1
|
Jing B, Chen D, Dai H, Liu J, Chen C, Dai M, Hu J, Lu Z, Wang J. Association between neutrophil-to-lymphocyte ratio and postoperative fatigue in elderly patients with hip fracture. Heliyon 2023; 9:e22314. [PMID: 38144319 PMCID: PMC10746395 DOI: 10.1016/j.heliyon.2023.e22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/26/2023] Open
Abstract
Background and purpose: Postoperative fatigue (POF) is a common and distressing post-operative symptom. This study aimed to explore the relationship between neutrophil-to-lymphocyte ratio (NLR) and POF in elderly patients with hip fracture. Method Elderly patients (age ≥65 years) with acute hip fracture admitted to the Department of Orthopedics of Anqing Municipal Hospital from June 2018 to June 2020 were included. Fatigue was assessed using the Fatigue Severity Scale at the 3-month follow-up postoperatively. Univariate and multivariate analyses were performed to explore the associations between NLR and POF. The diagnostic performance of NLR was analysed using Receiver Operating Characteristic (ROC) curve analysis and the Delong test. Result A total of 321 elderly patients with hip fractures were included; 120 (37.4 %) of them were diagnosed with POF. Univariate analysis indicated significant differences in NLR, platelet-to-lymphocyte ratio (PLR), education, neutrophil count, lymphocyte count, Hamilton Depression Scale (HAMD) and Insomnia Severity Index (ISI) scores (P < 0.05). Multivariate analysis indicated neutrophil count (odds ratio [OR], 1.46; 95 % confidence interval [CI] 1.27-1.67), lymphocyte count (OR 0.32, 95 % CI 0.19-0.53), NLR (OR1.81, 95 % CI 1.50-2.17) and PLR (OR 1.005, 95 % CI 1.001-1.009) were significantly associated with POF. The areas under the ROC curves (AUCs) of neutrophil count, lymphocyte count, NLR and PLR were 0.712, 0.667, 0.775 and 0.605, respectively. The Delong test indicated that NLR had the best diagnostic performance (p < 0.05). Conclusion NLR independently predicts POF in elderly patients with acute hip fracture.
Collapse
Affiliation(s)
- Baosheng Jing
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Dangui Chen
- Department of Hematology, AnQing Municipal Hospitals, Anqing, China
| | - Huming Dai
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Jingrui Liu
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Cheng Chen
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Mingjun Dai
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Jing Hu
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| | - Zhengfeng Lu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianjun Wang
- Department of Orthopedics, AnQing Municipal Hospitals, Anqing, China
| |
Collapse
|
2
|
Mendy N, Moriceau J, Sacuto Y, Besnier E, Clavier T, Ndangang MM, Castel H, Dureuil B, Compère V. Postoperative fatigue after day surgery: prevalence and risk factors. A prospective observational study. Minerva Anestesiol 2020; 86:1269-1276. [DOI: 10.23736/s0375-9393.20.14358-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
3
|
Affiliation(s)
- Katia Donadello
- Unit of Anesthesiology and Intensive Care B, Department of Surgery, Dentistry, Gynecology and Pediatrics, AOUI-University Hospital Integrated Trust of Verona, University of Verona, Verona, Italy -
| | - Leonardo Gottin
- Unit of Cardio-Thoracic Anesthesiology and Intensive Care, Department of Surgery, Dentistry, Gynecology and Pediatrics, AOUI-University Hospital Integrated Trust of Verona, University of Verona, Verona, Italy
| |
Collapse
|
4
|
Xu XY, Lu JL, Xu Q, Hua HX, Xu L, Chen L. Risk factors and the utility of three different kinds of prediction models for postoperative fatigue after gastrointestinal tumor surgery. Support Care Cancer 2020; 29:203-211. [PMID: 32337625 DOI: 10.1007/s00520-020-05483-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/20/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Postoperative fatigue (POF) is a common complication after gastrointestinal tumor surgery, and it also brings negative effect on prognosis and life quality. However, there are no prediction models for POF, and studies of risk factors are not comprehensive. Therefore, the aim of this study is to investigate the risk factors and pick out the best prediction model for POF and to validate it. METHODS A prospective study was conducted for patients undergoing elective gastrointestinal tumor surgery. Physiological, psychological, and socioeconomic factors were collected. Logistic regression, back-propagation artificial neural networks (BP-ANNs), and classification and regression tree (CART) were constructed and compared. RESULTS A total of 598 patients consisting of 463 derivation sample and 135 validation sample were included. The incidence of POF in derivation sample, validation sample, and total were 58.3%, 57.0%, and 58.7%, respectively. Logistic regression results showed age, higher degree of education, lower personal monthly income, advanced cancer, hypoproteinemia, preoperative anxiety or depression, and limited social support were risk factors for POF. Receiver operating characteristic curve (ROC) and performance indices were used to test three models. BP-ANN was the best by the comparison of models, and its strong predictive performance was also validated. CONCLUSIONS More attention should be paid on specific patients after gastrointestinal tumor surgery. BP-ANN is a powerful mathematical tool that could predict POF exactly. It may be used as a noninvasive screening tool to guide clinicians for early identification of high-risk patients and grading interventions.
Collapse
Affiliation(s)
- Xin-Yi Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jin-Ling Lu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China.
| | - Hong-Xia Hua
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Le Xu
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Li Chen
- Department of general surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
5
|
Wu JM, Yang HT, Ho TW, Shun SC, Lin MT. Association between Interleukin-6 Levels and Perioperative Fatigue in Gastric Adenocarcinoma Patients. J Clin Med 2019; 8:jcm8040543. [PMID: 31010015 PMCID: PMC6518263 DOI: 10.3390/jcm8040543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Gastric adenocarcinoma (GA), one of the most common gastrointestinal cancers worldwide, is often accompanied by cancer cachexia in the advanced stage owing to malnutrition and cancer-related symptoms. Although resection is the most effective curative procedure for GA patients, it may cause perioperative fatigue, worsening the extent of cancer cachexia. Although the relationship between cytokines and cancer fatigue has been evaluated, it is unclear which cytokines are associated with fatigue in GA patients. Therefore, this study aimed to investigate whether the changes in cytokine levels were associated with the perioperative changes in fatigue amongst GA patients. Methods: We included GA patients undergoing gastric surgery in a single academic medical center between June 2017 and December 2018. Fatigue-related questionnaires, serum cytokine levels (interferon-gamma, interleukin (IL)-1, IL-2, IL-5, IL-6, IL-12 p70, tumor necrosis factor-alpha, and granulocyte-macrophage colony-stimulating factor), and biochemistry profiles (albumin, prealbumin, C-reactive protein, and white blood cell counts) were assessed at three time points (preoperative day 0 (POD 0), post-operative day 1 (POD 1), and postoperative day 7 (POD 7)). We used the Brief Fatigue Inventory-Taiwan Form to assess the extent of fatigue. The change in fatigue scores among the three time points, as an independent variable, was adjusted for clinicopathologic characteristics, malnutrition risk, and cancer stages. Results: A total of 34 patients were included for analysis, including 12 female and 22 male patients. The mean age was 68.9 years. The mean score for fatigue on POD 0, POD 1, and POD 7 was 1.7, 6.2, and 3.6, respectively, with significant differences among the three time points (P < 0.001). Among the cytokines, only IL-6 was significantly elevated from POD 0 to POD 1. In the regression model, the change in IL-6 levels between POD 0 and POD 1 (coefficients = 0.01 for every 1 pg/mL increment; 95% confidence interval: 0.01–0.02; P = 0.037) and high malnutrition risk (coefficients = 2.80; 95% confidence interval: 1.45–3.52; P = 0.041) were significantly associated with changes in fatigue scores. Conclusions: The perioperative changes in plasma IL-6 levels are positively associated with changes in the fatigue scores of GA patients undergoing gastric surgery. Targeting the IL-6 signaling cascade or new fatigue-targeting medications may attenuate perioperative fatigue, and further clinical studies should be designed to validate this hypothesis.
Collapse
Affiliation(s)
- Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd. Taipei 10002, Taiwan.
| | - Hui-Ting Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei 10002, Taiwan.
| | - Te-Wei Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd. Taipei 10002, Taiwan.
| | - Shiow-Ching Shun
- School of Nursing, College of Medicine, National Taiwan University, Taipei 10002, Taiwan.
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, 7 Chung-Shan South Rd. Taipei 10002, Taiwan.
| |
Collapse
|
6
|
Defining the cut-off point of clinically significant postoperative fatigue in three common fatigue scales. Qual Life Res 2018; 28:991-1003. [PMID: 30506178 DOI: 10.1007/s11136-018-2068-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 11/12/2022]
Abstract
PURPOSE Postoperative fatigue (POF) is an often underestimated problem after surgery. Studies on POF often report fatigue scores without relating this to the clinical relevance for the patients. The aim of this study was to define the cut-off point for clinically significant POF in three commonly applied fatigue scales; the Postoperative Fatigue Scale, Christensen's Fatigue Scale, and the Chalder Fatigue Questionnaire. The identification of cut-off points will make it possible to indicate whether statistically significant findings of increased fatigue are of clinical relevance. METHODS We combined data from day 0 (pre-operatively) and day 1, 3, 6, and 30 after surgery in two fatigue-related studies with 442 patients. In order to define clinically significant fatigue, a key question was added in each questionnaire; "Given your current description of fatigue, would you say it has been of considerable significance to you?"; "Yes/No". We analysed each scale's ability to identify clinically significant fatigue, by performing receiver-operating characteristics (ROC) analyses, and calculated the optimal cut-off point between Sensitivity and Specificity. RESULTS The average weighted cut-off point for clinically significant POF when measured with the Postoperative Fatigue Scale was ≥ 50 (scale range 0-100), with Christensen's Fatigue Scale ≥ 6 (scale range 1-10) and with the Chalder Fatigue Questionnaire ≥ 16 (scale range 0-33). CONCLUSION In three commonly used fatigue scales, we have identified cut-off points for clinically significant fatigue among patients recovering from surgery. This can be particularly valuable for diagnostic purposes and in treatment evaluation. Further, it may be possible to analyse and review data from earlier studies in light of clinical relevance.
Collapse
|
7
|
Burton D, King A, Bartley J, Petrie KJ, Broadbent E. The surgical anxiety questionnaire (SAQ): development and validation. Psychol Health 2018; 34:129-146. [DOI: 10.1080/08870446.2018.1502770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dominic Burton
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amy King
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jim Bartley
- Department of Otorhinolaryngology – Head and Neck Surgery, Counties Manukau District Health Board, Otahuhu, Auckland, New Zealand
| | - Keith J. Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
8
|
Abstract
BACKGROUND Nutrition monitoring in the context of critical care presents unique challenges. Traditionally used anthropometric and biochemical markers may be difficult to obtain or confounded by factors such as fluid status and the inflammatory response. A previous survey identified 15 parameters in common use, all of which have confounding influences during critical illness. MATERIALS AND METHODS A literature search was conducted to assess current use of commonly used nutrition-monitoring parameters and to explore other possible methods that might be more useful. More than 1000 journal articles were reviewed to identify indicators of nutrition status or nutrition progress that have been used in ICU studies. The most recent 200 articles were examined to quantify the number of occurrences for each indicator. Each parameter was rated for availability and feasibility in the ICU. RESULTS There were 53 parameters found, including the 15 already identified as commonly used; 27 were used in ≥3 recent studies. Less-well-established nutrition indicators with potential for use in the ICU (moderate or high feasibility and availability) included ultrasound measurement of arm or leg muscle thickness, fatigue scoring with the Chalder scale, urinary creatinine assay, and serum insulin-like growth factor 1 level. None of these was among the commonly used indicators in recent studies. CONCLUSION This study identifies commonly used nutrition-monitoring parameters and discusses their feasibility and availability in the critical care setting. Further investigation of nutrition indicators in ICU is needed, ideally as part of a randomized trial to reduce the effect of the many possible confounding factors.
Collapse
Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Erica Tsang
- Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
9
|
Nostdahl T, Fredheim OM, Bernklev T, Doksrod TS, Mohus RM, Raeder J. A randomised controlled trial of propofol vs. thiopentone and desflurane for fatigue after laparoscopic cholecystectomy. Anaesthesia 2017; 72:864-869. [DOI: 10.1111/anae.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Affiliation(s)
- T. Nostdahl
- Department of Anaesthesiology; Telemark Hospital; Skien Norway
| | - O. M. Fredheim
- Department of Circulation and Medical Imaging; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Centre of Palliative Medicine, Surgical Division; Akershus University Hospital; Lørenskog Norway
- National Competence Centre for Complex Symptom Disorders; Department of Pain and Complex Disorders; Trondheim Norway
| | - T. Bernklev
- Research and Development; Vestfold Hospital Trust; Tønsberg Norway
- Institute of Clinical Medicine; Medical Faculty; University of Oslo; Oslo Norway
| | - T. S. Doksrod
- Department of Anaesthesiology; Telemark Hospital; Skien Norway
| | - R. M. Mohus
- Department of Anaesthesiology; St. Olav University Hospital; Trondheim Norway
| | - J. Raeder
- Institute of Clinical Medicine; Medical Faculty; University of Oslo; Oslo Norway
- Department of Anaesthesiology; Oslo University Hospital; Oslo Norway
| |
Collapse
|
10
|
Lu Y, Yang R, Jiang X, Yang Y, Peng F, Yuan H. Serum metabolite profiles of postoperative fatigue syndrome in rat following partial hepatectomy. J Clin Biochem Nutr 2016; 58:210-5. [PMID: 27257346 PMCID: PMC4865597 DOI: 10.3164/jcbn.15-72] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/03/2015] [Indexed: 01/29/2023] Open
Abstract
Postoperative fatigue syndrome is a general complication after surgery. However, there is no ‘‘gold standard’’ for fatigue assessment due to the lack of objective biomarkers. In this study, a rodent model of postoperative fatigue syndrome based on partial hepatectomy was firstly established and serum metabonomic method based on ultra-high performance liquid chromatography coupled with Q-TOF mass spectrometry was applied. Partial least-squares discriminant analysis was used to identify the differential metabolites in 70% partial hepatectomy rats relative to sham rats and 30% partial hepatectomy rats, which showed 70% partial hepatectomy group was significantly distinguishable from 30% partial hepatectomy group and sham group. Eighteen serum metabolites responsible for the discrimination were identified. The levels of hypoxanthine, kynurenine, tryptophan, uric acid, phenylalanine, palmitic acid, arachidonic acid and oleic acid showed progressive elevation from sham group to 30% partial hepatectomy group to 70% partial hepatectomy group, and levels of valine, tyrosine, isoleucine, linoleyl carnitine, palmitoylcarnitine, lysophosphatidylcholine (16:0), lysophosphatidylcholine (20:3), citric acid, succinic acid and hippuric acid showed progressive declining trend from sham group to 30% partial hepatectomy group to 70% partial hepatectomy group. These potential biomarkers help to understand of etiology, pathophysiology and treatment of postoperative fatigue syndrome.
Collapse
Affiliation(s)
- Ye Lu
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Rui Yang
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Xin Jiang
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Yajuan Yang
- Department of Nursing, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu district, Shanghai 200003, China
| | - Fei Peng
- Department of Nursing, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu district, Shanghai 200003, China
| | - Hongbin Yuan
- Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| |
Collapse
|
11
|
Postoperative fatigue; translation and validation of a revised 10-item short form of the Identity-Consequence Fatigue Scale (ICFS). J Psychosom Res 2016; 84:1-7. [PMID: 27095152 DOI: 10.1016/j.jpsychores.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Postoperative fatigue is a common problem after otherwise uncomplicated surgery. It may defer patients from resuming their daily activities and is often reported to be among their most severe symptoms. There are few validated instruments for assessing postoperative fatigue. Our aim was to translate into Norwegian and explore a Short Form of the Identity-Consequences Fatigue Scale; a fatigue questionnaire specifically developed to assess postoperative fatigue. METHODS The fatigue scale was translated to Norwegian through a forward-backward process, and subsequently validated in a large, mixed surgical population. We performed Principal Component Analyses on the complete 31-item scale and on the 10-item Short Form. The analyses were performed separately on pre- and postoperative data (n=422 and n=315, respectively). RESULTS The factor analyses confirmed that the translation was valid and revealed three defined dimensions in the 10-item scale. There was no statistically significant difference between means of reported fatigue when measured with the 31- or 10-item scale. Ninety-eight% of change in fatigue from pre- to postoperative status was retained when using the 10-item scale as compared to the 31-item scale. CONCLUSION The abridged, 10-item Short Form performed equal to the 31-item scale and may replace the complete 31-item ICSF scale in exploring the incidence of pre- and post-operative fatigue.
Collapse
|
12
|
Yu J, Zhuang CL, Shao SJ, Liu S, Chen WZ, Chen BC, Shen X, Yu Z. Risk factors for postoperative fatigue after gastrointestinal surgery. J Surg Res 2015; 194:114-9. [DOI: 10.1016/j.jss.2014.09.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/31/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
|
13
|
Silva YR. Response to letter regarding 'Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation on high-risk open upper abdominal surgery alter patient outcomes? Cluster randomised controlled trial'. Physiotherapy 2014; 100:275-6. [PMID: 24680093 DOI: 10.1016/j.physio.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Y R Silva
- Concord Repatriation General Hospital, Concord, NSW, Australia.
| |
Collapse
|
14
|
Silva Y, Li S, Rickard M. Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial. Physiotherapy 2013. [DOI: 10.1016/j.physio.2012.09.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Hovens IB, Schoemaker RG, van der Zee EA, Heineman E, Nyakas C, van Leeuwen BL. Surgery-induced behavioral changes in aged rats. Exp Gerontol 2013; 48:1204-11. [PMID: 23916881 DOI: 10.1016/j.exger.2013.07.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/09/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022]
Abstract
Elderly patients may experience impairments in cognition or mood following surgery. To study the development and underlying mechanisms of these postoperative behavioral changes, young (3 months) and aged (18-20 months) male rats were subjected to abdominal surgery followed by behavioral testing during a period of 6 weeks. Microglia activation (IBA-1) and neurogenesis (DCX) were immunohistochemically determined. In separate experiments, the effects of anesthesia and the cytokine response (IL-6) following surgery were evaluated. Increased age was associated with changes in affective behavior, decreased cognitive flexibility and increased microglia activation as well as increased weight loss and plasma IL-6 following surgery. No effects of surgery on cognition were observed at either age. However, aged rats displayed long-term changes in affective behavior and had increased microgliosis in the CA1 hippocampal region following surgery. Microglia activation following surgery was positively correlated to parameters of behavior and spatial learning. These findings support the hypothesis that elderly patients have an increased behavioral and (neuro)inflammatory response to surgery and these factors may be related.
Collapse
Affiliation(s)
- Iris B Hovens
- Department of Molecular Neurobiology, University of Groningen, Nijenborgh 7, 9747 AG, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
16
|
The effect of perioperative psychological intervention on fatigue after laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 2012; 26:1730-6. [PMID: 22258294 DOI: 10.1007/s00464-011-2101-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 11/25/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Fatigue is one of the main complaints after surgery and may last longer than physical symptoms. It prevents return to normal function and activity. Relaxation interventions, performed prior to abdominal surgery, have been shown to reduce pain, wound erythema, and systemic cortisol levels. However, there is a lack of data on the impact of this intervention on patient well-being, functional recovery, activities of daily living, and fatigue after discharge from hospital. METHODS The study was a randomised single-blinded trial. Patients who were to undergo elective laparoscopic cholecystectomy for any indication between April 2008 and May 2010 were screened for inclusion. Those in the intervention group attended a standardised 45 min relaxation session with a health psychologist and were given relaxation exercise CDs to take home. The control group did not have the intervention. Patients were followed for 30 days. Fatigue was measured using the identity-consequence fatigue scale. RESULTS Seventy-five patients were randomised. Fifteen patients were excluded after randomization for various reasons; hence, 60 patients were followed up and analysed. Both groups had similar fatigue at baseline. There was improved fatigue and consequence of fatigue on postoperative day 30 in the intervention group. There was no difference in fatigue at any other time point postoperatively. CONCLUSION This was the first interventional study targeting fatigue after laparoscopic cholecystectomy by using a brief psychological relaxation intervention. It has shown a reduction of fatigue and impact of fatigue at 30 days postoperatively in the intervention group.
Collapse
|
17
|
Zhang XD, Chen BC, Dong QT, Andersson R, Pan XD, Tan SJ, Ye XZ, Yao JG, Yu Z. Establishment and assessments of a new model for the postoperative fatigue syndrome by major small intestinal resection in rats. Scand J Gastroenterol 2011; 46:1302-9. [PMID: 21854092 DOI: 10.3109/00365521.2011.610001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Postoperative fatigue syndrome (POFS) is a general and main complication after surgery. However, there is no stable and standardized animal model for POFS. The aim of the present study was to establish a rodent model of POFS by small intestinal resection, with POFS evaluated by acknowledged physical and behavioral methods. MATERIAL AND METHODS Forty-two Sprague-Dawley rats were randomly divided into four groups according to the length of a "middle" small intestinal resection: 0% (sham group; i.e., laparotomy alone), 10%, 40% and 70% groups, with corresponding lengths of small intestinal resections. Following surgery, the general state of health was evaluated. Tail suspension test, open field test and Morris water maze test were used to evaluate the degree of POFS. Serum albumin, transferrin, prealbumin and fibronectin were measured to assess the nutritional status, and superoxide dismutase (SOD) and malondialdehyde (MDA) were also measured. RESULTS As compared with the other three groups, the 70% small intestinal resection group showed the worst general state of health, decreased strength of the tail suspension test and decreased score of Morris water maze test (p < 0.05) after operation. All rats in whom the small intestinal resection was done demonstrated a certain degree of malnutrition and behavior of depression, and the 70% resection group had the lowest levels of transferrin, prealbumin and fibronectin as compared with the other groups (p < 0.05), as well as decreased SOD and increased MDA in serum (p < 0.05). CONCLUSIONS Resection of 70% of the small intestine resulted in typical characteristics of POFS. As this procedure is simple, stable and easily reproducible, it may serve as a model for research on POFS.
Collapse
Affiliation(s)
- Xiao-Dong Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Kahokehr AA, Zargar-Shoshtari K, Sammour T, Srinivasa S, Hill AG. Fatigue postopératoire : mythe ou réalité. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.pratan.2010.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
19
|
Montgomery GH, Schnur JB, Erblich J, Diefenbach MA, Bovbjerg DH. Presurgery psychological factors predict pain, nausea, and fatigue one week after breast cancer surgery. J Pain Symptom Manage 2010; 39:1043-52. [PMID: 20538186 PMCID: PMC2918882 DOI: 10.1016/j.jpainsymman.2009.11.318] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/27/2022]
Abstract
Before scheduled surgery, breast cancer surgical patients frequently experience high levels of distress and expect a variety of postsurgery symptoms. Previous literature has supported the view that presurgery distress and response expectancies are predictive of postsurgery outcomes. However, the contributions of distress and response expectancies to postsurgical side effect outcomes have rarely been examined together within the same study. Furthermore, studies on the effects of response expectancies in the surgical setting have typically focused on the immediate postsurgical setting rather than the longer-term setting. The purpose of the present study was to test the contribution of presurgery distress and response expectancies to common postsurgery side effects (pain, nausea, and fatigue). Female patients (n=101) undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery pain severity (P<0.05) and fatigue (P<0.003) one week after surgery. Response expectancies uniquely contributed to pain severity (P<0.001), nausea (P<0.012), and fatigue (P<0.010) one week after surgery. Sobel tests indicated that response expectancies partially mediated the effects of distress on pain severity (P<0.03) and fatigue (P<0.03). Response expectancies also mediated the effects of age on pain severity, nausea, and fatigue. Results highlight the contribution of presurgery psychological factors to postsurgery side effects, the importance of including both emotional and cognitive factors within studies as predictors of postsurgery side effects, and suggest presurgical clinical targets for improving patients' postoperative experiences of side effects.
Collapse
Affiliation(s)
- Guy H Montgomery
- Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
| | | | | | | | | |
Collapse
|
20
|
Montgomery GH, Hallquist MN, Schnur JB, David D, Silverstein JH, Bovbjerg DH. Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: response expectancies and emotional distress. J Consult Clin Psychol 2010; 78:80-8. [PMID: 20099953 DOI: 10.1037/a0017392] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). METHOD Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispanic, 13% African American, and 9% other) were randomized to a hypnosis or to an attention control group. Prior to surgery, patients completed assessments of hypothesized mediators (response expectancies and emotional distress), and following surgery, patients completed assessments of outcome variables (pain, nausea, and fatigue). RESULTS Structural equation modeling revealed the following: (a) Hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p < .0001) but not by distress (p = .12); (b) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p = .02) but not by nausea expectancy (p = .10); and (c) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p = .0001) and presurgical distress (p = .02). CONCLUSIONS The results demonstrate the mediational roles of response expectancies and emotional distress in clinical benefits associated with a hypnotic intervention for breast cancer surgical patients. More broadly, the results improve understanding of the underlying mechanisms responsible for hypnotic phenomena and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery.
Collapse
Affiliation(s)
- Guy H Montgomery
- Department of Oncological Sciences, Box 1130, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029-6574, USA.
| | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Abstract
Cancer-related fatigue (CRF) is influenced and modulated by a number of critical factors, and the mechanism that is both necessary and sufficient to induce development of severe fatigue in patients with cancer has not yet been identified. Specific research efforts to understand the factors that may contribute to CRF development have been made, including studies of the direct effects of tumor burden, the effects of cancer treatment, and other pathophysiologic and psychosocial conditions. Compelling new hypotheses regarding CRF pathophysiology have been proposed, such as the pro-inflammatory hypothesis, the serotonin hypothesis, the vagal-afferent-activation hypothesis, the anemia hypothesis, and the adenosine triphosphate hypothesis; some of these have been tested in both animal models and humans and some in animals only. Gaining an understanding of the specific mechanisms related to the development of fatigue in patients with cancer and survivors requires further investigation. Pathophysiologic research in CRF could be applied in the clinic to improve CRF diagnosis and to enable administration of mechanism-driven interventions. A targeted intervention study with CRF as a primary end point also would be useful.
Collapse
Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
23
|
Zargar-Shoshtari K, Paddison JS, Booth RJ, Hill AG. A prospective study on the influence of a fast-track program on postoperative fatigue and functional recovery after major colonic surgery. J Surg Res 2008; 154:330-5. [PMID: 19118844 DOI: 10.1016/j.jss.2008.06.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 06/05/2008] [Accepted: 06/17/2008] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Enhanced Recovery After Surgery (ERAS) programs have demonstrated significant reduction in hospital stay for patients undergoing colonic surgery; however, their impact on long-term outcomes, such as postoperative fatigue (POF), has not been fully established. AIM To assess the impact of an ERAS program on POF and recovery following elective open colonic surgery. METHOD In a prospective study, 26 consecutive patients undergoing open colonic surgery under a conventional care plan were compared with 26 consecutive patients in an ERAS program. RESULTS Demographic and clinical characteristics were comparable at baseline. The median duration of total hospital stay (4 versus 7 d, P < 0.001), rates of urinary tract infections (P = 0.028) and ileus (P = 0.042) were significantly smaller in the ERAS group. Postoperatively, POF significantly increased in both groups. However, peak POF score was significantly lower in the ERAS group (P = 0.001). In the first 30 d after surgery, Fatigue Consequence scores were also significantly smaller in the ERAS group. Overall, the total fatigue experience (P = 0.035) and the total fatigue impact (P = 0.005) were significantly smaller in the ERAS group. CONCLUSION The impact of ERAS programs may extend beyond the commonly reported short-term outcomes, and ERAS may accelerate overall recovery and return to normal function.
Collapse
|
24
|
Laederach-Hofmann K, Rüddel H, Mussgay L. Pathological baroreceptor sensitivity in patients suffering from somatization disorders: do they correlate with symptoms? Biol Psychol 2008; 79:243-9. [PMID: 18611426 DOI: 10.1016/j.biopsycho.2008.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 06/04/2008] [Accepted: 06/10/2008] [Indexed: 11/17/2022]
Abstract
AIM We conducted a study to investigate whether patients with somatization disorders (ICD-10, F45.0) show abnormal values in autonomic testing. METHOD 35 patients with a diagnosis of somatization disorder (SP) were matched to 35 healthy volunteers (HV). International standardized autonomic testing based on heart rate variation and continuously measured blood pressure signals was used to assess autonomic activity and establish baroreceptor sensitivity (BRS). Three different statistical procedures were used to confirm the reliability of the findings. RESULTS There were no statistical differences between the 2 groups in age, BMI, systolic and diastolic blood pressures, and spectral values (total power, low, and high frequency power). However, heart rate was higher (p=0.044) and baroreceptor sensitivity was lower (p=0.002) in the patients compared to the healthy volunteers. Median BRS (+/-S.E.M.) of patients was 9.09+/-0.65 compared to 12.04+/-0.94 ms/mmHg in healthy volunteers. Twenty-two of the 35 patients had a BRS of -1.0S.D. below the mean of HV. SP with lower values differed from SP with normal BRS in values of total power, low-, mid-, and high-frequency bands (p<0.01 to <0.0001). No differences in psychometric testing were found between patients with lower or higher BRS. In addition, no correlation whatsoever was found in relation to autonomic variables between HV and SP, except for a higher LF/HF quotient in the latter (p<0.05). CONCLUSION Autonomic regulation was impaired in 62% of patients with a somatization disorder. Severity of clinical symptoms measured by psychometric instruments did not preclude autonomic function impairment. Accordingly, autonomic dysfunction may constitute an independent somatic factor in this patient group.
Collapse
Affiliation(s)
- Kurt Laederach-Hofmann
- Psychobiology and Psychosomatic Center, Department of Behavioural Medicine and Rehabilitation, University of Trier, St-Franziska-Stift Psychosomatic Hospital, Bad Kreuznach, Germany.
| | | | | |
Collapse
|
25
|
Is cancer-related fatigue more strongly correlated to haematological or to psychological factors in cancer patients? Support Care Cancer 2007; 16:943-6. [PMID: 18071764 DOI: 10.1007/s00520-007-0357-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
Abstract
GOALS OF WORK Cancer-related fatigue is a very frequent problem in cancer, interfering with many patients' life activities. Anaemia is present in a large number of fatigued patients. The aim of this study was to evaluate cancer-related fatigue, in relation with haematic haemoglobin levels and the presence of anxiety and depression. MATERIALS AND METHODS The Functional Assessment Of Chronic Illness Therapy-Fatigue scale was used to assess fatigue. The Hospital Anxiety and Depression Scale was administered to screen for psychological distress. Haematological values were measured by blood tests. All data were analysed using Chi-squared, and a logistic regression analysis was conducted. MAIN RESULTS Eighty patients were enrolled in the study. Significant associations were found between fatigue and depression, fatigue and anxiety and between fatigue and haemoglobin. CONCLUSION Anxiety and depression, other than heamoglobin levels, were found associated with fatigue. Hence, implications for a multi-dimensional treatment of fatigue are discussed.
Collapse
|
26
|
Abstract
OBJECTIVE Some patients with chronic fatigue syndrome (CFS) exhibit low basal cortisol levels, but it is not known whether low cortisol is a cause of CFS, predates the onset of CFS symptoms, or is an epiphenomenon caused by the behavioral changes typical of CFS. Because elective surgery is one of the few predictable risk factors for chronic fatigue, in this study, we followed a cohort of surgery patients from before to 6 months after their operation to test these theories. METHOD One hundred sixty-one patients completed fatigue questionnaires and provided salivary cortisol samples before undergoing an elective inpatient surgical procedure, and then 2 days, 3 weeks, and 6 months afterward. RESULTS Controlling for relevant demographic and surgical variables and for preoperative fatigue, low preoperative cortisol did not predict postoperative fatigue severity on any occasion (p > .05). Similarly, there was no correlation between low postoperative cortisol and postoperative fatigue severity at 3 weeks or 6 months (p > .05). Although 16 patients met our case definition for "chronic fatigue" at the 6-month follow up, low preoperative and low postoperative cortisol did not significantly predict fatigue caseness (p > .05). CONCLUSIONS Any association between chronic fatigue and low cortisol would seem to develop after the onset of fatigue symptoms. Low cortisol is therefore unlikely to be the primary cause of chronic fatigue states.
Collapse
Affiliation(s)
- G James Rubin
- Division of Psychological Medicine, Institute of Psychiatry and Guy's, King's and St. Thomas' School of Medicine, King's College London, London, UK.
| | | | | | | |
Collapse
|