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Stuart CM, Bronsert MR, Dyas AR, Mott NM, Healy GL, Anioke T, Henderson WG, Randhawa SK, David EA, Mitchell JD, Meguid RA. Risk-adjusted discrete increases in length of stay by complication following anatomic lung resection: an analysis of 32 133 cases across the USA. Eur J Cardiothorac Surg 2024; 66:ezae293. [PMID: 39107905 DOI: 10.1093/ejcts/ezae293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/15/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES Prior studies have associated morbidity following anatomic lung resection with prolonged postoperative length of stay; however, each complication's individual impact on length of stay as a continuous variable has not been studied. The purpose of this study was to determine the risk-adjusted increase in length of stay associated with each individual postoperative complications following anatomic lung resection. METHODS Patients who underwent anatomic lung resection cataloged in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program participant use file, 2005-2018, were targeted. The association between preoperative characteristics, postoperative complications and length of stay in days was tested. A negative binomial model adjusting for the effect of preoperative characteristics and 18 concurrent postoperative complications was used to generate incidence rate ratios. This model was fit to generate risk-adjusted increases in length of stay by complication. RESULTS Of 32 133 patients, 5065 patients (15.8%) experienced at least one post-operative complication. The most frequent complications were pneumonia (n = 1829, 5.7%), the need for transfusion (n = 1794, 5.6%) and unplanned reintubation (n = 1064, 3.3%). The occurrence of each of the 18 individual complications was associated with significantly increased length of stay. This finding persisted after risk-adjustment, with the greatest risk-adjusted increases being associated with prolonged ventilation (+17.4 days), followed by septic shock (+17.2 days), acute renal failure (+16.5 days) and deep surgical site infection (+13.2 days). CONCLUSIONS All 18 postoperative complications studied following anatomic lung resection were associated with significant risk-adjusted increases in length of stay, ranging from an increase of 17.4 days with prolonged ventilation to 2.6 days following the need for transfusion.
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Affiliation(s)
- Christina M Stuart
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Adam R Dyas
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole M Mott
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Garrett L Healy
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tochi Anioke
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Simran K Randhawa
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth A David
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John D Mitchell
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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2
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Dietary modification of myeloid-derived suppressor cells (MDSC) activity in sepsis. Proc Natl Acad Sci U S A 2022; 119:e2201396119. [PMID: 35290112 PMCID: PMC8944247 DOI: 10.1073/pnas.2201396119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
ABSTRACT Immune maturation and response to inflammation depend on good nutritional status. Protein and amino acid deficiencies can compromise innate and adaptive immune functions, particularly following injury or during illness. Dietary omega-3 long-chain fatty acids, prebiotics and micronutrients are beneficial to the immune system. A complex interplay exists between diet, microbiome, and epigenetic factors. The effect of single nutrients on immune function may hence be difficult to study. Well-designed intervention studies, investigating the effects of whole dietary pattern on the immune system, are needed.
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Wan GY, Yuan H, Xue H, Li HQ, Hu HY, Zhang XY. Assessment of compliance with oral nutritional supplementation and exploration of barriers and facilitators for patients after gastrectomy: A mixed-methods study. J Adv Nurs 2021; 77:2845-2859. [PMID: 33818820 DOI: 10.1111/jan.14851] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/18/2021] [Accepted: 03/21/2021] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the compliance of patients after gastrectomy in taking oral nutritional supplementation and to explore the promoting and hindering factors. DESIGN A mixed-methods design with an explanatory sequential approach was employed. METHODS We conducted a 12-week longitudinal study to evaluate the oral nutritional supplementation compliance of 122 patients after gastric cancer surgery and the factors that affected their compliance. After the quantitative phase, we selected the interview subjects and developed the interview outline based on the analysis of the quantitative results. In-depth interviews (n = 15) were conducted to explain and supplement the quantitative phase results. Data were collected from October 2019 to May 2020. RESULTS The average overall compliance rate of oral nutritional supplementation in patients with gastric cancer over 12 weeks was 30.59%. Adverse reactions to oral nutritional supplementation, the identity of the main caregivers and the patient's financial ability were independent factors that affected patient compliance. In subsequent interviews, we extracted four themes: social support plays an important role in patients taking oral nutritional supplementation, adverse reactions discourage patients from continuing to take oral nutritional supplementation, patients' attitudes affect their motivation to take oral nutritional supplementation, and the different needs of patients for oral nutritional supplementation affect patient compliance. CONCLUSION Patients' compliance with oral nutritional supplementation after gastric cancer surgery is very low. Health education should pay more attention to the management of adverse reactions and the role of patients' peers and family members. Oral nutritional supplementation products should be diversified to provide patients with more choices. IMPACT This study clarifies the factors that hinder and promote oral nutritional supplementation compliance and provides an important reference for the establishment and revision of health education strategies for patients after gastric cancer surgery.
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Affiliation(s)
- Guang-Ying Wan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hui Xue
- Department of Histology & Embryology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hui-Qin Li
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
| | - Hai-Yan Hu
- Department of Gastric Colorectal Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, P.R. China
| | - Xiu-Ying Zhang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, P.R. China
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Pimiento JM, Evans DC, Tyler R, Barrocas A, Hernandez B, Araujo-Torres K, Guenter P. Value of nutrition support therapy in patients with gastrointestinal malignancies: a narrative review and health economic analysis of impact on clinical outcomes in the United States. J Gastrointest Oncol 2021; 12:864-873. [PMID: 34012673 DOI: 10.21037/jgo-20-326] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Malnutrition, particularly under-nutrition, is highly prevalent among adult patients with a diagnosis of gastrointestinal (GI) cancer and negatively affects patient outcomes. Malnutrition is associated with clinical and surgical complications for patients undergoing therapy for GI cancers and the costs associated with those complications is a high burden for the US health system. Our objective was to identify high-quality evidence for nutrition support interventions associated with cost savings for patient care, followed by a complex economic value analysis to project cost savings for the US health system. A narrative literature search was conducted in which combined keywords in the areas of therapeutic nutrition (nutrition, malnutrition), a specific therapeutic area [GI cancer (esophageal, gastric, gallbladder, pancreatic, liver/hepatic, small and large intestine, colorectal)], and clinical outcomes and healthcare cost, to look for nutrition interventions that could significantly improve clinical outcomes. Medicare claims data were then analyzed using the findings of these identified studies and this modeling exercise supported identifying the cost and healthcare resource utilization implications of specific populations to determine the impact of nutrition support on reducing these costs as reflected in the summary of the evidence. Eight studies were found that provided clinical outcomes and health cost savings data, 2 of those had the strongest level of evidence and were used for Value Analysis calculations. Nutrition interventions such as oral diet modifications, enteral nutrition (EN) supplementation, and parenteral nutrition (PN) have been studied especially in the peri-operative setting. Specifically, peri-operative immunonutrition administration and utilization of enhanced recovery pathways after surgery have been associated with significant improvement in postoperative complications and decreased length of hospital stay (LOS). Utilizing economic modeling of Medicare claims data from GI cancer patients, potential annual cost savings of $242 million were projected by the widespread adoption of these interventions. Clinical outcomes can be improved with the use of nutrition interventions in patients with GI cancers. Healthcare costs can be reduced as a result of fewer in-hospital complications and shorter lengths of hospital stay. The application of nutrition intervention provides a positive clinical and economic value proposition to the healthcare system for patients with GI cancers.
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Affiliation(s)
- Jose M Pimiento
- Gastrointestinal Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David C Evans
- Ohio Health Trauma and Surgical Services, Columbus OH, USA
| | - Renay Tyler
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Albert Barrocas
- Surgery Department, Tulane School of Medicine, New Orleans, LA, USA
| | | | | | - Peggi Guenter
- American Society for Parenteral Nutrition, Silver Spring, MD, USA
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Verduci E, D'Auria E, Bosetti A, DI Profio E, Vizzuso S, Milanta C, Pendezza E, Borsani B, Zuccotti GV. Immunomodulatory diet in pediatric age. Minerva Pediatr (Torino) 2021; 73:128-149. [PMID: 33880904 DOI: 10.23736/s2724-5276.21.06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In the last few decades, the importance of a functioning immune system and health status has become more evident. Multiple factors are able to influence the development of chronic diseases and diet is one of the most important environmental factors. Evidence demonstrates that dietary patterns high in fat and low in fiber are associated with the development of non-communicable diseases. Moreover, optimal nutritional status can modulate immune maturation and response to inflammation. During inflammatory conditions, nutritional deficiencies may occur, establishing a vicious circle, consequently a balanced nutritional status is essential to prevent and counteract infections. Dietary diversity can prevent allergic diseases and nutrients such as DHA, arginine, vitamins and trace elements have an impact on physical barriers (such as gut mucosal barrier and skin), on the immune system response and on microbiome modulation. Protein deficiencies can compromise innate and adaptive immune functions; arginine availability can affect the immune response in injured states and other disease processes; EPA and DHA can modulate both innate and adaptive immunity; prebiotics have a beneficial effect on the functioning of the immune system. Zinc, copper, selenium and iron are involved in the correct development and function of the immune system. Vitamins D, E, A, B and C have a role on immune system through different mechanisms of action. Since a complex interplay exists between diet, microbiome and epigenetic factors which determine nutrient-induced changes on the immune function, the effect of each single nutrient may be difficult to study. Well-designed intervention studies, investigating the effects of whole dietary pattern, should be performed to clarify impact of foods on the immune function and disease risk.
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Affiliation(s)
- Elvira Verduci
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy - .,Department of Health Science, University of Milan, Milan, Italy -
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy.,Department of Health Science, University of Milan, Milan, Italy
| | | | | | - Sara Vizzuso
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Chiara Milanta
- Department of Health Science, University of Milan, Milan, Italy
| | - Erica Pendezza
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Barbara Borsani
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
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Holmes JL, Biella A, Morck T, Rostorfer J, Schneeman B. Medical Foods: Science, Regulation, and Practical Aspects. Summary of a Workshop. Curr Dev Nutr 2021; 5:nzaa172. [PMID: 33409445 PMCID: PMC7775186 DOI: 10.1093/cdn/nzaa172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/30/2020] [Accepted: 11/19/2020] [Indexed: 01/03/2023] Open
Abstract
On August 13-14, 2019, the Healthcare Nutrition Council and the ASN held the Medical Foods Workshop: Science, Regulation, and Practical Aspects. Medical food products help patients manage their disease and improve their quality of life. Yet many hurdles exist to getting patients new products. In this workshop, participants addressed some of these hurdles, with specific emphasis on topics like the statutory term distinctive nutritional requirements, the regulatory term modification of the diet alone, the role of clinical guidelines, the requirement that medical foods be used under medical supervision, and differentiation of foods for special dietary use from medical foods, as well as product innovation and future research. Real-world examples were discussed for intractable epilepsy, diabetes, end-stage renal disease, and inflammatory bowel disease.
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Affiliation(s)
| | - Alexandre Biella
- Regulatory Affairs US, Nestlé Health Science, Bridgewater, NJ, USA
| | | | - Jena Rostorfer
- Regulatory Affairs, Abbott Laboratories, Columbus, OH, USA
| | - Barbara Schneeman
- Department of Nutrition, University of California, Davis, Davis, CA, USA
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8
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Lorenzon L, Grossman RC, Soreide K. Impact of Randomized Controlled Trials in the Social Media: Does Science Trend As Much As Everyday Events? World J Surg 2020; 45:88-96. [PMID: 32892272 DOI: 10.1007/s00268-020-05769-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The approach to the scientific literature is evolving. Currently, dissemination of articles happens in real time through social media (SoMe) channels, and little is known about its impact in medicine. The aim of this study was to investigate if SoMe dissemination followed trends independent from articles type and content. METHODS First, the SoMe engagement of a popular theme (#BlackFriday) and a relevant theme (#ClimateChange) was compared using a SoMe analytic tool to test if the popular theme would reach more engagement. In a second analysis, themes in colorectal surgery in the SoMe community were explored. Altmetric Explorer was searched for the term "colorectal surgery" and the outputs were categorized into 'randomized controlled trials' (RCTs) and 'other studies'. Subgroups were compared for the Altmetric scores using statistical analyses. RESULTS The analytic tool documented that #BlackFriday outnumbered #ClimateChange in mentions and engagement (1.6 million vs 127.000 mentions). Following, Altmetric Explorer identified 1381 articles, including 92 RCTs (7.1%). Overall, 25,554 mentions were documented from 1205 outputs (97.0% by Twitter). A greater percentage of "other studies" ranked in the lower Altmetric score categories (p = 0.0007). Similarly, the median Altmetric score was higher in the RCT subgroup comparing with "other studies" (6.5 vs. 2.0, Mann-Whitney p = 0.0001). CONCLUSIONS In this study, RCTs represented just the 7.1% of the studies and produced 11% of Twitter outputs. The median Altmetric scores obtained by RCTs were higher than those of other studies.
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Affiliation(s)
- Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Rebecca C Grossman
- Department of General Surgery, Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Knackstedt R, Oliver J, Gatherwright J. Evidence-Based Perioperative Nutrition Recommendations: Optimizing Results and Minimizing Risks. Plast Reconstr Surg 2020; 146:423-435. [PMID: 32740600 DOI: 10.1097/prs.0000000000007004] [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: 11/25/2022]
Abstract
Plastic surgery patients span the nutritional spectrum from generally healthy, nutritionally competent patients to inherently catabolic, nutritionally deficient, and chronic wound patients. Therefore, plastic and reconstructive surgery affords the opportunity to investigate the impact of nutrition across a heterogeneous patient population following a wide variety of procedures. Although patients may be nutritionally deficient in certain vitamins warranting perioperative repletion, other supplements have the potential to benefit all patients, regardless of nutritional status. Despite these putative benefits, there is a dearth of information regarding nutritional optimization, with the limited, available literature focusing mostly on herbal supplements and their potential side effects. A significant barrier to supplement use is the lack of education and available supporting information regarding the indications, contraindications, and physiology of these adjuncts. The goal of this article is to provide a comprehensive, evidence-based review of available nutritional supplements that can be considered for the plastic surgery patient in the perioperative period to optimize surgical outcomes while minimizing risk. Prospective, well-designed studies using validated, high-quality supplements will be critical in determining the significance that perioperative supplementation can have for surgical outcomes. Until well-done prospective studies are performed, the supplement, dose, and duration should be determined on an individual, patient-per-patient basis at the discretion of the operating surgeon.
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Affiliation(s)
- Rebecca Knackstedt
- From the Department of Plastic Surgery, Cleveland Clinic; the Mayo Medical School; and the Division of Plastic Surgery, MetroHealth
| | - Jeremie Oliver
- From the Department of Plastic Surgery, Cleveland Clinic; the Mayo Medical School; and the Division of Plastic Surgery, MetroHealth
| | - James Gatherwright
- From the Department of Plastic Surgery, Cleveland Clinic; the Mayo Medical School; and the Division of Plastic Surgery, MetroHealth
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10
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Jiang XH, Chen XJ, Wang XY, Chen YZ, Xie QQ, Peng JS. Optimal Nutrition Formulas for Patients Undergoing Surgery for Colorectal Cancer: A Bayesian Network Analysis. Nutr Cancer 2020; 73:775-784. [PMID: 32692267 DOI: 10.1080/01635581.2020.1770812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Optimal nutrition formulas for colorectal cancer patients underwent surgery remains uncertainty. We constructed an indirect comparison study to assess comparative efficacy of different immunonutrition formulas and standard nutrition in colorectal cancer patients underwent surgery. PubMed, the Cochrane Library, EMBASE, ClinicalTrials.gov and Web of Science databases were searched to identify RCTs that compared immunonutrition with standard nutrition or different immunonutrition formulas. Data on length of hospital stays (LOS), infectious complications (IC), noninfectious complications (NIC) and anastomotic leakage (AL) were extracted from the included RCTs for Bayesian network analysis using a random-effect model. Twelve articles that included 1032 individuals were incorporated into this study. The indirect comparison confirmed the potential improvement of arginine-based immunonutrition on IC (odds ratios [OR] = 0.43, 95%confidence interval [CI]: 0.17 to 0.95), glutamine on NIC (OR = 0.07 CI: 0.00 to 0.78) and LOS (MD=-3.91 CI: -6.33 to -1.69) and omega-3 polyunsaturated fatty acids on LOS (OR=-3.49 CI: -5.46 to -1.00). Results indicated that glutamine had the highest probability of reducing complications and hospital stays. As for colorectal cancer patients underwent surgery, this indirect comparison suggested some superiority of glutamine. Future more RCTs with larger scale are required to provide evidence for the optimal immunonutrition formulas.
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Affiliation(s)
- Xiao-Han Jiang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Xi-Jie Chen
- Guangdong Institute of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin-You Wang
- Guangdong Institute of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun-Zhi Chen
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, and Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China
| | - Qin-Qin Xie
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Jun-Sheng Peng
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.,Guangdong Institute of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Stokes SM, Wakeam E, Antonoff MB, Backhus LM, Meguid RA, Odell D, Varghese TK. Optimizing health before elective thoracic surgery: systematic review of modifiable risk factors and opportunities for health services research. J Thorac Dis 2019; 11:S537-S554. [PMID: 31032072 PMCID: PMC6465421 DOI: 10.21037/jtd.2019.01.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/31/2018] [Indexed: 12/20/2022]
Abstract
Despite progress in many different domains of surgical care, we are still striving toward practices which will consistently lead to the best care for an increasingly complex surgical population. Thoracic surgical patients, as a group, have multiple medical co-morbidities and are at increased risk for developing complications after surgical intervention. Our healthcare systems have been focused on treating complications as they occur in the hopes of minimizing their impact, as well as aiding in recovery. In recent years there has emerged a body of evidence outlining opportunities to optimize patients and likely prevent or decrease the impact of many complications. The purpose of this review article is to summarize four major domains-optimal pain control, nutritional status, functional fitness, and smoking cessation-all of which can have a substantial impact on the thoracic surgical patient's course in the hospital-as well as to describe opportunities for improvement, and areas for future research efforts.
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Affiliation(s)
- Sean M. Stokes
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Elliot Wakeam
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson, Cancer Center, Houston, TX, USA
| | - Leah M. Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Robert A. Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - David Odell
- Division of Thoracic Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Thomas K. Varghese
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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