mortality are the major challenges. BMC Cancer 2022; 22:302. [PMID: 35313841 PMCID: PMC8939202 DOI: 10.1186/s12885-022-09384-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. Methods All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 90-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. Results Among 237 octogenarian patients treated with major resections with curative intent, the 90-day mortality was 9.3%. Among 215 patients that survived the first 90 days, the 5 year relative survival rate was 98.7%. The 90-day mortality of octogenarian patients was significantly higher than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 90-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 90-day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 90-day mortality was high, but after surviving 90 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 90-day mortality risk.
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Affiliation(s)
- Øystein Høydahl
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway. .,IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Tom-Harald Edna
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Athanasios Xanthoulis
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Birger Henning Endreseth
- IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Multimodal prehabilitation in older adults before major abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:2193-2204. [PMID: 35233645 DOI: 10.1007/s00423-022-02479-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Multimodal prehabilitation aims to prepare frail older patients for major surgery. The objective of this review is to determine the benefits of pre-operative multimodal prehabilitation compared to standard care in older patients. METHODS Data sources included MEDLINE, EMBASE, CENTRAL, CINAHL and PsychINFO. They were searched from inception to September 2021. Only randomized controlled trials (RCT) with an average study population age ≥ 65 that had undergone major abdominal operation with at least two components (physical, nutritional, psychological) of prehabilitation programs were included. RESULTS Nine RCTs were included with a total of 823 patients, of whom 705 completed the study with 358 undergoing prehabilitation and 347 were controls. Significantly lower complications were observed in the prehabilitation group compared to control (OR 0.67; 95% CI 0.46 to 0.99; p = 0.04; I2 = 32%). A significant increase in 6-min walking distance (6MWD) from baseline to immediately prior to surgery (mean difference 35.1 m; 95%CI 11.6-58.4; p = 0.003; I2 = 67%) and 8 weeks post-surgery (mean difference 44.9 m; 95%CI 6.0-83.8; p = 0.02; I2 = 75%) was noted in the prehabilitation group. No difference was observed in length of stay (OR 0.59; 95% CI - 0.23 to 1.40; p = 0.16; I2 = 91%) or 30-day emergency department visit (OR 0.72; 95% CI 0.41 to 1.26; p = 0.25; I2 = 0%). Patient reported outcome measures were not significantly different. CONCLUSIONS Amongst older patients, multimodal prehabilitation increases peri-operative functional capacity and may potentially decrease post-operative complications. Future studies should continue to focus on older patients who are frail as this is the group that prehabilitation would likely have a clinically significant impact on.
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Bamdad MC, Brown CS, Kamdar N, Weng W, Englesbe MJ, Lussiez A. Patient, Surgeon, or Hospital: Explaining Variation in Outcomes after Colectomy. J Am Coll Surg 2022; 234:300-309. [PMID: 35213493 PMCID: PMC10369366 DOI: 10.1097/xcs.0000000000000063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complication rates after colectomy remain high. Previous work has failed to establish the relative contribution of patient comorbidities, surgeon performance, and hospital systems in the development of complications after elective colectomy. STUDY DESIGN We identified all patients undergoing elective colectomy between 2012 and 2018 at hospitals participating in the Michigan Surgical Quality Collaborative. The primary outcome was development of a postoperative complication. We used risk- and reliability-adjusted generalized linear mixed models to estimate the degree to which variance in patient-, surgeon-, and hospital-level factors contribute to complications. RESULTS A total of 15,755 patients were included in the study. The mean hospital-level complication rate was 15.8% (range, 8.7% to 30.2%). The proportion of variance attributable to the patient level was 35.0%, 2.4% was attributable to the surgeon level, and 1.8% was attributable to the hospital level. The predicted probability of complication for the least comorbid patient was 1.5% (CI 0.7-3.1%) at the highest performing hospital with the highest performing surgeon, and 6.6% (CI 3.2-12.2%) at the lowest performing hospital with the lowest performing surgeon. By contrast, the most comorbid patient in the cohort had a 66.3% (CI 39.5-85.6%) or 89.4% (CI 73.7-96.2%) risk of complication. CONCLUSIONS This study demonstrated that variance from measured factors at the patient level contributed more than 8-fold more to the development of complications after colectomy compared with variance at the surgeon and hospital level, highlighting the impact of patient comorbidities on postoperative outcomes. These results underscore the importance of initiatives that optimize patient foundational health to improve surgical care.
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Affiliation(s)
- Michaela C Bamdad
- From the Department of Surgery, University of Michigan, Ann Arbor, MI
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Development and validation of patients' surgical safety checklist. BMC Health Serv Res 2022; 22:259. [PMID: 35216592 PMCID: PMC8873354 DOI: 10.1186/s12913-022-07470-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Poor uptake and understanding of critical perioperative information represent a major safety risk for surgical patients. Implementing a patient-driven surgical safety checklist might enhance the way critical information is given and increase patient involvement in their own safety throughout the surgical pathway. The aim of this study was to develop and validate a Surgical Patient Safety Checklist (PASC) for use by surgical patients. Method This was a prospective study, involving patient representatives, multidisciplinary healthcare professionals and elective surgical patients to develop and validate PASC using consensus-building techniques in two Norwegian hospitals. A set of items intended for PASC were rated by patients and then submitted to Content Validation Index (CVI) analyses. Items of low CVI went through a Healthcare Failure Mode and Effect Analysis (HFMEA) Hazard Scoring process, as well as a consensus process before they were either kept or discarded. Reliability of patients’ PASC ratings was assessed using Intraclass Correlation Coefficient analysis. Lastly, the face validity of PASC was investigated through focus group interviews with postoperative patients. Results Initial development of PASC resulted in a checklist consisting of two parts, one before (32 items) and one after surgery (26 items). After achieving consensus on the PASC content, 215 surgical patients from six surgical wards rated the items for the CVI analysis on a 1-4 scale and mostly agreed on the content. Five items were removed from the checklist, and six items were redesigned to improve PASCs’ user-friendliness. The total Scale-level index/Average (S-CVI/Ave) before revision was 0.83 and 0.86 for pre- and post-operative PASC items, respectively. Following revision, these increased to 0.86 and 0.93, respectively. The PASC items reliability score was 0.97 (95% confidence interval 0.96 to 0.98). The qualitative assessment identified that patients who used PASC felt more in control of their situation; this was achieved when PASC was given to them at what they felt was the right time and healthcare professionals took part in its usage. Conclusion Multidisciplinary perioperative care staff and surgical patients agreed upon PASC content, the checklist ratings were reliable, and qualitative assessment suggested good face validity. PASC appears to be a usable and valid checklist for elective surgical patients across specialties. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07470-z.
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Jeske P, Wojtera B, Banasiewicz T. Prehabilitation – current role in surgery. POLISH JOURNAL OF SURGERY 2022. [DOI: 10.5604/01.3001.0015.7340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction
Prehabilitation concerns preoperative activities aimed in proper preparation to undergo a surgery and improve postoperative recovery. It includes the interdisciplinary approach by presurgical improvement of physical fitness and nourishment status, mental training and quitting addictions. The aim of the study was to investigate the recent publications in the field of prehabilitation.
Methods
We performed a systematic review in the PubMed database using the formula ‘preopreative OR before surgery, postoperative OR after surgery, prehabilitation’. The inclusion criteria were studies with a minimum population of 50 patients, including preoperative interventions, defined with a term prehabilitation, and their impact on a postoperative course of the patient. Three hundred seventy records were revealed and 13 studies were finally included in the analysis.
Results
According to qualified studies, prehabilitation improves significantly postoperative complications rate, length of hospital stay, postoperative physical activity, treatment costs, perioperative transfusions rate, antibiotic administration, and following the postoperative recommendations by patients. On the other hand, there is a lack of statistically significant impact of prehabilitation on quality of life, psychological condition, readmissions, and reoperations.
Discussion
Prehabilitation promotes development of multimodal care putting the patient’s well-being in the centre. Numerous studies indicate positive results of prehabilitation programs.
The final results depend on the protocol of prehabilitation, selected group of patients and standard of care of the center.
Conclusion
Prehabilitation is necessary for providing the highest quality of care for a surgical patient. Interdisciplinary approach benefit a patient during the operation as well as in the postoperative period. Every surgical clinic should be aware of the idea of prehabilitation and possibly create their own programs.
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Affiliation(s)
- Pamela Jeske
- Katedra i Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Uniwersytet Medyczny w Poznaniu
| | - Bartosz Wojtera
- Katedra i Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Uniwersytet Medyczny w Poznaniu
| | - Tomasz Banasiewicz
- Katedra i Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Uniwersytet Medyczny w Poznaniu
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Is the Integration of Prehabilitation into Routine Clinical Practice Financially Viable? A Financial Projection Analysis. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-021-00506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zietlow KE, Wong S, Heflin MT, McDonald SR, Sickeler R, Devinney M, Blitz J, Lagoo-Deenadayalan S, Berger M. Geriatric Preoperative Optimization: A Review. Am J Med 2022; 135:39-48. [PMID: 34416164 PMCID: PMC8688225 DOI: 10.1016/j.amjmed.2021.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 02/07/2023]
Abstract
This review summarizes best practices for the perioperative care of older adults as recommended by the American Geriatrics Society, American Society of Anesthesiologists, and American College of Surgeons, with practical implementation strategies that can be readily implemented in busy preoperative or primary care clinics. In addition to traditional cardiopulmonary screening, older patients should undergo a comprehensive geriatric assessment. Rapid screening tools such as the Mini-Cog, Patient Health Questionnaire-2, and Frail Non-Disabled Survey and Clinical Frailty Scale, can be performed by multiple provider types and allow for quick, accurate assessments of cognition, functional status, and frailty screening. To assess polypharmacy, online resources can help providers identify and safely taper high-risk medications. Based on preoperative assessment findings, providers can recommend targeted prehabilitation, rehabilitation, medication management, care coordination, and/or delirium prevention interventions to improve postoperative outcomes for older surgical patients. Structured goals of care discussions utilizing the question-prompt list ensures that older patients have a realistic understanding of their surgery, risks, and recovery. This preoperative workup, combined with engaging with family members and interdisciplinary teams, can improve postoperative outcomes.
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Affiliation(s)
- Kahli E Zietlow
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Michigan Medicine, Ann Arbor.
| | - Serena Wong
- Division of Geriatrics, Department of Medicine, Duke Health, Durham, NC
| | - Mitchell T Heflin
- Division of Geriatrics, Department of Medicine, Duke Health, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC
| | - Shelley R McDonald
- Division of Geriatrics, Department of Medicine, Duke Health, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC
| | | | - Michael Devinney
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | | | - Miles Berger
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
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Campbell S, Fichera A, Thomas S, Papaconstantinou H, Essani R. Outpatient colectomy-a dream or reality? Proc AMIA Symp 2022; 35:24-27. [PMID: 34970026 DOI: 10.1080/08998280.2021.1973327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Whereas the advancement of minimally invasive surgical techniques and enhanced recovery after surgery (ERAS) pathways for partial colectomies has shortened postoperative length of stay, the ideal length of stay after partial colectomy with or without diverting loop ileostomy is still up for debate. This article examines the safety and efficacy of discharging select patients home from day surgery following partial colectomy. We performed a retrospective review of 7 patients who underwent partial colectomy at one tertiary care center from December 2020 to August 2021. None of our cases suffered complications such as anastomotic leak, surgical site infection, or bowel obstruction or required admission to the hospital. One patient was seen in the emergency department on postoperative day 1 for nausea and vomiting and was managed as an outpatient. A second patient required a fluid bolus in the clinic for high ileostomy output. In conclusion, our study suggests that appropriately selected patients can be successfully managed in the outpatient setting without increased complications following partial colectomy when preoperative preparation and education are put in place alongside our colon ERAS pathway and minimally invasive surgical techniques.
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Affiliation(s)
- Stephen Campbell
- Division of Colon and Rectal Surgery, Baylor Scott and White Health Central Texas, Temple, Texas
| | - Alessandro Fichera
- Division of Colon and Rectal Surgery, Baylor Scott and White Health North Texas, Dallas, Texas
| | - Scott Thomas
- Division of Colon and Rectal Surgery, Baylor Scott and White Health Central Texas, Temple, Texas
| | - Harry Papaconstantinou
- Division of Colon and Rectal Surgery, Baylor Scott and White Health Central Texas, Temple, Texas
| | - Rahila Essani
- Division of Colon and Rectal Surgery, Baylor Scott and White Health Central Texas, Temple, Texas
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Varley PR, Borrebach JD, Arya S, Massarweh NN, Bilderback AL, Wisniewski MK, Nelson JB, Johnson JT, Johanning JM, Hall DE. Clinical Utility of the Risk Analysis Index as a Prospective Frailty Screening Tool within a Multi-practice, Multi-hospital Integrated Healthcare System. Ann Surg 2021; 274:e1230-e1237. [PMID: 32118596 DOI: 10.1097/sla.0000000000003808] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The goal of this project was to first address barriers to implementation of the Risk Analysis Index (RAI) within a large, multi-hospital, integrated healthcare delivery system, and to subsequently demonstrate its utility for identifying at-risk surgical patients. BACKGROUND Prior studies demonstrate the validity of the RAI for evaluating preoperative frailty, but they have not demonstrated the feasibility of its implementation within routine clinical practice. METHODS Implementation of the RAI as a frailty screening instrument began as a quality improvement initiative at the University of Pittsburgh Medical Center in July 2016. RAI scores were collected within a REDCap survey instrument integrated into the outpatient electronic health record and then linked to information from additional clinical datasets. NSQIP-eligible procedures were queried within 90 days following the RAI, and the association between RAI and postoperative mortality was evaluated using logistic regression and Cox proportional hazards models. Secondary outcomes such as inpatient length of stay and readmissions were also assessed. RESULTS RAI assessments were completed on 36,261 unique patients presenting to surgical clinics across five hospitals from July 1 to December 31, 2016, and 8,172 of these underwent NSQIP-eligible surgical procedures. The mean RAI score was 23.6 (SD 11.2), the overall 30-day and 180-day mortality after surgery was 0.7% and 2.6%, respectively, and the median time required to collect the RAI was 33 [IQR 23-53] seconds. Overall clinic compliance with the recommendation for RAI assessment increased from 58% in the first month of the study period to 84% in the sixth and final month. RAI score was significantly associated with risk of death (HR=1.099 [95% C.I.: 1.091 - 1.106], p < 0.001). At an RAI cutoff of ≥37, the positive predictive values for 30- and 90-day readmission were 14.8% and 26.2%, respectively, and negative predictive values were 91.6% and 86.4%, respectively. CONCLUSIONS The RAI frailty screening tool can be efficiently implemented within multi-specialty, multi-hospital healthcare systems. In the context of our findings and given the value of the RAI in predicting adverse postoperative outcomes, health systems should consider implementing frailty screening within surgical clinics.
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Affiliation(s)
| | - Jeffrey D Borrebach
- Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Shipra Arya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Surgical Service Line VA Palo Alto Healthcare System, Palo Alto, CA
| | - Nader N Massarweh
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, TX; Division of Surgical Oncology, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Andrew L Bilderback
- Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mary Kay Wisniewski
- Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joel B Nelson
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE; Nebraska Western Iowa VA Health System, Omaha, NE
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA.,Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
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Gillis C, Phillips SM. Protein for the Pre-Surgical Cancer Patient: a Narrative Review. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00494-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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