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Chen TH, Huang WW, Lu LC, Ma CC. Factors associated with postoperative efficacy evaluation in patients with morbid obesity. Sci Rep 2024; 14:12255. [PMID: 38806598 PMCID: PMC11133406 DOI: 10.1038/s41598-024-63099-4] [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: 01/08/2024] [Accepted: 05/24/2024] [Indexed: 05/30/2024] Open
Abstract
The global obesity problem is becoming increasingly serious, with eight of the top ten causes of death in Taiwan in 2020 being related to obesity. Morbid obesity poses a significant threat to one's health and well-being. In recent years, bariatric surgery has emerged as a more effective treatment option for patients with morbid obesity. However, the procedure is not without risks. This study aims to examine the factors that impact the postoperative efficacy evaluation of patients with morbid obesity. This study uses a retrospective cross-sectional design, with medical records being collected retrospectively. The data was collected from patients who underwent bariatric surgery between July 1, 2017 and June 30, 2020 at a hospital in southern Taiwan. A total of 663 patients were included in the study and were observed for 1 year after the surgery. The independent variables included demographic variables, perceived symptoms variables, perceived lifestyle variables, and surgery-related variables, while the dependent variables included weight loss outcomes and complications. The prognostic factors affecting the postoperative efficacy evaluation of patients with pathological obesity were determined using multiple regression analysis and binary regression analysis. The study found that 65.6% of the participants were female, with an average age of 36.8 years. The results of the multiple regression and binary logistic regression showed that gender, age, BMI, diabetes, and smoking habit were the predictors of postoperative weight loss. Hypertension, diabetes, liver disease, kidney disease, smoking habit, drinking habit, and operation time were the predictors of postoperative complications. The study found that the presence of the aforementioned 12 significant factors can affect the success of weight loss after surgery and the incidence of postoperative complications. This information can serve as a reference for clinical care institutions and patients to improve the postoperative efficacy evaluation.
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Affiliation(s)
- Tai-Hsiang Chen
- Department of Healthcare Administration, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C
| | - Wen-Wen Huang
- Executive Master Program of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan, R.O.C
| | - Liu-Chun Lu
- Operating Room, E-DA Dachang Hospital, Kaohsiung, Taiwan, R.O.C
| | - Chen-Chung Ma
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan, R.O.C..
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Kawa N, Araji T, Kaafarani H, Adra SW. A Narrative Review on Intraoperative Adverse Events: Risks, Prevention, and Mitigation. J Surg Res 2024; 295:468-476. [PMID: 38070261 DOI: 10.1016/j.jss.2023.11.045] [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: 09/12/2023] [Revised: 10/16/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Adverse events from surgical interventions are common. They can occur at various stages of surgical care, and they carry a heavy burden on the different parties involved. While extensive research and efforts have been made to better understand the etiologies of postoperative complications, more research on intraoperative adverse events (iAEs) remains to be done. METHODS In this article, we reviewed the literature looking at iAEs to discuss their risk factors, their implications on surgical care, and the current efforts to mitigate and manage them. RESULTS Risk factors for iAEs are diverse and are dictated by patient-related risk factors, the nature and complexity of the procedures, the surgeon's experience, and the work environment of the operating room. The implications of iAEs vary according to their severity and include increased rates of 30-day postoperative morbidity and mortality, increased length of hospital stay and readmission, increased care cost, and a second victim emotional toll on the operating surgeon. CONCLUSIONS While transparent reporting of iAEs remains a challenge, many efforts are using new measures not only to report iAEs but also to provide better surveillance, prevention, and mitigation strategies to reduce their overall adverse impact.
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Affiliation(s)
- Nisrine Kawa
- Department of Dermatology, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York City, New York
| | - Tarek Araji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haytham Kaafarani
- Division of Trauma, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Emergency Surgery and Critical Care, Boston, Massachusetts
| | - Souheil W Adra
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Majid OW. Further evidence confirms the association between smoking and dry socket: a motivational opportunity for tobacco cessation. Evid Based Dent 2023; 24:181-183. [PMID: 37814003 DOI: 10.1038/s41432-023-00938-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
DESIGN A systematic review and meta-analysis of observational studies. DATA SOURCES Electronic search included PubMed, Scopus, and Web of Science databases up to March 2022 using appropriate keywords. SELECTION CRITERIA The review included all observational studies (case-control, cohort and cross-sectional studies) published in English after 2000, comparing the prevalence of dry socket between smokers and non-smokers after simple or surgical tooth extraction. Exclusion criteria included patients with other post-extraction complications, prevalence of different risk factors, and unrelated study designs (literature reviews, case reports, expert opinion, and conference reports). DATA EXTRACTION AND SYNTHESIS Two independent investigators screened the records (by title, abstract, and full text), and selected the eligible studies according to the predefined criteria. Collected data from each study included author name and country, year of publication, gender and age of patients, smoking status, inclusion and exclusion criteria, medical history and oral hygiene, prevalence of dry socket, type of tooth and extraction technique, symptoms and treatment. Risk of bias was assessed according to the (NHLBI, NIH) Quality Assessment Tool For Observational Cohort and Cross-Sectional Studies, while the level of evidence was assessed using the classification of the Oxford Centre for Evidence-Based Medicine levels for diagnosis. Two independent reviewers conducted the assessments, and any disagreements were addressed through discussion. RESULTS Eleven studies from ten different countries representing a total of 10,195 patients (3007 smokers and 7188 non-smokers) were included in the final analysis. Nine studies were classified as having "good" quality and two as "intermediate," while all of the studies have the third or fourth level of evidence (through 5-graded scale). The prevalence of dry socket in smokers was about 13.2% (95% CI: 5.8-23.1%) and in non-smokers about 3.8% (95% CI: 2.1-6.0%). Meta-analysis showed that regular tobacco smoking was associated a more than 3-fold increase in the odds of dry socket after tooth extraction. CONCLUSION Despite heterogeneity among the included studies (different age groups and types of teeth extracted), there was a consistent association between cigarette smoking and an elevated risk of developing dry socket post tooth extraction.
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Affiliation(s)
- Omer Waleed Majid
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Mosul University, Mosul, Iraq.
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Winhard M, Mehilli J. [Cardiovascular assessment and management of patients undergoing non-cardiac surgeries - A case based resumé]. Dtsch Med Wochenschr 2023; 148:1118-1122. [PMID: 37611577 DOI: 10.1055/a-1977-3059] [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: 08/25/2023]
Abstract
In August 2022, the European Society of Cardiology (ESC) published new guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. In order to cope with the complexity of the patients and the multidisciplinary, representatives of the European Society of Anesthesia and Intensive Care Medicine as well as 2 patient representatives were involved in the development of the published document in addition to authors from the European Society of Cardiology. As a result, the document contains 147 recommendations on this complex topic, with more than half of them being grade I recommendations.The interdisciplinarity and the need for interdisciplinary cooperation in this context is particularly emphasized. Particular attention was also paid to recommendations for action for a structured preoperative risk stratification. The new guidelines also focus on increasing vigilance for perioperative myocardial damage and identifying it at an early stage.In the following article, some of the essential innovations and revisions will be highlighted using practical clinical case studies.
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Affiliation(s)
- Maximilian Winhard
- Medizinische Klinik I für Kardiologie, Pneumologie, internistische Intensivmedizin, Krankenhaus Landshut-Achdorf, Landshut
| | - Julinda Mehilli
- Medizinische Klinik I für Kardiologie, Pneumologie, internistische Intensivmedizin, Krankenhaus Landshut-Achdorf, Landshut
- Ludwig-Maximilians-Universität, Klinikum der Universität München, München
- Standort Munich Heart Alliance, Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., München
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Cole MW, Collins LK, Waters TL, Salas Z, Sherman WF, Cyriac M. Put Down the Tin: Chewing Tobacco Use Is Associated With Worse Outcomes After Primary Lumbar Fusion. Clin Spine Surg 2023; 36:E332-E338. [PMID: 37053116 DOI: 10.1097/bsd.0000000000001457] [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] [Received: 09/04/2022] [Accepted: 03/09/2023] [Indexed: 04/14/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE This study evaluated the impact of chewing tobacco on both medical and spine-related complication rates after spinal lumbar fusions in comparison to both a control cohort and a smoking cohort. SUMMARY OF BACKGROUND DATA Smoking is a prevalent modifiable risk factor that has been demonstrated to be associated with increased complications after lumbar fusion. Although smoking rates have decreased in the United States, chewing tobacco use has not similarly reduced. Despite chewing tobacco delivering up to 4 times the dose of smoking, the impact of chewing tobacco is incompletely understood. METHODS A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent lumbar spine fusion and used chewing tobacco were matched with a control cohort and a smoking cohort. Medical complications within 90 days after primary lumbar fusion were evaluated, including deep venous thrombosis, acute kidney injury, pulmonary embolism, transfusion, acute myocardial infarction, and inpatient readmission. Spine-related complications were evaluated at 2 years postoperatively, including pseudoarthrosis, incision and drainage (I&D), instrument failure, revision, and infection. RESULTS After primary lumbar fusion, the chewing tobacco cohort demonstrated significantly higher rates of pseudoarthrosis [odds ratio (OR): 1.41], revision (OR: 1.57), and any spine-related complication (OR: 1.32) compared with controls. The smoking cohort demonstrated significantly higher rates of pseudoarthrosis (OR: 1.88), I&D (OR: 1.27), instrument failure (OR: 1.39), revision (OR: 1.54), infection (OR: 1.34), and any spine-related complication (OR: 1.77) compared with controls. The chewing tobacco cohort demonstrated significantly lower rates of pseudoarthrosis (OR: 0.84), I&D (OR: 0.49), infection (OR: 0.70), and any spine-related complication (OR: 0.81) compared with the smoking cohort. CONCLUSIONS This study demonstrated that chewing tobacco is associated with higher rates of both spine-related and medical complications after primary lumbar fusion. However, chewing tobacco use is associated with less risk of complications compared with smoking. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Matthew W Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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[ESC guidelines 2022 on cardiovascular assessment and management of patients undergoing non-cardiac surgery : What is new?]. Herz 2023; 48:31-38. [PMID: 36449042 DOI: 10.1007/s00059-022-05150-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/03/2022]
Abstract
The new European Society of Cardiology (ESC) guidelines on the cardiovascular assessment and management of patients undergoing non-cardiac surgery were published in August 2022. In the preparation of the new document the previous guidelines published in 2014 were completely revised and the recommendations for action were adapted or renewed. Furthermore, the guidelines have been supplemented with some new chapters. The new and revised recommendations result in significant changes for the clinical practice. This particularly applies to the preoperative risk stratification, the perioperative risk management and the detection and management approaches in cases of perioperative and postoperative complications. Cardiovascular biomarkers play a special role in both the preoperative risk stratification and the detection of postoperative complications in combination with appropriate algorithms for action. The perioperative management of antithrombotic treatment (antiplatelet therapy or oral anticoagulation) is becoming increasingly individualized depending on the risk of ischemia or bleeding of the planned surgery. Particular attention is paid to the early detection of perioperative or postoperative myocardial infarctions based on determination of high-sensitivity (hs) cardiac troponin, not least because its association with high risk of morbidity and mortality. In patients with complex cardiovascular diseases, such as severe coronary artery disease, valvular heart diseases or those with ventricular support systems, the decision in an interdisciplinary team is highly recommended.
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Gavilan E, Fernández E, Minguell J, Trilla E, Zuriguel-Pérez E, Martínez C. Efficacy of Presurgical Interventions to Promote Smoking Cessation: A Systematic Review. Anesth Analg 2023; 136:43-50. [PMID: 36534716 DOI: 10.1213/ane.0000000000006240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate the efficacy of presurgical interventions for promoting smoking cessation in terms of achieving smoking abstinence and reducing surgical complication rates. A systematic review of randomized clinical trials (RCTs) published from March 2009 to April 2021 was performed following the PRISMA guidelines. References were found in MEDLINE (via PubMed), Web of Science (WOS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). RCTs comparing the efficacy of a smoking cessation program directed at an intervention group (IG) versus the usual intervention or another directed at a control group (CG) were included. No language restrictions were applied in the search. All approaches to smoking cessation were admitted (face-to-face, telephone, group, individual, multicomponent, etc.), as were all methods for assessing abstinence, follow-up times, surgical specialties, definitions of smokers, and all types of surgical complications. Four hundred forty-four references were pulled out, and 79 duplicates were discarded. We excluded 346 records that were after application of the inclusion/exclusion criteria. In addition to the remaining 19 articles, 1 article obtained from citation searches was also assessed. We finally included 11 original articles in this systematic review, corresponding to 9 studies, because 2 of the RCTs had 2 different articles referring to different aspects of the same study. The results showed long-term postoperative (6 to 12 months) abstinence rates between 25.0% and 36.4% in RCTs with intensive multicomponent interventions, versus rates about 13.0% in brief interventions. Two multicomponent interventions obtained significant improvements regarding the reduction of short-term postoperative surgical complications. In conclusion, presurgical multicomponent smoking cessation interventions are more effective than brief interventions in terms of achieving abstinence and reducing surgical complications. The follow-up time and the intensity of the interventions were predictors of dropout.
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Affiliation(s)
- Eva Gavilan
- From the Surgical Area, Vall d´Hebron University Hospital, Barcelona, Spain.,International University of Catalonia, Barcelona, Spain.,Multidisciplinary Nursing Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Science, Bellvitge Campus, University of Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain.,CIBER in Respiratory Diseases, Madrid, Spain
| | - Joan Minguell
- Orthopedic Surgery and Traumatology Department, Vall d´Hebron University Hospital, Barcelona, Spain.,School of Medicine and Health Science, Vall d´Hebron Campus, Autonomous University of Barcelona, Barcelona, Spain.,Reconstructive Surgery of the Locomotor System, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Enrique Trilla
- School of Medicine and Health Science, Vall d´Hebron Campus, Autonomous University of Barcelona, Barcelona, Spain.,Urology Department, Vall d´Hebron University Hospital, Barcelona, Spain.,CIBBIM-Nanomedicine, Kidney Phisiopathology Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Management of Knowledge and Evaluation, Vall d´Hebron University Hospital, Barcelona, Spain
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Science, Bellvitge Campus, University of Barcelona, l'Hospitalet de Llobregat, Barcelona, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, De Hert S, de Laval I, Geisler T, Hinterbuchner L, Ibanez B, Lenarczyk R, Mansmann UR, McGreavy P, Mueller C, Muneretto C, Niessner A, Potpara TS, Ristić A, Sade LE, Schirmer H, Schüpke S, Sillesen H, Skulstad H, Torracca L, Tutarel O, Van Der Meer P, Wojakowski W, Zacharowski K. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826-3924. [PMID: 36017553 DOI: 10.1093/eurheartj/ehac270] [Citation(s) in RCA: 247] [Impact Index Per Article: 123.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery. Langenbecks Arch Surg 2022; 407:1131-1138. [DOI: 10.1007/s00423-021-02381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
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10
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Aslaner O. Comparison of Oxidative Effects of Electronic Cigarette and Tobacco Smoke Exposure Performed Experimentally. Eur Addict Res 2022; 28:41-47. [PMID: 34515107 DOI: 10.1159/000518204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/30/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cigarette smoking is a life-threatening habit that has rapidly spread in every socioeconomic part of the public worldwide. There exist mechanisms of nicotine delivery available to use in the hope of halting cigarette smoking, and the electronic cigarette (EC) is one of the common methods used for tobacco smoking replacement. This study aimed to investigate experimentally the oxidative effects of tobacco smoke and EC smoke which contain nicotine. METHOD We constructed smoke circuit rooms for exposing the rats to EC or tobacco smoke. Three groups were created, the control group (N = 8); the electronic cigarette group (N = 8), exposure to electronic cigarette smoke for 2 h per day; and the tobacco group (N = 8), exposure to traditional cigarette smoke for 2 h per day. After the first and second week of exposure, blood samples were obtained, and serum oxidative stress index (OSI), paraoxonase 1 (PON1) activity, and prolidase levels were evaluated. RESULTS Higher values of OSI and prolidase levels were detected in the first week of EC or tobacco smoke exposure in both study groups (p < 0.001) when compared with the control group, and partial decrements were observed in the second week. By contrast, elevated PON1 levels were observed in the second week after EC or tobacco smoke exposure. The highest OSI levels were observed in the tobacco smoke group (p < 0.001). The lowest values of PON1 levels were detected in the first week of the electronic cigarette smoke group, and this decremental value was statistically different than normal, the second week of the electronic cigarette smoke group, the first week of the traditional cigarette smoke exposure group, and the second week of the traditional cigarette smoke exposure group values (p < 0.000). CONCLUSION Our results indicate that EC smoke induced oxidative stress. Therefore, ECs are potentially risky for human health and can lead to important health problems.
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Affiliation(s)
- Oktay Aslaner
- Department of Thoracic Surgery, Medical Faculty, Alanya Alaaddin Keykubat Univercity, Antalya, Turkey
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11
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Alligood DM, Albo D, Meiler SE, Cartwright SM, Kelly A, Xu H, Saeed M. Using NSQIP Data to Reduce Institutional Postoperative Pneumonia Rates in Non-ICU Patients: A Plan-Do-Study-Act Approach. J Am Coll Surg 2021; 233:193-202.e5. [PMID: 34015453 DOI: 10.1016/j.jamcollsurg.2021.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a program designed to measure and improve surgical care quality. In 2015, the study institution formed a multidisciplinary team to address the poor adult postoperative pneumonia performance (worst decile). STUDY DESIGN The study institution is a 450+ bed tertiary care center that performs 12,000+ surgical procedures annually. From January 2016 to December 2019, the institution abstracted surgical cases and assigned postoperative pneumonia as a complication per the NSQIP operations manual. Using a plan-do-study-act approach, a multidisciplinary postoperative pneumonia prevention team implemented initiatives regarding incentive spirometry education, anesthetic optimization, early mobility, and oral care. The team measured the initiatives' success by analyzing semiannual reports (SAR) provided by the ACS NSQIP and regional adjusted percentile rankings provided by the Georgia Surgical Quality Collaborative (GSQC). RESULTS The 2015 SAR postoperative pneumonia rate was 4.20% (odds ratio [OR] 3.86, confidence interval [CI] 2.92-5.11). After project initiation, the postoperative pneumonia rates decreased for all NSQIP cases, from 2.51% (OR 2.67, CI 1.89-3.77) in 2016 to 2.08% (OR 2.61, CI 1.82-3.74) in 2017, to 0.85% (OR 1.10, CI 0.69-1.75) in 2018, and then increased slightly to 1.14% (OR 1.27, CI 0.84-1.92) in 2019. The institution's adjusted percentile regional rank of participating regional ACS NSQIP hospitals' postoperative pneumonia rate improved from 14/14 (July 2015-June 2016) to 6/14 (July 2018-June 2019). CONCLUSIONS The multidisciplinary postoperative pneumonia prevention team successfully decreased the postoperative pneumonia rate, therefore improving surgical patients' outcomes. Furthermore, this quality improvement project also saved valuable revenue for the hospital.
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Affiliation(s)
| | - Daniel Albo
- Department of Surgery, Augusta University Medical Center, Augusta GA
| | - Steffen E Meiler
- Department of Anesthesiology, Augusta University Medical Center, Augusta GA
| | | | - Allen Kelly
- Perioperative Services, Augusta University Medical Center, Augusta GA
| | - Hongyan Xu
- Biostatistics, Augusta University, Augusta GA
| | - Muhammad Saeed
- Department of Surgery, Augusta University Medical Center, Augusta GA
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Preoperative Cumulative Smoking Dose on Lung Cancer Surgery in a Japanese Nationwide Database. Ann Thorac Surg 2021; 113:237-243. [PMID: 33600791 DOI: 10.1016/j.athoracsur.2021.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Smoking is a known risk factor for postoperative mortality and morbidity. However, the significance of cumulative smoking dose in preoperative risk assessment has not been established. We examined the influence of preoperative cumulative smoking dose on surgical outcomes after lobectomy for primary lung cancer. METHODS A total of 80,989 patients with primary lung cancer undergoing lobectomy from 2014 to 2016 were enrolled. Preoperative cumulative smoking dose was categorized by pack-years (PY): nonsmokers, PY = 0; light smokers, 0 < PY < 10; moderate smokers, 10 ≤ PY < 30; and heavy smokers, 30 ≤ PY. The risk of short-term outcomes was assessed according to PY by multivariable analysis adjusted for other covariates. RESULTS Postoperative 30-day mortality, as well as pulmonary, cardiovascular, and infectious complications, increased with preoperative PY. Multivariable analysis revealed that the odds ratios (ORs) for postoperative mortality compared with nonsmokers were 1.76 for light smokers (P = .044), 1.60 for moderate smokers (P = .026), and 1.73 for heavy smokers (P = .003). The ORs for pulmonary complications compared with nonsmokers were 1.20 for light smokers (P = .022), 1.40 for moderate smokers (P < .001), and 1.72 for heavy smokers (P < .001). Heavy smokers had a significantly increased risk of postoperative cardiovascular (OR, 1.26; P = .002) and infectious (OR, 1.39; P = .007) complications compared with nonsmokers. CONCLUSIONS The risk of mortality and morbidity after lung resection could be predicted according to preoperative cumulative smoking dose. These findings contribute to the development of strategies in perioperative management of lung resection patients.
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Self-Reported Smoking Compared to Serum Cotinine in Bariatric Surgery Patients: Smoking Is Underreported Before the Operation. Obes Surg 2020; 30:23-37. [PMID: 31512159 DOI: 10.1007/s11695-019-04128-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Smoking has been associated with postoperative complications and mortality in bariatric surgery. The evidence for smoking is based on self-report and medical charts, which can lead to misclassification and miscalculation of the associations. Determination of cotinine can objectively define nicotine exposure. We determined the accuracy of self-reported smoking compared to cotinine measurement in three phases of the bariatric surgery trajectory. METHODS Patients in the phase of screening (screening), on the day of surgery (surgery), and more than 18 months after surgery (follow-up) were consecutively selected. Self-reported smoking was registered and serum cotinine was measured. We evaluated the accuracy of self-reported smoking compared to cotinine, and the level of agreement between self-report and cotinine for each phase. RESULTS In total, 715 patients were included. In the screening, surgery, and follow-up group, 25.6%, 18.0%, and 15.5%, respectively, was smoking based on cotinine. The sensitivity of self-reported smoking was 72.5%, 31.0%, and 93.5% in the screening, surgery, and follow-up group, respectively (p < 0.001). The specificity of self-report was > 95% in all groups (p < 0.02). The level of agreement between self-report and cotinine was 0.778, 0.414, and 0.855 for the screening, surgery, and follow-up group, respectively. CONCLUSIONS Underreporting of smoking occurs before bariatric surgery, mainly on the day of surgery. Future studies on effects of smoking and smoking cessation in bariatric surgery should include methods taking into account the issue of underreporting.
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A review of the effects of tobacco smoking on the treatment of prostate cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Prostate cancer is the most commonly diagnosed malignancy and the third leading cause of death among Canadian men. The standard treatment modalities for prostate cancer include prostatectomy, radiation therapy, hormonal therapy and chemotherapy or any combination depending on the stage of the tumour. However, several studies have reported that tobacco smoking at the time of diagnosis and during treatment can potentially impact treatment efficacy, outcome and patients quality of life after treatment.Materials and methods:This narrative literature review elucidates the impacts of tobacco smoking on prostate cancer progression, treatment efficacy, including its effects on prostatectomy, radiation therapy and chemotherapy, risk of cancer recurrence and mortality and quality of life after treatment. Furthermore, we discuss the importance of integrating a smoking cessation programme into the treatment regimen for prostate cancer patients in order to yield more favourable treatment outcomes, reduce risk of recurrence and mortality and increase the quality of life after treatment for prostate cancer patients.Conclusions:Smoking cessation is one of the most important interventions to prevent cancer and it is also essential after the diagnosis of prostate cancer to improve clinical outcomes. All prostate cancer patients should be advised to quit tobacco use since it can potentially improve treatment response rates and survival, as well as reduce the risk of developing treatment complications and potentially improve the quality of life after treatment. There are several benefits to smoking cessation and it should become an important component of the cancer care continuum in all oncology programmes, starting from prevention of cancer through diagnosis, treatment, survivorship and palliative care. Evidence-based smoking cessation intervention should be sustainably integrated into any comprehensive cancer programme, and the information should be targeted to the specific benefits of cessation in cancer patients.
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Gräsbeck H, Ekroos H, Halonen K, Vasankari T. Weak smoking cessation awareness in primary health care before surgery: a real-world, retrospective cohort study. Scand J Prim Health Care 2020; 38:42-46. [PMID: 32019399 PMCID: PMC7054971 DOI: 10.1080/02813432.2020.1717093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.Design: This was a retrospective cohort study.Setting: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016, involving both primary health care and specialized health care. The goals of the project were smoking awareness and preoperative smoking cessation.Subjects: Our study involved 1482 surgical patients operated at Porvoo Hospital between May and December of 2016.Main outcome measures: We studied the recording of smoking status in all patients, and ICD-10 diagnosis of nicotine dependency and the initiation of preoperative smoking cessation in current smokers. Variables were studied from electronic patient records, comparing primary health care referrals and surgical outpatient clinic records.Results: Smoking status was visible in 14.2% of primary health care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n = 275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for initiation of preoperative smoking cessation. The differences between primary health care referrals and outpatient clinic records were statistically significant for all three variables (p ≤ .001).Conclusion: In primary health care, very little attention was paid to preoperative smoking cessation. Rates were significantly better at the surgical outpatient clinic, but still low. We could not demonstrate any certain effect of the intervention. Our results call for future research on ways to improve smoking cessation rates.Key pointsTobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.We found weak smoking awareness and weak smoking cessation intervention numbers among both primary and specialized health care doctors. Our results indicate an urgent need for an efficient preoperative smoking cessation model involving both primary and specialized health care.
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Affiliation(s)
- Helene Gräsbeck
- Department of Pulmonary Medicine, Porvoo Hospital, Porvoo, Finland;
- Doctoral Programme of Clinical Research, University of Helsinki, Helsinki, Finland;
- CONTACT Helene Gräsbeck Department of Pulmonary Medicine, Porvoo Hospital, Sairaalantie 1, 06150 Porvoo, Finland
| | - Heikki Ekroos
- Department of Pulmonary Medicine, Porvoo Hospital, Porvoo, Finland;
| | - Kimmo Halonen
- Department of Surgery, Porvoo Hospital, Porvoo, Finland;
| | - Tuula Vasankari
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland;
- Finnish Lung Health Association (FILHA), Helsinki, Finland
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Shin YS, Lee Y. Associations between smoking and postoperative complications following elective craniotomy. J Neurosurg Sci 2019; 65:642-647. [PMID: 31220912 DOI: 10.23736/s0390-5616.19.04693-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evidence of postoperative complications associated with smoking has varied. We conducted this study to clarify the relationships between tobacco smoking and postoperative complications following craniotomy. METHODS A retrospective cohort analysis identified 800 patients who underwent cranial surgery with general anesthesia at a medical center with 2,700 beds in Seoul, Korea between January and December 2011. RESULTS Prior smokers (34.8%) and current smokers (35.1%) were hospitalized for at least 11 days longer than never smokers (25.5%) (x2 = 6.74, p = 0.036). There were no statistically significant differences in the incidence of postoperative complications among never smokers (5.2%), prior smokers (9.6%), and current smokers (9.6%). The incidences of postoperative complications among prior smokers (9.6%) and current smokers (9.6%) were similar. Comparisons between never smokers (25.5%) and current smokers (34.9%) showed smokers had longer hospital stays and a higher incidence of complications (x2 = 6.74, p = 0.012). The incidence of major complications (x2 = 5.27, p = 0.024) and overall complications (x2 = 4.84, p = 0.033) were also significantly higher among smokers than never smokers. The impact of smoking status on postoperative complications was not identified. CONCLUSIONS We found significant associations between smoking status and postoperative complications. The incidence of major complications was twice as high among smokers as among never smokers. Therefore, it is recommended to continuously monitor current smokers to prevent postoperative complications after craniotomy.
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Affiliation(s)
- Yong S Shin
- School of Nursing, Hanyang University, Seoul, Korea
| | - Yoonyoung Lee
- Department of Nursing, Sunchon National University, Suncheon, Korea -
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Grau L, Orozco FR, Duque AF, Post ZD, Ponzio DY, Ong AC. A Simple Protocol to Stratify Pulmonary Risk Reduces Complications After Total Joint Arthroplasty. J Arthroplasty 2019; 34:1233-1239. [PMID: 30777628 DOI: 10.1016/j.arth.2019.01.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pulmonary complications after total joint arthroplasty are a burden to patients and the healthcare system. The aim of this study is to demonstrate the effectiveness of a pulmonary screening questionnaire and intervention protocol developed at our institution to prevent pulmonary complications. METHODS Between 2010 and 2015, 7658 consecutive total joint arthroplasty patients at our institution were reviewed. Based on our pre-operative pulmonary risk assessment tool, 1625 patients were flagged as high pulmonary risk. Patients were determined to be high risk if they were a current or former heavy smoker with an abnormal spirometry, had a positive obstructive sleep apnea screening, required continuous positive airway pressure/bi-level positive airway pressure use, had a history of significant pulmonary disease, had an oxygen saturation <90%, or had body mass index >40. A standardized monitoring protocol and interventions including smoking cessation, treatment and optimization of primary pulmonary conditions, peri-operative inhaler use, spinal anesthesia, aspiration precautions, elevated head of bed >20° resting and >45° while eating, maintaining oxygen saturation ≥92%, early use of incentive spirometer, avoidance of narcotics and early respiratory therapy consult were initiated for all high risk patients. RESULTS Only 7 of 7658 (0.091%) patients suffered pulmonary complications after initiating our intervention protocol. These included 3 aspiration pneumonias, 1 asthma exacerbation, 1 chronic obstructive pulmonary disease exacerbation, 1 continuous positive airway pressure intolerance in a patient with obstructive sleep apnea, and 1 requirement of bi-level positive airway pressure. The pulmonary risk questionnaire accurately identified all patients who had pulmonary complications. The overall pulmonary complication rate at our institution decreased from 5.7% to 0.09% after implementing our screening questionnaire and intervention protocol (P < .0001). CONCLUSION Our results demonstrate a more than 63-fold reduction in pulmonary complications at our institution. Our screening questionnaire and intervention protocol is an effective way of identifying and preventing pulmonary complications.
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Affiliation(s)
- Luis Grau
- Department of Orthopaedic Surgery, Rothman Orthopaedics at Thomas Jefferson University, Egg Harbor Township, NJ
| | - Fabio R Orozco
- Department of Orthopaedic Surgery, Rothman Orthopaedics at Thomas Jefferson University, Egg Harbor Township, NJ
| | - Andres F Duque
- Department of Orthopaedic Surgery, Rothman Orthopaedics at Thomas Jefferson University, Egg Harbor Township, NJ
| | - Zachary D Post
- Department of Orthopaedic Surgery, Rothman Orthopaedics at Thomas Jefferson University, Egg Harbor Township, NJ
| | - Danielle Y Ponzio
- Department of Orthopaedic Surgery, Rothman Orthopaedics at Thomas Jefferson University, Egg Harbor Township, NJ
| | - Alvin C Ong
- Department of Orthopaedic Surgery, Rothman Orthopaedics at Thomas Jefferson University, Egg Harbor Township, NJ
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Gavilán E, Moreno M, Pérez À, Castellano Y, Fernández E, Martínez C. Pre-surgical register of tobacco consumption. Med Clin (Barc) 2018; 151:315-319. [PMID: 29588061 DOI: 10.1016/j.medcli.2018.01.028] [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: 10/27/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE Smoking cessation before surgery decreases the risk of complications. The aim of this study was to analyse the smoking register, associated variables and a short talk given to smokers in pre-surgical visits. MATERIAL AND METHOD Cross-sectional study. The pre-surgical records of 680 patients were assessed. We selected patient sociodemographic variables, surgical intervention characteristics, smoking status and consumption pattern. Logistic regression was used to study the variables association with smoking. RESULTS A percentage of 97.2 of the pre-surgical records include information on tobacco consumption. Overall 20% of surgical patients are smokers. The probability of smoking is higher among men (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 1.7-4.0) and≤60 years (aOR 5.4, 95% CI 3.2-9.1). None of the records had information regarding a short talk given to patients to give up smoking. CONCLUSION Smoking consumption was prevalent, but the characterisation of a smoker's profile and short talk given to patient before surgery was practically nonexistent. Ensuring that patients who smokes receives a short talk to give up smoking before surgery is necessary.
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Affiliation(s)
- Eva Gavilán
- Hospital General Vall d'Hebron, Barcelona, España; Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España; Unidad de Control de Tabaquismo, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - Montse Moreno
- Servicio de Prevención, Hospital Sant Joan de Déu de Martorell, Martorell, Barcelona, España
| | - Àngels Pérez
- Control de la Infección, Hospital Sant Joan de Déu de Martorell, Martorell, Barcelona, España
| | - Yolanda Castellano
- Unidad de Control de Tabaquismo, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - Esteve Fernández
- Unidad de Control de Tabaquismo, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Campus de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Cristina Martínez
- Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España; Unidad de Control de Tabaquismo, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Departamento de Salud Pública, Salud Mental y Perinatal, Facultad de Medicina y Ciencias de la Salud, Campus de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.
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Anesthesia for Video-Assisted Thoracoscopic Surgery. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Affiliation(s)
- Erika L Brinson
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Kevin C Thornton
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
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Carlson BB, Burton DC, Jackson RS, Robinson S. Recidivism Rates After Smoking Cessation Before Spinal Fusion. Orthopedics 2016; 39:e318-22. [PMID: 26942471 DOI: 10.3928/01477447-20160301-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/01/2015] [Indexed: 02/03/2023]
Abstract
Tobacco use has documented negative effects on perioperative complications and clinical outcomes. Smoking cessation before spinal surgery may improve clinical outcomes. The goal of this study was to determine the recidivism rate after smoking cessation before spinal fusion. A prospective observational study was performed at the University of Kansas Medical Center between 2006 and 2011. All patients with serum-confirmed nicotine cessation before spinal fusion surgery were eligible. Smoking status was determined with questionnaires at 3 months, 6 months, and 1 year postoperatively. All reported nonsmokers had confirmatory serum nicotine and cotinine tests. Two-tailed Pearson chi-square and independent t tests were conducted, and significance was set at α=0.05. A total of 42 subjects (21 women, 21 men) with confirmed preoperative serum-negative test results were prospectively enrolled over a period of 3.9 years. Of these patients, 1 opted out at 6 months and 1 died of unknown cause. The findings showed a recidivism rate (response rate) of 60% (40 of 41) at 3 months, 61% (33 of 41) at 6 months, and 68% (25 of 40) at 1 year. One case of asymptomatic pseudarthrosis occurred 1 year postoperatively in a confirmed nonsmoker. No correlation was found between smoking status at 3 months and sex, primary vs revision surgery, or complications (P>.05). Smokers who relapsed at 3 months were older than nonsmokers (55.2 vs 44.2 years, respectively; P=.03). Some patients are willing to cease smoking before spinal fusion for optimal clinical outcomes; however, the rate of recidivism is high (60%) within the first 3 months post-operatively.
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Dela Cruz AC, Vilchez V, Kim S, Barnes B, Ravinuthala A, Zanni A, Galuppo R, Sourianarayanane A, Patel T, Maynard E, Shah MB, Daily MF, Uhl T, Esser K, Gedaly R. A prospective analysis of factors associated with decreased physical activity in patients with cirrhosis undergoing transplant evaluation. Clin Transplant 2015; 29:958-64. [PMID: 26263921 DOI: 10.1111/ctr.12602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical activity (PA) has been associated with improved recovery time after transplantation. Handgrip strength has been related to post-transplant outcomes. AIM To evaluate predictors of PA and grip strength in patients with cirrhosis undergoing liver transplant evaluation. METHODS Single-center, prospective analysis. RESULTS One hundred patients were evaluated (54% male, mean age 53 ± 9). Common etiologies of liver disease were non-alcoholic steatohepatitis (27%), hepatitis C (22%) and alcoholic liver disease (21%). Mean model of end-stage liver disease (MELD) score was 13.5. Forty-one percent had a history of smoking. Ninety-three patients completed the International Physical Activity Questionnaire (IPAQ). The median total PA score was 33 metabolic equivalent (MET)-min/wk. The mean total grip strength was 62.1 ± 22 lb. Total grip strength was found to be an independent predictor of low-moderate PA (OR 4.7, 95% CI 1.4-16.2, p = 0.038), and smoking was the only significant factor associated with reduced grip strength (OR 3.4, 95% CI 1.4-8, p = 0.005). CONCLUSIONS Patients with end-stage liver disease undergoing liver transplant evaluation have reduced total PA by IPAQ. Total grip strength was found to be a significant predictor of low-moderate PA in patients with cirrhosis. Smoking is a risk factor for reduced grip strength, an important indicator of muscle wasting in cirrhotics.
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Affiliation(s)
- Anna Christina Dela Cruz
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Valery Vilchez
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Sooyeon Kim
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Benjamin Barnes
- Center for Muscle Biology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Abhishek Ravinuthala
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Anthony Zanni
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Roberto Galuppo
- Department of Radiology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Achuthan Sourianarayanane
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Trushar Patel
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Erin Maynard
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Malay B Shah
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Michael F Daily
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Timothy Uhl
- Center for Muscle Biology, University of Kentucky, College of Medicine, Lexington, KY, USA.,Department of Rehabilitation Sciences, University of Kentucky, College of Health Sciences, Lexington, KY, USA
| | - Karyn Esser
- Center for Muscle Biology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Roberto Gedaly
- Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, USA
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Non-ventilatory approaches to prevent postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol 2015; 29:397-410. [PMID: 26643103 DOI: 10.1016/j.bpa.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 02/07/2023]
Abstract
This educational narrative review provides a summary of non-ventilatory strategies to prevent postoperative pulmonary complications (PPCs). It highlights patient- and procedure-related risk factors for PPCs that are non-modifiable, potentially modifiable, or well modifiable. Non-ventilatory strategies, mainly based on the modification of risk factors, play a key role in reducing PPCs. Non-modifiable risk factors, most importantly age, American Society of Anesthesiologists (ASA) class, and risk of the procedure, should be recognized and patients intensively screened for the potential to optimize other, potentially or well-modifiable, risk factors. Potentially modifiable risk factors, mainly comorbidities and the surgical approach, increase the risk of PPCs. Patient-related factors can be improved while procedure-related factors may be adapted in high-risk patients. Well-modifiable risk factors, mainly certain anesthesia techniques, for example, general anesthesia, intravenous opioids or liberal fluid management, and smoking or alcohol abuse, should be avoided as far as possible in order to prevent PPCs.
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Taylor A, DeBoard Z, Gauvin JM. Prevention of Postoperative Pulmonary Complications. Surg Clin North Am 2015; 95:237-54. [DOI: 10.1016/j.suc.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Schultz CR, Benson JJ, Cook DA, Warner DO. Training for perioperative smoking cessation interventions: a national survey of anesthesiology program directors and residents. J Clin Anesth 2014; 26:563-9. [DOI: 10.1016/j.jclinane.2014.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 01/07/2023]
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Selvarajah S, Ahmed AA, Schneider EB, Canner JK, Pawlik TM, Abularrage CJ, Hui X, Schwartz DA, Hisam B, Haider AH. Cholecystectomy and wound complications: smoking worsens risk. J Surg Res 2014; 192:41-9. [PMID: 25015752 DOI: 10.1016/j.jss.2014.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 05/23/2014] [Accepted: 06/06/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the United States, approximately 800,000 cholecystectomies are performed annually. We sought to determine the influence of preoperative smoking on postcholecystectomy wound complication rates. MATERIALS AND METHODS Using the National Surgical Quality Improvement Program database (2005-2011), patients aged ≥18 y who underwent elective open or laparoscopic cholecystectomy (LC) for benign gallbladder disease were identified using current procedural terminology codes. Multivariate regression was performed to determine the association between smoking status and wound complications, by surgical approach. RESULTS Of 143,753 identified patients, 128,692 (89.5%) underwent LC, 27,788 (19.3%) were active smokers, and 100,710 (70.2%) were females. Active smokers were younger than nonsmokers (mean + standard deviation age: 44.2 (14.9) versus 51.6 (17.9) years); P < 0.001) and had fewer comorbidities. Within 30-d postcholecystectomy, wound complications were reported in 2011 (1.4%) patients. Compared with nonsmokers, active smokers demonstrated increased odds of wound complications after both open cholecystectomy (odds ratio 1.28; P = 0.010) and LC (odds ratio 1.20; P = 0.020) after adjustment for demographic and clinical characteristics. Having wound complications increased the average postoperative length of stay by 2-4 d (P <0.001). CONCLUSIONS Active smokers are more likely to develop wound complications after cholecystectomy, regardless of surgical approach. Occurrence of wound complications consequently increases postoperative length of stay. Smoking abstinence before cholecystectomy may reduce the burden associated with wound complications.
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Affiliation(s)
- Shalini Selvarajah
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Ammar A Ahmed
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric B Schneider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy M Pawlik
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J Abularrage
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuan Hui
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane A Schwartz
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Butool Hisam
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adil H Haider
- Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Accessible or Inaccessible? Diagnostic Efficacy of CT-Guided Core Biopsies of Head and Neck Masses. Cardiovasc Intervent Radiol 2014; 38:422-9. [DOI: 10.1007/s00270-014-0922-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 04/02/2014] [Indexed: 12/17/2022]
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Impact of tobacco and alcohol consumption in patients registered on waiting list on early morbidity following liver transplantation. Clin Res Hepatol Gastroenterol 2013; 37:473-8. [PMID: 23522692 DOI: 10.1016/j.clinre.2013.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/14/2013] [Accepted: 01/30/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a high-risk surgery associated with postoperative complications. Smoking and drinking are known risk factors of long-term post-LT complications, but their role in early complications is still questioned. PATIENTS AND METHODS We retrieved from our medical files the data of all patients registered for LT and who had had a consultation with a physician specialized in substance abuse. Consumption of alcohol, tobacco, and drugs before and after registration for LT was assessed. RESULTS One hundred and five patients were included. Pre-registration smoking and drinking rates were 75.3 and 69.5%, respectively. Forty-three patients continued smoking and nine continued drinking until LT. Mortality and early morbidity rates were not impacted by smoking or drinking. Active smokers had significantly increased prevalence of bacterial cholangitis in comparison to patients who stopped smoking when registered for LT. CONCLUSION Persistent drinking in patients registered for LT is rare as compared to smoking; however, in our series, smoking until LT was not associated with major risk of early complication, except for cholangitis. This suggests that clinicians should take time to encourage patients to quit smoking and the intervention of a team specialized in substance abuse could be highly beneficial.
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Dautzenberg B, Pereira ST, Minot C, Osman J, Bougdal M, Dautzenberg MD. [Smoking prevention in preoperative patient factsheets]. Presse Med 2013; 42:e393-9. [PMID: 24134814 DOI: 10.1016/j.lpm.2013.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 04/17/2013] [Accepted: 04/30/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Information for patients undergoing elective surgery is often supported by factsheets. This information is required for ethical and legal reasons. Among the 11 million surgical procedures performed annually in France, three million concern smokers. Data of a 2005 French Expert's conference show that smoking doubles or triples the risk of postoperative complications and quitting smoking cancels this risk. METHODS By a query on www.google.fr, 100 factsheets were collected in 2009 (pilot study) and 500 in 2012. These factsheets were systematically analyzed on tobacco information. Issuers were contacted by mail, email and telephone to suggest improvements on these factsheets. A return to the websites where the 500 factsheets have been issued was performed 6 months later. RESULTS In 2009, only 24.0% of factsheets mentioned tobacco. In 2012, 29.4% of factsheets evoked tobacco. When tobacco is mentioned, information's were rarely complete. Cosmetic surgeons, maxillofacial surgeons and to a lesser extent orthopaedists are those who raise most often the tobacco issue. After contact with issuers, 41 factsheets were removed from the sites. Factsheets with tobacco information increased from 147/500 (29.4%) to 175/459 (38.1%) and the quality score of the information increased from 3.4 to 6.0. The message suggested by OFT was: "Smoking increases the risk of surgical complications of any surgery. Quitting smoking 6-8 weeks before surgery eliminates this additional risk. If you smoke, talk to your doctor, your surgeon and your anesthesiologist or call the French quitline TIS 3989 to help you to reduce the risk and put all the chances on your side". This sentence was included in 54 factsheets. CONCLUSION There is still work to do to improve information's on smoking risk in perioperative factsheets. The aim is to reduce postoperative complications, costs and avoid court sentences against practitioner who do not inform properly on the risks of smoking on surgical procedures.
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Affiliation(s)
- Bertrand Dautzenberg
- Office français de prévention du tabagisme (OFT), 75006 Paris, France; Groupe hospitalier Pitié Salpêtrière-Charles Foix, université Pierre-et-Marie-Curie, service de pneumologie et de réanimation (AP-HP), Paris-6, Paris, France.
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Abstract
OBJECTIVE The aim of this study was to delineate the impact of smoking on postoperative outcomes after colorectal resection for malignant and benign processes. BACKGROUND Studies to date have implicated smoking as a risk factor for increased postoperative complications. However, there is a paucity of data on the effects of smoking after colorectal surgery and in particular for malignant compared with benign processes. METHODS The American College of Surgeon's National Surgical Quality Improvement Program (2005-2010) database was queried for patients undergoing elective major colorectal resection for colorectal cancer, diverticular disease, or inflammatory bowel disease. Risk-adjusted 30-day outcomes were assessed and compared between patient cohorts identified as never-smokers, ex-smokers, and current smokers. Primary outcomes of incisional infections, infectious and major complications, and mortality were evaluated using regression modeling adjusting for patient characteristics and comorbidities. RESULTS A total of 47,574 patients were identified, of which 26,333 had surgery for colorectal cancer, 14,019 for diverticular disease, and 7222 for inflammatory bowel disease. More than 60% of patients had never smoked, 20.4% were current smokers, and 19.2% were ex-smokers. After adjustment, current smokers were at a significantly increased risk of postoperative morbidity [odds ratio (OR), 1.3; 95% confidence interval (CI), 1.21-1.40] and mortality (OR, 1.5; 95% CI, 1.11-1.94) after colorectal surgery. This finding persisted across malignant and benign diagnoses and also demonstrated a significant dose-dependent effect when stratifying by pack-years of smoking. CONCLUSIONS Smoking increases the risk of complications after all types of major colorectal surgery, with the greatest risk apparent for current smokers. A concerted effort should be made toward promoting smoking cessation in all patients scheduled for elective colorectal surgery.
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Nonventilatory strategies to prevent postoperative pulmonary complications. Curr Opin Anaesthesiol 2013; 26:141-51. [PMID: 23385322 DOI: 10.1097/aco.0b013e32835e8bac] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery. RECENT FINDINGS Although nonavoidable, most comorbidities can be modified in order to reduce the incidence of pulmonary events postoperatively. The physical status of patients suffering from chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, and congestive heart failure can be improved preoperatively, and a number of measures can be undertaken to prevent PPCs, including physiotherapy for pulmonary rehabilitation and drug therapies. Also, smokers may benefit from both short and long-term smoke cessation. Furthermore, the risk of PPCs may be reduced upon: choice of an adequate anesthesia strategy (e.g. regional vs. general); appropriate neuromuscular blockade and reversal; use of volatile instead of intravenous anesthetics in lung surgery; judicious intravascular volume expansion (restrictive vs. liberal strategy); regional instead of systemic analgesia after major surgery in high-risk patients; more strict indication for nasogastric decompression in order to avoid silent aspiration; and laparoscopic instead of open bariatric surgery. SUMMARY Nonventilatory strategies can play an important role in reducing PPCs and improving clinical outcome after noncardiac surgery, especially in high-risk patients.
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Arthroscopic suture-bridge repair for small to medium size supraspinatus tear: healing rate and retear pattern. Arthroscopy 2013; 29:10-7. [PMID: 23159493 DOI: 10.1016/j.arthro.2012.06.020] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 06/21/2012] [Accepted: 06/21/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to assess the repair site integrity after transosseous equivalent/suture-bridge (TOE/SB) repair with the use of magnetic resonance imaging (MRI). METHODS One hundred seven consecutive shoulders with a small to medium-size full-thickness supraspinatus tear were repaired arthroscopically with use of the TOE/SB technique. There were 64 men and 41 women, and mean age at the time of surgery was 54.8 years (range, 21 to 74 years). All patients underwent postoperative MRI and clinical examination. Mean follow-up was 16.1 months (range, 12 to 28 months). RESULTS The mean Constant score improved from 54.5 ± 12.5 points preoperatively to 80 ± 12.1 points postoperatively (P < .0001). The mean pain score improved from 7 ± 2 points preoperatively to 13 ± 2.5 postoperatively (P < .0001). The mean active forward flexion improved from 151° ± 37° preoperatively to 169° ± 14° postoperatively (P < .0001). The mean Constant score was 81 points when repaired tendon had healed and it was 72.6 points when repaired tendon was unhealed (P = .02). Smoking status was found to have detrimental influence on the tendon healing (P = .04). Postoperative MRI showed a healed repair in 96 (89.7%) of 107 shoulders. Among 11 retears, 10 occurred at the greater tuberosity and 1 occurred at the musculotendinous junction. CONCLUSIONS Arthroscopic TOE/SB repair of full-thickness supraspinatus tendon led to a healing rate of 89.7%. Patients with healed tendons according to MRI had significant better functional and subjective outcome. Smoking habit was found to be detrimental on healing. Retears occurred mainly at tendon-bone interface at the greater tuberosity, whereas medial cuff failure was observed in only one case in the mean time of follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Icard P, Heyndrickx M, Guetti L, Galateau-Salle F, Rosat P, Le Rochais JP, Hanouz JL. Morbidity, mortality and survival after 110 consecutive bilobectomies over 12 years. Interact Cardiovasc Thorac Surg 2012; 16:179-85. [PMID: 23117235 DOI: 10.1093/icvts/ivs419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse statistical aspects of mortality, morbidity and survival after bilobectomy (BT), an operation rarely studied in the literature. METHODS One hundred and ten cases were studied, comprising 58 upper-middle bilobectomies and 52 lower-middle bilobectomies performed between 1999 and 2010. Indications were of 9 benign diseases, 12 carcinoid tumours, 5 metastases and 84 non-small cell lung cancers (2 stage 0; 34 stage I; 22 stage II; 25 stage III and 1 stage IV). RESULTS Mortality was nil. Twenty-six percent of patients experienced significant morbidity, influenced in multivariate analysis by the presence of three or more comorbidities (P = 0.03) and by a forced expiratory volume in 1 s of <60% (P = 0.01). Lower-middle BT was associated with more postoperative complications than upper-middle BT (P = 0.012). The 5-year survival rate of patients with non-small cell lung carcinoma was 82% in stage I, 59% in stage II and 20% in stage IIIA. Survival was significantly influenced by stage (P = 0.0018) and tobacco weaning (P = 0.0012). CONCLUSIONS BT can be achieved with low mortality, and survival results that are comparable with those unregistered after standard lobectomy. However, almost one quarter of patients experienced significant postoperative complications. Surgical techniques aiming to reduce residual pleural space should be especially considered after lower-middle BT, due to the highest morbidity being associated with this procedure.
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Affiliation(s)
- Philippe Icard
- Department of Thoracic Surgery, University of Caen Basse-NormandSie and University Hospital of Caen, Caen, France
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Abstract
Enhanced recovery after surgery (ERAS) programs have been shown to minimise morbidity in other types of surgery, but comparatively less data exist investigating ERAS in bariatric surgery. This article reviews the existing literature to identify interventions which may be included in an ERAS program for bariatric surgery. A narrative literature review was conducted. Search terms included 'bariatric surgery', 'weight loss surgery', 'gastric bypass', 'ERAS', 'enhanced recovery', 'enhanced recovery after surgery', 'fast-track surgery', 'perioperative care', 'postoperative care', 'intraoperative care' and 'preoperative care'. Interventions recovered by the database search, as well as interventions garnered from clinical experience in ERAS, were used as individual search terms. A large volume of evidence exists detailing the role of multiple interventions in perioperative care. However, efficacy and safety for a proportion of these interventions for ERAS in bariatric surgery remain unclear. This review concludes that there is potential to implement ERAS programs in bariatric surgery.
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Bortoluzzi MC, Capella DL, Barbieri T, Marchetti S, Dresch CP, Tirello C. Does smoking increase the incidence of postoperative complications in simple exodontia? Int Dent J 2012; 62:106-8. [DOI: 10.1111/j.1875-595x.2011.00098.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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