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Zöllner C. [Preoperative evaluation of adult patients before elective, non-cardiothoracic surgery : A joint recommendation of the German Society for Anesthesiology and Intensive Care Medicine, the German Society for Surgery and the German Society for Internal Medicine]. DIE ANAESTHESIOLOGIE 2024; 73:294-323. [PMID: 38700730 PMCID: PMC11076399 DOI: 10.1007/s00101-024-01408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Abstract
The 70 recommendations summarize the current status of preoperative risk evaluation of adult patients prior to elective non-cardiothoracic surgery. Based on the joint publications of the German scientific societies for anesthesiology and intensive care medicine (DGAI), surgery (DGCH), and internal medicine (DGIM), which were first published in 2010 and updated in 2017, as well as the European guideline on preoperative cardiac risk evaluation published in 2022, a comprehensive re-evaluation of the recommendation takes place, taking into account new findings, the current literature, and current guidelines of international professional societies. The revised multidisciplinary recommendation is intended to facilitate a structured and common approach to the preoperative evaluation of patients. The aim is to ensure individualized preparation for the patient prior to surgery and thus to increase patient safety. Taking into account intervention- and patient-specific factors, which are indispensable in the preoperative risk evaluation, the perioperative risk for the patient should be minimized and safety increased. The recommendations for action are summarized under "General Principles (A)," "Advanced Diagnostics (B)," and the "Preoperative Management of Continuous Medication (C)." For the first time, a rating of the individual measures with regard to their clinical relevance has been given in the present recommendation. A joint and transparent agreement is intended to ensure a high level of patient orientation while avoiding unnecessary preliminary examinations, to shorten preoperative examination procedures, and ultimately to save costs. The joint recommendation of DGAI, DGCH and DGIM reflects the current state of knowledge as well as the opinion of experts. The recommendation does not replace the individualized decision between patient and physician about the best preoperative strategy and treatment.
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Affiliation(s)
- Christian Zöllner
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Martinistr. 52, 20246, Hamburg, Deutschland.
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Czajka S, Krzych ŁJ. Association between self-reported METs and other perioperative cardiorespiratory fitness assessment tools in abdominal surgery-a prospective cross-sectional correlation study. Sci Rep 2024; 14:7826. [PMID: 38570523 PMCID: PMC10991501 DOI: 10.1038/s41598-024-56887-5] [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: 10/02/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Cardiovascular complications represent a significant proportion of adverse events during the perioperative period, necessitating accurate preoperative risk assessment. This study aimed to investigate the association between well-established risk assessment tools and self-reported preoperative physical performance, quantified by metabolic equivalent (MET) equivalents, in high-risk patients scheduled for elective abdominal surgery. A prospective cross-sectional correlation study was conducted, involving 184 patients admitted to a Gastrointestinal Surgery Department. Various risk assessment tools, including the Revised Cardiac Risk Index (RCRI), Surgical Mortality Probability Model (S-MPM), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and Surgical Risk Calculator (NSQIP-MICA), were utilized to evaluate perioperative risk. Patients self-reported their physical performance using the MET-REPAIR questionnaire. The findings demonstrated weak or negligible correlations between the risk assessment tools and self-reported MET equivalents (Spearman's ρ = - 0.1 to - 0.3). However, a statistically significant relationship was observed between the ability to ascend two flights of stairs and the risk assessment scores. Good correlations were identified among ASA-PS, S-MPM, NSQIP-MICA, and AUB-HAS2 scores (Spearman's ρ = 0.3-0.8). Although risk assessment tools exhibited limited correlation with self-reported MET equivalents, simple questions regarding physical fitness, such as the ability to climb stairs, showed better associations. A comprehensive preoperative risk assessment should incorporate both objective and subjective measures to enhance accuracy. Further research with larger cohorts is needed to validate these findings and develop a comprehensive screening tool for high-risk patients undergoing elective abdominal surgery.
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Affiliation(s)
- Szymon Czajka
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medyków 14, 40-772, Katowice, Poland.
| | - Łukasz J Krzych
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases, Zabrze, Poland
- Department of Acute Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Hiraoka E, Tanabe K, Izuta S, Kubota T, Kohsaka S, Kozuki A, Satomi K, Shiomi H, Shinke T, Nagai T, Manabe S, Mochizuki Y, Inohara T, Ota M, Kawaji T, Kondo Y, Shimada Y, Sotomi Y, Takaya T, Tada A, Taniguchi T, Nagao K, Nakazono K, Nakano Y, Nakayama K, Matsuo Y, Miyamoto T, Yazaki Y, Yahagi K, Yoshida T, Wakabayashi K, Ishii H, Ono M, Kishida A, Kimura T, Sakai T, Morino Y. JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery. Circ J 2023; 87:1253-1337. [PMID: 37558469 DOI: 10.1253/circj.cj-22-0609] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Tadao Kubota
- Department of General Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | | | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, International University of Health and Welfare Narita Hospital
| | - Yasuhide Mochizuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Taku Inohara
- Department of Cardiovascular Medicine, Keio University Graduate School of Medicine
| | - Mitsuhiko Ota
- Department of Cardiovascular Center, Toranomon Hospital
| | | | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital
| | - Yumiko Shimada
- JADECOM Academy NP·NDC Training Center, Japan Association for Development of Community Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomofumi Takaya
- Department of Cardiovascular Medicine, Hyogo Prefectural Himeji Cardiovascular Center
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital
| | - Kenichi Nakazono
- Department of Pharmacy, St. Marianna University Yokohama Seibu Hospital
| | | | | | - Yuichiro Matsuo
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | | | | | | | | | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
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Dankert A, Neumann-Schirmbeck B, Dohrmann T, Plümer L, Wünsch VA, Sasu PB, Sehner S, Zöllner C, Petzoldt M. Stair-Climbing Tests or Self-Reported Functional Capacity for Preoperative Pulmonary Risk Assessment in Patients with Known or Suspected COPD-A Prospective Observational Study. J Clin Med 2023; 12:4180. [PMID: 37445215 DOI: 10.3390/jcm12134180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This prospective study aims to determine whether preoperative stair-climbing tests (SCT) predict postoperative pulmonary complications (PPC) better than self-reported poor functional capacity (SRPFC) in patients with known or suspected COPD. METHODS A total of 320 patients undergoing scheduled for major non-cardiac surgery, 240 with verified COPD and 80 with GOLD key indicators but disproved COPD, underwent preoperative SRPFC and SCT and were analyzed. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection. Two multivariable regression models were fitted, the SRPFC model (baseline variables such as sociodemographic, surgical and procedural characteristics, medical preconditions, and GOLD key indicators plus SRPFC) and the SCT model (baseline variables plus SCTPFC). RESULTS Within all stair-climbing variables, LASSO exclusively selected self-reported poor functional capacity. The cross-validated area under the receiver operating characteristic curve with bias-corrected bootstrapping 95% confidence interval (95% CI) did not differ between the SRPFC and SCT models (0.71; 0.65-0.77 for both models). SRPFC was an independent risk factor (adjusted odds ratio (OR) 5.45; 95% CI 1.04-28.60; p = 0.045 in the SRPFC model) but SCTPFC was not (adjusted OR 3.78; 95% CI 0.87-16.34; p = 0.075 in the SCT model). CONCLUSIONS Our findings indicate that preoperative SRPFC adequately predicts PPC while additional preoperative SCTs are dispensable in patients with known or suspected COPD.
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Affiliation(s)
- André Dankert
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Benedikt Neumann-Schirmbeck
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Thorsten Dohrmann
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Lili Plümer
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Viktor Alexander Wünsch
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Phillip Brenya Sasu
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Zöllner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Martin Petzoldt
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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5
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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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Subjective methods for preoperative assessment of functional capacity. BJA Educ 2022; 22:249-257. [PMID: 35754857 PMCID: PMC9214434 DOI: 10.1016/j.bjae.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 01/09/2023] Open
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Meijer R, van Hooff M, Papen-Botterhuis NE, Molenaar CJL, Regis M, Timmers T, van de Poll-Franse LV, Savelberg HHCM, Schep G. Estimating VO2peak in 18–90 Year-Old Adults: Development and Validation of the FitMáx©-Questionnaire. Int J Gen Med 2022; 15:3727-3737. [PMID: 35411174 PMCID: PMC8994663 DOI: 10.2147/ijgm.s355589] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Cardiorespiratory fitness (CRF) plays an essential role in health outcomes and quality of life. However, it is often not assessed nor estimated. Objective CRF assessment is costly, labour intensive and not widely available. Patient-reported outcome measures estimate CRF more cost-efficiently, but current questionnaires lack accuracy. The aim of this study is to develop a new self-reported questionnaire to estimate CRF. Materials and Methods The FitMáx©-questionnaire, consisting of only three questions assessing walking, stair climbing, and cycling capacity, was compared with the commonly used Duke Activity Status Index (DASI) and Veterans Specific Activity Questionnaire (VSAQ). These questionnaires were compared to peak oxygen uptake (VO2peak) as measured with cardiopulmonary exercise testing. This study included 759 cardiac, pulmonary and oncologic patients and healthy persons aged 18‒90. Results FitMáx© strongly correlated (r = 0.94 (0.92‒0.95) SEE = 4.14 mL∙kg−1∙min−1) with measured VO2peak. Bias between predicted and measured VO2peak was −0.24 (−9.23‒8.75; 95% limits of agreement) mL·kg−1·min−1. The FitMáx© scored superiorly on correlation and SEE compared with the DASI and VSAQ, r = 0.75 (0.68‒0.80) SEE = 4.62 mL∙kg−1∙min−1 and r = 0.87 (0.83‒0.90) SEE = 6.75 mL∙kg−1∙min−1, respectively. Conclusion FitMáx© is a valid and accessible questionnaire to estimate CRF expressed as VO2peak in clinical practice and shows substantial improvement compared to currently used questionnaires.
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Affiliation(s)
- Renske Meijer
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Correspondence: Renske Meijer, Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands, Tel +31 40 8888 000, Email ; ;
| | - Martijn van Hooff
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | | | - Marta Regis
- Academy, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Mathematics and Computer Science, University of Technology, Eindhoven, the Netherlands
| | - Thomas Timmers
- Department of Research & Development, Interactive Studios, Rosmalen, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Net
herlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Goof Schep
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
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Osman T, Lew E, Sng BL, Dabas R, Griva K, Car J. Delphi Consensus on American Society of Anesthesiologists' Physical Status Classification in an Asian Tertiary Women's Hospital. Korean J Anesthesiol 2021; 75:168-177. [PMID: 34911175 PMCID: PMC8980290 DOI: 10.4097/kja.21426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background The American Society of Anesthesiologists (ASA) score is generated based on patients’ clinical status. Accurate ASA classification is essential for the communication of perioperative risks and resource planning. Literature suggests that ASA classification can be automated for consistency and time-efficiency. To develop a rule-based algorithm for automated ASA classification, this study seeks to establish consensus in ASA classification for clinical conditions encountered at a tertiary women’s hospital. Methods Thirty-seven anesthesia providers rated their agreement on a 4-point Likert scale to ASA scores assigned to items via the Delphi technique. After Round 1, the group’s collective responses and individual item scores were shared with participants to improve their responses for Round 2. For each item, the percentage agreement (‘agree’ and ‘strongly agree’ responses combined), median (interquartile range/IQR), and SD were calculated. Consensus for each item was defined as a percentage agreement ≥ 70%, IQR ≤ 1.0, and SD < 1.0. Results All participants completed the study and none had missing data. The number of items that reached consensus increased from 25 (51.0%) to 37 (75.5%) in the second Delphi round, particularly for items assigned ASA scores of III and IV. Nine items, which pertained to alcohol intake, asthma, thyroid disease, limited exercise tolerance, and stable angina, did not reach consensus even after two Delphi rounds. Conclusions Delphi consensus was attained for 37 of the 49 study items (75.5%), facilitating their incorporation into a rule-based clinical support system designed to automate the prediction of ASA classification.
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Affiliation(s)
- Tarig Osman
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Eileen Lew
- Women's Anaesthesia, KK Women's and Children's Hospital. Anaesthesiology and Perioperative Sciences Academic Clinical Programme, Singhealth DukeNUS Academic Medical Centre, Singapore
| | - Ban L Sng
- Women's Anaesthesia, KK Women's and Children's Hospital. Anaesthesiology and Perioperative Sciences Academic Clinical Programme, Singhealth DukeNUS Academic Medical Centre, Singapore
| | - Rajive Dabas
- Women's Anaesthesia, KK Women's and Children's Hospital. Anaesthesiology and Perioperative Sciences Academic Clinical Programme, Singhealth DukeNUS Academic Medical Centre, Singapore
| | - Konstadina Griva
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
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Deana C, Vetrugno L, Bignami E, Bassi F. Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint. J Thorac Dis 2021; 13:6037-6051. [PMID: 34795950 PMCID: PMC8575828 DOI: 10.21037/jtd-21-940] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/16/2022]
Abstract
Objective This review summarizes the peri-operative anesthesiological approaches to esophagectomy considering the best up-to-date, evidence-based medicine, discussed from the anesthesiologist’s standpoint. Background Esophagectomy is the only curative therapy for esophageal cancer. Despite the many advancements made in the surgical treatment of this tumour, esophagectomy still carries a morbidity rate reaching 60%. Patients undergoing esophagectomy should be referred to high volume centres where they can receive a multidisciplinary approach to treatment, associated with better outcomes. The anesthesiologist is the key figure who should guide the peri-operative phase, from diagnosis through to post-surgery rehabilitation. We performed an updated narrative review devoted to the study of anesthesia management for esophagectomy in cancer patients. Methods We searched MEDLINE, Scopus and Google Scholar databases from inception to May 2021. We used the following terms: “esophagectomy”, “esophagectomy AND pre-operative evaluation”, “esophagectomy AND protective lung ventilation”, “esophagectomy AND hemodynamic monitoring” and “esophagectomy AND analgesia”. We considered only articles with abstract written in English and available to the reader. We excluded single case-reports. Conclusions Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize any medical condition. During surgery, protective ventilation and judicious fluid management are the cornerstones of intraoperative “protective anesthesia”. Post-operative care should be provided by an intensive care unit or high-dependency unit depending on the patient’s condition, the type of surgery endured and the availability of local resources. The provision of adequate post-operative analgesia favours early mobilization and rapid recovery. Anesthesiologist has an important role during the peri-operative care for esophagectomy. However, there are still some topics that need to be further studied to improve the outcome of these patients.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy.,Department of Medical Area, University of Udine, Udine, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy
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Quantification of metabolic equivalents (METs) by the MET-REPAIR questionnaire: A validation study in patients with a high cardiovascular burden. J Clin Anesth 2021; 76:110559. [PMID: 34687977 DOI: 10.1016/j.jclinane.2021.110559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE Quantifying functional capacity is a core component of preoperative cardiovascular risk assessment. Lower metabolic equivalents (METs) are associated with higher morbidity/mortality in non-surgical and surgical populations. However, actually measuring METs preoperatively is rare. We sought to determine the correlation of self-reported METs using the questionnaire of the MET: REevaluation for Perioperative cArdIac Risk (MET-REPAIR) study and objectively measured METs by gold-standard cardiopulmonary exercise testing (CPET). DESIGN Single-center prospective validation study. SETTING University hospital. PATIENTS We enrolled adult patients aged ≥45 undergoing out-patient cardiac rehabilitation. INTERVENTION Patients completed the MET-REPAIR Questionnaire and the Duke Activity Status Index (DASI), had blood samples drawn, and underwent undergoing routine CPET. MEASUREMENTS We compared measured METs by CPET to 1) self-reported METs (the MET-REPAIR Questionnaire), 2) the DASI score, 3) stand-alone questions, and 4) N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations. MAIN RESULTS 140 patients were recruited. Measured METs by CPET correlated with 1) self-reported METs by the MET-REPAIR Questionnaire (ρ = 0.489, "fair"), 2) self-reported physical activity by the DASI (ρ = 0.487, "fair"), 3) the self-reported continual stair climbing ability (one of the stand-alone questions; ρ = 0.587, "fair") and 4) NT-proBNP concentrations (ρ = -0.353, "poor"). The area under the receiver operating characteristic curve (AUROC) for the ability to perform more than 4 METs were: highest for flights of stairs (0.841 [95%CI 0.735-0.948], p < 0.05 to rest, optimum: 3 flights), not significantly different between MET-REPAIR Questionnaire and DASI (0.666 [95%CI 0.551-0.781], optimum: 6 METs vs. 0.704 [95%CI 0.578-0.829], optimum: 32.2 points or 6.7 METs, p = 0.405), and not significant for NT-proBNP: (0.623 [95%CI 0.483-0.763]). CONCLUSIONS The MET-REPAIR Questionnaire correlates with measured METs; all utilized forms of self-reported physical activity overestimate measured METs. NT-proBNP correlates poorly with measured METs.
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Prehabilitation Program in Elderly Patients: A Prospective Cohort Study of Patients Followed Up Postoperatively for Up to 6 Months. J Clin Med 2021; 10:jcm10194500. [PMID: 34640516 PMCID: PMC8509125 DOI: 10.3390/jcm10194500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 12/13/2022] Open
Abstract
The preoperative period may be an opportune period to optimize patients' physical condition with a multimodal preoperative program. The impact of a "prehabilitation" program on elderly patients is discussed. This mono-center observational cohort study included consecutively 139 patients planned for major abdominal and thoracic surgery, with 44 in the control group (age < 65) and 95 in the elderly group (age > 65). All patients followed a "prehabilitation" program including exercise training, nutritional optimization, psychological support, and behavioral change. Seventeen patients in the control group and 45 in the elderly group completed the study at six months. The 6-minute walk test (6 MWT) increased in both groups from the initial evaluation to the last (median value of 80 m (interquartile range 51) for those under 65 years; 59 m (34) for the elderly group; p = 0.114). The 6 MWT was also similar after one month of prehabilitation for both populations. The rate of postoperative complications was similar in the two groups. Prehabilitation showed equivalence in patients over 65 years of age compared to younger patients in terms of increase in functional capabilities and of postoperative evolution. This multimodal program represents a bundle of care that can benefit a frailer population.
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12
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El-Kefraoui C, Rajabiyazdi F, Pecorelli N, Carli F, Lee L, Feldman LS, Fiore JF. Prognostic value of the Duke Activity Status Index (DASI) in patients undergoing colorectal surgery. World J Surg 2021; 45:3677-3685. [PMID: 34448918 DOI: 10.1007/s00268-021-06256-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Complications are common after colorectal surgery and remain a target for quality improvement. Lower preoperative physical functioning is associated with poor postoperative outcomes, but assessment often relies on subjective judgment or resource-intensive tests. Recent literature suggests that self-reported functional capacity, measured using the Duke Activity Status Index (DASI), is a strong predictor of postoperative outcomes. This study aimed to estimate the extent to which DASI predicts 30-day complications after colorectal surgery. METHODS In this observational study, 100 patients undergoing colorectal resection [median age 63, 57% men, 81% laparoscopic, 37% rectal surgery] responded to DASI two weeks preoperatively. Complications were classified according to Clavien-Dindo and quantified using the comprehensive complication index (CCI). Our primary analysis targeted the relationship between preoperative DASI and odds of complications. Secondary analyses focused on 30-day severe complications, CCI, readmissions, and length of stay (LOS). We also explored the predictive ability of DASI with scores dichotomized based on a previously validated threshold (≤ 34). RESULTS Mean preoperative DASI was 48 ± 12. Forty-six patients (46%) experienced 30-day complications (8% severe, CCI 9.6 ± 15). Lower DASI scores were associated with higher odds of complications (OR 1.08, 95%CI 1.03-1.14; p = 0.001). Preoperative DASI was also an independent predictor of severe complications, CCI, and readmissions. The predictive ability was supported when scores were dichotomized at ≤ 34. CONCLUSION DASI is a significant predictor of postoperative complications after colorectal surgery. This questionnaire can be easily implemented in clinical practice to identify patients with low preoperative functional capacity and target interventions to those at higher risk.
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Affiliation(s)
- Charbel El-Kefraoui
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Fateme Rajabiyazdi
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Nicolò Pecorelli
- Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Franco Carli
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Lawrence Lee
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada. .,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. .,Department of Surgery, McGill University, Montreal, QC, Canada. .,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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13
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Zientara A, Schwegler I, Dzemali O, Bruijnen H, Bernheim A, Dick F, Attigah N. Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair. BMC Surg 2021; 21:130. [PMID: 33714271 PMCID: PMC7955627 DOI: 10.1186/s12893-021-01143-0] [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: 12/12/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reliable prediction of the preoperative risk is of crucial importance for patients undergoing aortic repair. In this retrospective cohort study, we evaluated the metabolic equivalent of task (MET) in the preoperative risk assessment with clinical outcome in a cohort of consecutive patients. METHODS Retrospective analysis of prospectively collected data in a single center unit of 296 patients undergoing open or endovascular aortic repair from 2009 to 2016. The patients were divided into four anatomic main groups (infrarenal (endo: n = 94; open: n = 88), juxta- and para-renal (open n = 84), thoraco-abdominal (open n = 13) and thoracic (endo: n = 11; open: n = 6). Out of these, 276 patients had a preoperative statement of their functional capacity in metabolic units and were evaluated concerning their postoperative outcome including survival, in-hospital mortality, postoperative complications, myocardial infarction and stroke, and the need of later cardiovascular interventions. RESULTS The median follow-up of the cohort was 10.8 months. Patients with < 4MET had a higher incidence of diabetes mellitus (p = 0.0002), peripheral arterial disease (p < 0.0001), history of smoking (p = 0.003), obesity (p = 0.03) and chronic obstructive pulmonary disease (p = 0.05). Overall in-hospital mortality was 4.4% (13 patients). There was no significant difference in the survival between patients with a functional capacity of more than 4 MET (220 patients, mean survival: 74.5 months) and patients with less than 4 MET (56 patients, mean survival: 65.4 months) (p = 0.64). The mean survival of the infrarenal cohort (n = 169) was 74.3 months with no significant differences between both MET groups (> 4 MET: 131 patients, mean survival 75.5 months; < 4 MET: 38 patients, mean survival 63.6 months. p = 0.35). The subgroup after open surgical technique with less than 4 MET had the lowest mean survival of 38.8 months. In 46 patients with > 4MET (20.9%) perioperative complications occurred compared to the group with < 4MET with 18 patients (32.1%) (p = 0.075). There were no significant differences in both groups in the late cardiovascular interventions (p = 0.91) and major events including stroke and myocardial infarction (p = 0.4) monitored during the follow up period. The risk to miss a potential need for cardiac optimization in patients > 4MET was 7%. CONCLUSION The functional preoperative evaluation by MET in patients undergoing aortic surgery is a useful surrogate marker of perioperative performance but cannot be seen as a substitute for preoperative cardiopulmonary testing in selected individuals. Trial registration clinicaltrials.gov, registration number NCT03617601 (retrospectively registered).
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Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospital, Sydney Street, London, SW3 6NP, UK
| | - Igor Schwegler
- Department of Vascular Surgery, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland
| | - Hans Bruijnen
- Department of Vascular and Thoracic Surgery, Augsburg Hospital, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Alain Bernheim
- Department of Cardiology, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland
| | - Florian Dick
- Department of Vascular Surgery, Cantonal Hospital, Rohrschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Nicolas Attigah
- Department of Vascular Surgery, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland.
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Berkvens EM, Wegdam J, Visser RA, Bouvy N, Nienhuijs S, Reilingh TSV. Preoperative exercise therapy preventing postoperative complications following complex abdominal wall reconstruction: A feasibility study. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Constantine A, Clift P. Non-cardiac surgery in congenital heart disease-associated pulmonary arterial hypertension: risk recognition and management. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Current guidelines for the peri-operative assessment and management are not sufficient to allow effective risk assessment and management of the patient with pulmonary arterial hypertension associated with congenital heart disease. Well-established risk stratification tools are not validated in this group. Additional, disease-specific risks require individualised, specialist, multidisciplinary management.
Case presentation
We present an illustrative clinical case of patients with pulmonary arterial hypertension associated with congenital heart disease undergoing non-cardiac surgery. The case follows a 66-year-old male with pulmonary hypertension associated with an atrial septal defect underwent an elective hernia repair.
Conclusions
We discuss useful management strategies for minimising risk during the peri- and post-operative periods in this population.
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Hanley C, Donahoe L, Slinger P. "Fit for Surgery? What's New in Preoperative Assessment of the High-Risk Patient Undergoing Pulmonary Resection". J Cardiothorac Vasc Anesth 2020; 35:3760-3773. [PMID: 33454169 DOI: 10.1053/j.jvca.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
Abstract
Advances in perioperative assessment and diagnostics, together with developments in anesthetic and surgical techniques, have considerably expanded the pool of patients who may be suitable for pulmonary resection. Thoracic surgical patients frequently are perceived to be at high perioperative risk due to advanced age, level of comorbidity, and the risks associated with pulmonary resection, which predispose them to a significantly increased risk of perioperative complications, increased healthcare resource use, and costs. The definition of what is considered "fit for surgery" in thoracic surgery continually is being challenged. However, no internationally standardized definition of prohibitive risk exists. Perioperative assessment traditionally concentrates on the "three-legged stool" of pulmonary mechanical function, parenchymal function, and cardiopulmonary reserve. However, no single criterion should exclude a patient from surgery, and there are other perioperative factors in addition to the tripartite assessment that need to be considered in order to more accurately assess functional capacity and predict individual perioperative risk. In this review, the authors aim to address some of the more erudite concepts that are important in preoperative risk assessment of the patient at potentially prohibitive risk undergoing pulmonary resection for malignancy.
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Affiliation(s)
- Ciara Hanley
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Slinger
- Department of Anesthesia and Pain Management, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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17
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[Preoperative cardiovascular risk evaluation before elective noncardiac surgical interventions]. Herz 2020; 45:301-310. [PMID: 32322936 DOI: 10.1007/s00059-020-04917-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A careful and standardized but nevertheless individually adapted and targeted medical history and physical examination are essential components of a preoperative evaluation. The individual cardiovascular risk profile characterized by noninvasive diagnostics requires a targeted further assessment with noninvasive and invasive diagnostic investigations, which should be targeted to the medical needs of the individual patient. The aim is to assess the individual risk of undesired major adverse cardiac events (MACE). The preoperative examination procedures should be limited to the medically necessary needs in order to be able to optimally utilize the material and personnel resources. This review article presents a practical guide for preoperative cardiovascular risk evaluation in patients scheduled for elective, noncardiac surgery.
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18
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Carli F, Baldini G. From preoperative assessment to preoperative optimization of frail older patiens. Eur J Surg Oncol 2020; 47:519-523. [PMID: 32753116 DOI: 10.1016/j.ejso.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022] Open
Abstract
Physiological and mental reserve decreases with age and the ability to mount a response to a stress like surgery can represent a burden to the frail and sarcopenic patient. It is necessary to evaluate the cardiorespiratory capacity and muscle strength before surgery in the older persons and prepare adequately to the same extent the marathon runner prepares before a full marathon. Assessment and stratification of risk are necessary for decision-making, but also for planning interventions aimed at improving the functional and emotional status in anticipation of surgery. Prehabilitation can improve the physiological reserve by optimizing cardiorespiratory capacity, muscle strength, and mental resiliency. Patients with low reserve and chronic medical conditions at high risk can benefit.
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Affiliation(s)
- Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Room D10.165, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada.
| | - Gabriele Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Room D10.165, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada
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Raslau D, Bierle DM, Stephenson CR, Mikhail MA, Kebede EB, Mauck KF. Preoperative Cardiac Risk Assessment. Mayo Clin Proc 2020; 95:1064-1079. [PMID: 32107033 DOI: 10.1016/j.mayocp.2019.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/17/2019] [Accepted: 08/19/2019] [Indexed: 01/18/2023]
Abstract
Major adverse cardiac events are common causes of perioperative mortality and major morbidity. Preventing these complications requires thorough preoperative risk assessment and postoperative monitoring of at-risk patients. Major guidelines recommend assessment based on a validated risk calculator that incorporates patient- and procedure-specific factors. American and European guidelines define when stress testing is needed on the basis of functional capacity assessment. Favoring cost-effectiveness, Canadian guidelines instead recommend obtaining brain natriuretic peptide or N-terminal prohormone of brain natriuretic peptide levels to guide postoperative screening for myocardial injury or infarction. When conditions such as acute coronary syndrome, severe pulmonary hypertension, and decompensated heart failure are identified, nonemergent surgery should be postponed until the condition is appropriately managed. There is an evolving role of biomarkers and myocardial injury after noncardiac surgery to enhance risk stratification, but the effect of interventions guided by these strategies is unclear.
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Affiliation(s)
- David Raslau
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN.
| | - Dennis M Bierle
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | | | - Michael A Mikhail
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Esayas B Kebede
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karen F Mauck
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
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Abstract
Older Veterans are increasingly undergoing surgery and are at particularly high risk of postoperative morbidity and mortality. Prehabilitation has emerged as a method to improve postoperative outcomes by enhancing the patient's preoperative condition. We present data from our prehabilitation pilot project and plans for expansion and dissemination of a nationwide quality improvement effort. The infrastructure of the existing Veterans Affairs (VA) Gerofit health and exercise program was used to create our pilot. Pilot patients were screened for risk of postoperative functional decline, assessed for baseline physical function, enrolled in a personalized exercise program, and prepared to transition into the hospital for surgery. Patients (n = 9) completed an average of 17.7 prehabilitation sessions. After completing the program, 55.6% improved in ≥2 of the 5 fitness assessments completed. Postoperative outcomes including complications, 30-day mortality, and 30-day readmissions were better than predicted by the National Surgical Quality Improvement Program Surgical Risk Calculator. We have obtained institutional support for implementing similar prehabilitation programs at VA hospitals nationally through our designation as a VA Patient Safety Center for Inquiry. This is the first multi-institutional prehabilitation program for frail, older Veterans and represents an essential step toward optimizing surgical care for this vulnerable population.
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21
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Marsman M, van Waes JAR, Grobben RB, Weersink CSA, van Klei WA. Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury. Eur J Prev Cardiol 2020; 28:262-269. [PMID: 33891688 DOI: 10.1177/2047487320906918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Functional capacity is used as an indicator for cardiac testing before non-cardiac surgery and is often performed subjectively. However, the value of subjectively estimated functional capacity in predicting cardiac complications is under debate. We determined the predictive value of subjectively assessed functional capacity on postoperative cardiac complications and mortality. DESIGN An observational cohort study in patients aged 60 years and over undergoing elective inpatient non-cardiac surgery in a tertiary referral hospital. METHODS Subjective functional capacity was determined by anaesthesiologists. The primary outcome was postoperative myocardial injury. Secondary outcomes were postoperative inhospital myocardial infarction and one year mortality. Logistic regression analysis and area under the receiver operating curves were used to determine the added value of functional capacity. RESULTS A total of 4879 patients was included; 824 (17%) patients had a poor subjective functional capacity. Postoperative myocardial injury occurred in 718 patients (15%). Poor functional capacity was associated with myocardial injury (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5-2.0; P < 0.001), postoperative myocardial infarction (RR 2.9, 95% CI 1.9-4.2; P < 0.001) and one year mortality (RR 1.7, 95% CI 1.4-2.0; P < 0.001). After adjustment for other predictors, functional capacity was still a significant predictor for myocardial injury (odds ratio (OR) 1.3, 95% CI 1.0-1.7; P = 0.023), postoperative myocardial infarction (OR 2.0, 95% CI 1.3-3.0; P = 0.002) and one year mortality (OR 1.4, 95% CI 1.1-1.8; P = 0.003), but had no added value on top of other predictors. CONCLUSIONS Subjectively assessed functional capacity is a predictor of postoperative myocardial injury and death, but had no added value on top of other preoperative predictors.
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Affiliation(s)
- Marije Marsman
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Judith A R van Waes
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Remco B Grobben
- Department of Cardiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Corien S A Weersink
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, Universitair Medisch Centrum Utrecht, The Netherlands
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22
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Pouwels S, Sanches EE, Cagiltay E, Severin R, Philips SA. Perioperative Exercise Therapy in Bariatric Surgery: Improving Patient Outcomes. Diabetes Metab Syndr Obes 2020; 13:1813-1823. [PMID: 32547143 PMCID: PMC7261659 DOI: 10.2147/dmso.s215157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
Nowadays, obesity and related comorbidities like type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea syndrome are considered one of the medical challenges of the 21st century. Even with the rise of bariatric and metabolic surgery, obesity and metabolic syndrome are reaching endemic proportions. Even in 2020, obesity is still a growing problem. There is increasing evidence that next to bariatric surgery, exercise interventions in the perioperative period could give extra beneficial effects. In this regard, effects on anthropometrics, cardiovascular risk factors and physical fitness. The aim of this review is to summarise effects of preoperative and postoperative exercise, tools for screening and directions for future research and implementations.
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Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
- Correspondence: Sjaak Pouwels Department of Surgery, Haaglanden Medical Center, P.O. Box 432, 2501 CK, The Hague, the Netherlands Email
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Eylem Cagiltay
- University of Health Sciences Turkey, Sultan Abdulhamid Han Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, Istanbul, Uskudar, 34668, Turkey
| | - Rich Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Shane A Philips
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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23
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The usefulness of preoperative exercise therapy in patients scheduled for lung cancer surgery; a survey among Dutch pulmonologists and cardiothoracic surgeons. Support Care Cancer 2019; 28:1983-1989. [DOI: 10.1007/s00520-019-05014-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022]
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Topal B, Smelt HJ, Van Helden EV, Celik A, Verseveld M, Smeenk F, Pouwels S. Utility of preoperative exercise therapy in reducing postoperative morbidity after surgery; a clinical overview of current evidence. Expert Rev Cardiovasc Ther 2019; 17:395-412. [DOI: 10.1080/14779072.2019.1625771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Esmee V. Van Helden
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Alper Celik
- Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli, Istanbul, Turkey
| | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Frank Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
- SHE School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Sjaak Pouwels
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
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Sathananthan J, Lauck S, Piazza N, Martucci G, Kim DH, Popma JJ, Asgar AW, Perrault LP, Lefèvre T, Labinaz M, Lamy A, Peterson MD, Arora RC, Noiseux N, Généreux P, Webb JG, Afilalo J. Habitual Physical Activity in Older Adults Undergoing TAVR. JACC Cardiovasc Interv 2019; 12:781-789. [DOI: 10.1016/j.jcin.2019.02.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/22/2019] [Accepted: 02/11/2019] [Indexed: 01/23/2023]
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Accelerated Hypofractionated Radiation Therapy for Elderly Frail Bladder Cancer Patients Unfit for Surgery or Chemotherapy. Am J Clin Oncol 2019; 42:179-183. [DOI: 10.1097/coc.0000000000000491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee LKK, Tsai PNW, Ip KY, Irwin MG. Pre-operative cardiac optimisation: a directed review. Anaesthesia 2019; 74 Suppl 1:67-79. [PMID: 30604417 DOI: 10.1111/anae.14511] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 12/30/2022]
Affiliation(s)
- L. K. K. Lee
- Department of Anaesthesia; Pamela Youde Nethersole Eastern Hospital; Hong Kong Special Administrative Region; Hong Kong China
| | - P. N. W. Tsai
- Department of Adult Intensive Care Unit; Queen Mary Hospital; Hong Kong Special Administrative Region; Hong Kong China
| | - K. Y. Ip
- Department of Anaesthesiology; Queen Mary Hospital; Hong Kong Special Administrative Region; Hong Kong China
| | - M. G. Irwin
- Department of Anaesthesiology; The University of Hong Kong; Hong Kong Special Administrative Region; Hong Kong China
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Auais M, Morin SN, Finch L, Ahmed S, Mayo N. Toward a Meaningful Definition of Recovery After Hip Fracture: Comparing Two Definitions for Community-Dwelling Older Adults. Arch Phys Med Rehabil 2018; 99:1108-1115. [DOI: 10.1016/j.apmr.2018.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/30/2017] [Accepted: 01/15/2018] [Indexed: 01/09/2023]
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Vetrugno L, Orso D, Matellon C, Giaccalone M, Bove T, Bignami E. The Possible Use of Preoperative Natriuretic Peptides for Discriminating Low Versus Moderate-High Surgical Risk Patient. Semin Cardiothorac Vasc Anesth 2018; 22:395-402. [DOI: 10.1177/1089253217752061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perioperative risk scores for patients undergoing noncardiac surgery are generally considered inaccurate, poor, or, at best, modest. We propose estimating a patient’s pretest and posttest probability of cardiac morbidity and death using the preoperative scoring system plus the negative likelihood ratio from brain natriuretic peptide (BNP) or N-terminal proB-type natriuretic peptide (NT-proBNP) plasma levels. Our clinical challenge scenario showed a pretest probability of postoperative major cardiac complications with the patient risk factor as 6.6% for the Revised Cardiac Risk Index and between 1% and 5% (intermediate risk) per the recent European Society of Cardiology and the European Society of Anesthesiologist guidelines for surgical risk estimation. In fact, the American College of Cardiology and the American Heart Association guidelines consider the same surgical procedure for elevated risk. The posttest probability takes advantage of a negative likelihood ratio from BNP plasma levels, with patient risk factor reduced to 0.8% and surgical risk to 1.1%. In the same way, the pretest American College of Surgeons National Surgical Quality Improvement Program score decreased from 18.8% to 3.5% for severe complications and from 0.9% to 0.1% for death at ≤90 days. Following noncardiac surgery, postoperative complications and mortality are often cardiac in nature. The negative likelihood ratio of BNP and NT-proBNP plasma levels provides a quick, low-cost tool for recognizing and reclassifying the cardiovascular risk of those undergoing noncardiac surgery, thereby singling out low- versus moderate-high-risk surgical patients.
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Mörgeli R, Scholtz K, Kurth J, Treskatsch S, Neuner B, Koch S, Kaufner L, Spies C. Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia. Visc Med 2017; 33:267-274. [PMID: 29034255 DOI: 10.1159/000475611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. METHODS We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities. RESULTS Especially in combination with advanced age, the effects of malignancies can be devastating, bringing new health challenges, exacerbating preexisting conditions, and exerting severe psychological strain. An interdisciplinary assessment and process planning provide an ideal setting to identify and prevent potential complications, especially in regards to frailty and cardiovascular risk. In addition, important perioperative considerations are presented, such as malnutrition, fasting, intraoperative neuromonitoring, and hemodynamic control, as well as postoperative early mobilization, pain, and delirium management. CONCLUSION The decisions and interventions made in the perioperative stage can positively influence many intra- and postoperative factors, significantly improving the chances of successful treatment of elderly cancer patients. Appropriate management can help prevent or mitigate complications, secure a quick recovery, and improve short- and long-term outcomes.
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Affiliation(s)
- Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kathrin Scholtz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Kurth
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bruno Neuner
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanne Koch
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lutz Kaufner
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Charles JG, Hernandez A. Medical Care of the Surgical Patient. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J. The preoperative use of field tests of exercise tolerance to predict postoperative outcome in intra-abdominal surgery: a systematic review. J Clin Anesth 2016; 35:446-455. [DOI: 10.1016/j.jclinane.2016.09.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 12/25/2022]
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Preoperative exercise therapy in surgical care: a scoping review. J Clin Anesth 2016; 33:476-90. [DOI: 10.1016/j.jclinane.2016.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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Della Rocca G, Vetrugno L, Coccia C, Pierconti F, Badagliacca R, Vizza CD, Papale M, Melis E, Facciolo F. Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team. J Cardiothorac Vasc Anesth 2015; 30:530-8. [PMID: 27013123 DOI: 10.1053/j.jvca.2015.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Giorgio Della Rocca
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | - Federico Pierconti
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | | | | | | | - Enrico Melis
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
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Alvarez Escudero J, Calvo Vecino JM, Veiras S, García R, González A. Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery: reducing risk of heart failure patients in noncardiac surgery. ACTA ACUST UNITED AC 2015; 62:359-419. [PMID: 26164471 DOI: 10.1016/j.redar.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/29/2022]
Affiliation(s)
- J Alvarez Escudero
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - J M Calvo Vecino
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain; Associated Professor and Head of the Department of Anesthesiology, Infanta Leonor University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - S Veiras
- Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - R García
- Department of Anesthesiology, Puerta del Mar University Hospital. Cadiz, Spain
| | - A González
- Department of Anesthesiology, Puerta de Hierro University Hospital. Madrid, Spain
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La prueba de escaleras. En búsqueda de la necesaria simplicidad. Arch Bronconeumol 2015; 51:259-60. [DOI: 10.1016/j.arbres.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/23/2022]
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Bajwa SJS. Clinical conundrums and challenges during geriatric orthopedic emergency surgeries. Int J Crit Illn Inj Sci 2015; 5:38-45. [PMID: 25810963 PMCID: PMC4366827 DOI: 10.4103/2229-5151.152342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Despite so many advancements and innovations in anesthetic techniques, expectations and challenges have also grown in plenty. Cardiac, pediatric, obstetric and neuro-anesthesia have perfectly developed to fulfill the desired needs of respective patient population. However, geriatric anesthesia has been shown a lesser interest in teaching and clinical practices over the years as compared with other anesthetic sub-specialties. The large growing geriatric population globally is also associated with an increase number of elderly patients presenting for orthopedic emergency surgeries. Orthopedic emergency surgery in geriatric population is not only a daunting clinical challenge but also has numerous socio-behavioral and economic ramifications. Decision making in anesthesia is largely influenced by the presence of co-morbidities, neuro-cognitive functions and the current socio-behavioral status. Pre-anesthetic evaluation and optimization are extremely important for a better surgical outcome but is limited by time constraints during emergency surgery. The current review aims to highlight comprehensively the various clinical, social, behavioral and psychological aspects during pre-anesthetic evaluation associated with emergency orthopedic surgery in geriatric population.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
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Charles JG, Hernandez A. Medical Care of the Surgical Patient. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_64-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Novoa NM, Rodríguez M, Gómez MT, Jiménez MF, Varela G. Fixed-altitude stair-climbing test replacing the conventional symptom-limited test. A pilot study. Arch Bronconeumol 2014; 51:268-72. [PMID: 25453531 DOI: 10.1016/j.arbres.2014.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/13/2014] [Accepted: 09/15/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The objective of this study was to investigate whether a patient's maximum capacity is comparable in 2 different stair-climbing tests, allowing the simplest to be used in clinical practice. METHOD Prospective, observational study of repeated measures on 33 consecutive patients scheduled for lung resection. Stair-climbing tests were: the standard test (climb to 27 m) and the alternative fixed-altitude test (climb to 12 m). In both cases, heart rate and oxygen saturation were monitored before and after the test. The power output of stair-climbing for each test (Watt1 for the standard and Watt2 for the fixed-altitude test) was calculated using the following equation: Power (watt)=weight (kg)*9.8*height (m)/time (sec). Concordance between tests was evaluated using a regression model and the residuals were plotted against Watt1. Finally, power output values were analyzed using a Bland-Altman plot. RESULTS Twenty-one male and 12 female patients (mean age 63.2±11.2) completed both tests. Only 12 patients finished the standard test, while all finished the fixed-altitude test. Mean power output values were Watt1: 184.1±65 and Watt2: 214.5±75.1. The coefficient of determination (R(2)) in the linear regression was 0.67. No fixed bias was detected after plotting the residuals. The Bland-Altman plot showed that 32 out of 33 values were within 2 standard deviations of the differences between methods. CONCLUSIONS The results of this study show a reasonable level of concordance between both stair-climbing tests. The standard test can be replaced by the fixed-altitude test up to 12 m.
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Affiliation(s)
- Nuria M Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
| | - María Rodríguez
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - M Teresa Gómez
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Marcelo F Jiménez
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Gonzalo Varela
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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Grupo de Trabajo Conjunto sobre cirugía no cardiaca: Evaluación y manejo cardiovascular de la Sociedad Europea de Cardiología (ESC) y la European Society of Anesthesiology (ESA). Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, De Hert S, Ford I, Juanatey JRG, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Luescher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Uva MS, Voudris V, Funck-Brentano C. 2014 ESC/ESA Guidelines on non-cardiac surgery. Eur J Anaesthesiol 2014; 31:517-73. [DOI: 10.1097/eja.0000000000000150] [Citation(s) in RCA: 286] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Labbé V, Ederhy S, Szymkiewicz O, Cohen A. [Management of aortic stenosis in patients undergoing non-cardiac surgery]. Presse Med 2014; 44:11-9. [PMID: 25150777 DOI: 10.1016/j.lpm.2014.02.028] [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: 01/07/2014] [Accepted: 02/05/2014] [Indexed: 11/30/2022] Open
Abstract
There is a significant risk of cardiovascular morbidity and mortality in patients with severe aortic stenosis (valve area <1cm(2) or 0.6cm(2)/m(2) body surface area, and maximum jet velocity ≥4m/sec, and mean aortic pressure gradient ≥40mmHg) undergoing non-cardiac surgery, especially in patients with symptoms (dyspnoea, angina, syncope, or heart failure). Before any surgery, clinical assessment should search for signs of aortic stenosis which justifies echocardiographic examination, particularly in the elderly. A systematic rest echocardiography with searching aortic stenosis should be considered in patients undergoing high risk surgery. The key points of pre-operative cardiac risk assessment are: assessment of the severity of aortic stenosis, measurement of the functional capacity, evaluation of the left ventricular systolic function, search of associated coronary artery disease, estimate of the surgical risk of cardiac events, and achievement of risk indices. In symptomatic patients with severe aortic stenosis, only urgent non-cardiac surgery should be performed under careful haemodynamic monitoring. Aortic valve replacement should be considered before elective non-cardiac surgery. In asymptomatic patients with severe aortic stenosis, aortic valve replacement should be considered before non-cardiac high risk surgery. Non-cardiac surgery at low/intermediate risk can be performed provided an adapted anaesthetic technique.
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Affiliation(s)
- Vincent Labbé
- Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Tenon, pôle thorax voies aériennes, unité de réanimation médico-chirurgicale, 75970 Paris cedex 20, France.
| | - Stéphane Ederhy
- Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Saint-Antoine, service de cardiologie, 75012 Paris, France
| | - Olga Szymkiewicz
- Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Tenon, pôle thorax voies aériennes, service d'anesthésie-réanimation, 75970 Paris cedex 20, France
| | - Ariel Cohen
- Groupe hospitalier des hôpitaux universitaires de l'Est Parisien, AP-HP, hôpital Saint-Antoine, service de cardiologie, 75012 Paris, France
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Barakat HM, Shahin Y, Barnes R, Gohil R, Souroullas P, Khan J, McCollum PT, Chetter IC. Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair. Ann Vasc Surg 2014; 28:74-9. [PMID: 24332259 DOI: 10.1016/j.avsg.2013.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/12/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aerobic fitness is an important predictor of postoperative outcome in major surgery. In this study, we assess the effects of a period of preoperative exercise on aerobic fitness as measured by cardiopulmonary exercise testing (CPET) in patients scheduled for abdominal aortic aneurysm (AAA) repair. METHODS As part of a randomized trial, the first patients recruited in the intervention group were enrolled in a supervised exercise program of six week duration. Treadmill CPET parameters were measured before and after exercise preoperatively for these patients. These parameters were as follows: peak oxygen uptake (VO2 peak), anaerobic threshold (AT), and ventilator equivalents for oxygen and carbon dioxide (VE/VO2 and VE/VCO2, respectively). Total exercise time and the time at which AT was achieved were also recorded. A comparison between pre- and postexercise parameters was made to detect for a possible improvement in aerobic fitness. RESULTS Twenty patients with AAA (17 men; mean age: 74.9 ± 5.9 years) were included in this study. Thirty-five percent of patients had a history of ischemic heart disease, 25% of obstructive airway disease, and 15% of cerebral vascular events. Seventy percent were previous smokers, and 15% were current smokers. Fifty-five percent of patients were taking aspirin and 75% were undergoing statin therapy. The median (interquartile range) VO2 peak at baseline was 18.2 (15.4-19.9) mL/kg/min, and after exercise was 19.9 (17.1-21.1; P = 0.048). Median AT at baseline was 12.2 (10.5-14.9), and 14.4 (12.3-15.4) after exercise (P = 0.023). Time of exercise tolerated also improved from a median of 379 to 604 sec (P = 0.001). No significant changes were seen in VE/VO2, VE/VCO2, or the time at which AT was achieved. CONCLUSION This study shows that cardiopulmonary aerobic fitness improves after a period of supervised exercise in patients scheduled for AAA repair. This is justification for a randomized trial to assess whether this affects morbidity and mortality after AAA repair.
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Affiliation(s)
- Hashem M Barakat
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK.
| | - Yousef Shahin
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - Rachel Barnes
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - Risha Gohil
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - Panos Souroullas
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - Junaid Khan
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - Peter T McCollum
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, University of Hull and Hull York Medical School, Hull, UK
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Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014; 35:2383-431. [PMID: 25086026 DOI: 10.1093/eurheartj/ehu282] [Citation(s) in RCA: 808] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Pouwels S, Stokmans RA, Willigendael EM, Nienhuijs SW, Rosman C, van Ramshorst B, Teijink JAW. Preoperative exercise therapy for elective major abdominal surgery: a systematic review. Int J Surg 2013; 12:134-40. [PMID: 24325942 DOI: 10.1016/j.ijsu.2013.11.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/08/2013] [Accepted: 11/24/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The impact of postoperative complications after Major Abdominal Surgery (MAS) is substantial, especially when socio-economical aspects are taken into account. This systematic review focuses on the effects of preoperative exercise therapy (PEXT) on physical fitness prior to MAS, length of hospital admission and postoperative complications in patients eligible for MAS, and on what is known about the most effective kind of exercise regime. METHODS A systematic search identified randomised controlled trials on exercise therapy and pulmonary physiotherapy prior to MAS. The methodological quality of the included studies was rated using the 'Delphi List For Quality Assessment of Randomised Clinical Trials'. The level of agreement between the two reviewers was estimated with Cohen's kappa. RESULTS A total of 6 studies were included, whose methodological quality ranged from moderate to good. Cohen's kappa was 0.90. Three studies reported on improving physical fitness prior to MAS with the aid of PEXT. Two studies reported on the effect of training on postoperative complications, showing contradictory results. Three studies focused on the effect of preoperative chest physiotherapy on postoperative lung function parameters after MAS. While the effects seem positive, the optimal training regime is still unclear. CONCLUSION Preoperative exercise therapy might be effective in improving the physical fitness of patients prior to major abdominal surgery, and preoperative chest physiotherapy seems effective in reducing pulmonary complications. However consensus on training method is lacking. Future research should focus on the method and effect of PEXT before high-risk surgical procedures.
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Affiliation(s)
- Sjaak Pouwels
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, The Netherlands.
| | - Rutger A Stokmans
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, The Netherlands.
| | - Edith M Willigendael
- Department of General and Vascular Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands.
| | - Simon W Nienhuijs
- Department of Abdominal Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | - Camiel Rosman
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, The Netherlands.
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Paisani DM, Fiore JF, Lunardi AC, Colluci DBB, Santoro IL, Carvalho CRF, Chiavegato LD, Faresin SM. Preoperative 6-min walking distance does not predict pulmonary complications in upper abdominal surgery. Respirology 2013; 17:1013-7. [PMID: 22616954 DOI: 10.1111/j.1440-1843.2012.02202.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Field exercise tests have been increasingly used for pulmonary risk assessment. The 6-min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post-operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS). METHODS This prospective cohort study included 137 consecutive subjects undergoing elective UAS. Subjects performed the 6MWD on the day prior to surgery, and their performance were compared with predicted values of 6MWD (p6MWD) using a previously validated formula. PPCs (including pneumonia, tracheobronchitis, atelectasis with clinical repercussions, bronchospasm and acute respiratory failure) were assessed daily by a pulmonologist blinded to the 6MWD results. 6MWD and p6MWD were compared between subjects who developed PPC (PPC group) and those who did not (no PPC group) using Student's t-test. RESULTS Ten subjects experienced PPC (7.2%) and no significant difference was observed between the 6MWD obtained in the PPC group and no PPC group (466.0 ± 97.0 m vs. 485.3 ± 107.1 m; P = 0.57, respectively). There was also no significant difference observed between groups for the p6MWD (100.7 ± 29.1% vs. 90.6 ± 20.9%; P > 0.05). CONCLUSIONS The results of the present study suggest that the 6-min walking test is not a useful tool to identify subjects with increased risk of developing PPC following UAS.
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Affiliation(s)
- Denise M Paisani
- Respiratory Department, Federal University of São Paulo, São Paulo, Brazil.
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