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Kobylarz FC, Ciampa ML, Suydam CR, Beydoun HA, Schlussel AT, Richards CRN. Optimal Time to Surgery for Small Bowel Obstruction: A Risk Adjusted Analysis Utilizing the Nationwide Inpatient Sample. Am Surg 2023; 89:6035-6044. [PMID: 37326589 DOI: 10.1177/00031348231183117] [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] [Indexed: 06/17/2023]
Abstract
BACKGROUND The management of a small bowel obstruction (SBO) remains a challenge for general surgeons. The majority of SBOs can be treated conservatively; however, when surgery is required, the timing of operative intervention remains uncertain. Utilizing a large national database, we sought to evaluate the optimal timeframe for surgery following hospital admission with a diagnosis of SBO. METHODS This was a retrospective review utilizing the Nationwide Inpatient Sample (2006-2015). Outcomes following surgery for SBO were identified using ICD-9-CM coding. Two comorbidity indices were utilized to determine severity of illness. Patients were stratified into four groups based on time in days from admission to surgery. Propensity score models were created to predict the number of days until surgery following admission. Multivariate regression analysis was performed to determine risk adjusted postoperative outcomes. RESULTS We identified 92 807 cases of non-elective surgery for SBO. The overall mortality rate was 4.7%. Surgery on days 3-5 was associated with the lowest rate of mortality. A longer preoperative length of stay (LOS) (3-5 days) was associated with a significantly greater number of wound (OR = 1.24) and procedural (OR = 1.17) complications compared to day 0. However, delayed surgical intervention (≥6 days) was associated with decreased cardiac (OR = .69) and pulmonary complications (OR = .58). DISCUSSION After adjustment, a preoperative LOS of 3-5 days was associated with a decreased risk of mortality. In addition, increasing preoperative LOS was associated with decreased cardiopulmonary complications. However, an increased risk of procedural and wound complications during this time period suggest surgery may be more technically challenging.
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Affiliation(s)
- Fred C Kobylarz
- Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Maeghan L Ciampa
- Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Camille R Suydam
- Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Andrew T Schlussel
- Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Carly R N Richards
- Department of Surgery, Martin Army Community Hospital, Fort Benning, GA, USA
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Ruan J, Xu YM, Zhong BL. Loneliness in older Chinese adults amid the COVID-19 pandemic: Prevalence and associated factors. Asia Pac Psychiatry 2023; 15:e12543. [PMID: 37562972 DOI: 10.1111/appy.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/19/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Data on loneliness among older adults in China during the COVID-19 pandemic are still scarce. This study aimed to examine the prevalence of loneliness and identify its associated factors among older Chinese adults during the COVID-19 pandemic. METHODS During the COVID-19 pandemic, 1268 older Chinese adults (aged 50+ years) were recruited through snowball sampling. The Chinese version of the validated six-item De Jong Gierveld Loneliness Scale was used to assess participants' recent feelings of loneliness, and a cut-off score of two or more was used to indicate the presence of loneliness. RESULTS Loneliness was experienced by 37.9% of the participants in recent days. Factors significantly associated with loneliness included male sex (vs. female, OR: 1.62, p < .001), an education level of middle school and below (vs. college and above, OR: 1.50, p = .007), residing in the COVID-19 epicenter (vs. other provinces, OR: 1.48, p = .004), concern about contracting COVID-19 (OR: 1.68, p = .001), poor knowledge of COVID-19 (OR: 2.39, p = .012), and physical health problems (OR: 1.65, p < .001). DISCUSSION Loneliness is common among older Chinese adults amid the COVID-19 pandemic. Targeted intervention programs may be more effective in reducing loneliness among older adults who are worried about contracting COVID-19, have poor COVID-19 knowledge, and experience physical health problems.
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Affiliation(s)
- Juan Ruan
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
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Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Balfour A, Foss NB, Cooper Z, Dhesi JK, French WB, Grant MC, Hammarqvist F, Hare SP, Havens JM, Holena DN, Hübner M, Johnston C, Kim JS, Lees NP, Ljungqvist O, Lobo DN, Mohseni S, Ordoñez CA, Quiney N, Sharoky C, Urman RD, Wick E, Wu CL, Young-Fadok T, Scott MJ. Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient. World J Surg 2023; 47:1881-1898. [PMID: 37277506 PMCID: PMC10241556 DOI: 10.1007/s00268-023-07039-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND This is Part 3 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy using an enhanced recovery after surgery (ERAS) approach. This paper addresses organizational aspects of care. METHODS Experts in management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and MEDLINE database searches were performed for ERAS elements and relevant specific topics. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. RESULTS Components of organizational aspects of care were considered. Consensus was reached after three rounds of a modified Delphi process. CONCLUSIONS These guidelines are based on best current available evidence for organizational aspects of an ERAS® approach to patients undergoing emergency laparotomy and include discussion of less common aspects of care for the surgical patient, including end-of-life issues. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.
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Affiliation(s)
- Carol J. Peden
- Department of Anesthesiology Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA 90033 USA
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
| | - Geeta Aggarwal
- Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX UK
| | - Robert J. Aitken
- Sir Charles Gardiner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
| | - Iain D. Anderson
- Salford Royal NHS Foundation Trust, Stott La, Salford, M6 8HD UK
- University of Manchester, Manchester, UK
| | - Angie Balfour
- Western General Hospital, NHS Lothian, Edinburgh, EH4 2XU Scotland
| | | | - Zara Cooper
- Center for Surgery and Public Health, Harvard Medical School, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA 02120 USA
- Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA 02120 USA
| | - Jugdeep K. Dhesi
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Research Department of Targeted Intervention, Division of Surgery & Interventional Science, University College London, London, UK
| | - W. Brenton French
- Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA 23298 USA
| | - Michael C. Grant
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287 USA
| | - Folke Hammarqvist
- Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital Huddinge, Hälsovägen 3. B85, S 141 86 Stockholm, Sweden
| | - Sarah P. Hare
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY UK
| | - Joaquim M. Havens
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Daniel N. Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Carolyn Johnston
- Department of Anaesthesia, St George’s Hospital, Tooting, London, UK
| | - Jeniffer S. Kim
- Kaiser Permanente Research, Department of Research & Evaluation, 100 South Los Robles Ave, 2nd Floor, Pasadena, CA 91101 USA
| | - Nicholas P. Lees
- Department of General & Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD UK
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Dileep N. Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham University Hospitals and University of Nottingham, Nottingham, NG7 2UH UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, Queen’s Medical Centre, School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH UK
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, School of Medical Sciences, Orebro University Hospital, Orebro University, 701 85 Orebro, Sweden
| | - Carlos A. Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 – 49, 760032 Cali, Colombia
- Sección de Cirugía de Trauma y Emergencias, Universidad del Valle – Hospital Universitario del Valle, Cl 5 No. 36-08, 760032 Cali, Colombia
| | - Nial Quiney
- Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX UK
| | - Catherine Sharoky
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Richard D. Urman
- Department of Anesthesiology, The Ohio State University and Wexner Medical Center, 410 West 10th Ave, Columbus, OH 43210 USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA 94143 USA
| | - Christopher L. Wu
- Department of Anesthesiology, Critical Care and Pain Medicine, and Department of Anesthesiology, Weill-Cornell Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Tonia Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 e. Mayo Blvd., Phoenix, AZ 85054 USA
| | - Michael J. Scott
- Department of Anesthesiology and Critical Care Medicine, and Leonard Davis Institute for Health Economics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
- University College London, London, UK
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Chen WC, Chen SJ, Zhong BL. Sense of Alienation and Its Associations With Depressive Symptoms and Poor Sleep Quality in Older Adults Who Experienced the Lockdown in Wuhan, China, During the COVID-19 Pandemic. J Geriatr Psychiatry Neurol 2022; 35:215-222. [PMID: 35130783 PMCID: PMC8899829 DOI: 10.1177/08919887221078564] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the epidemiology of sense of alienation (SoA) and its associations with depressive symptoms and poor sleep quality (PSQ) in Chinese older adults who experienced lockdown during the COVID-19 pandemic. BACKGROUND There is a dearth of data on SoA in older adults during the COVID-19 pandemic. METHODS Altogether, 543 community-dwelling older adults (50+ years) were recruited via the three-tier mental health network in Wuhan, China, and completed an online questionnaire in April 2020, the first month after the reopening of Wuhan. SoA, depressive symptoms, and sleep quality were measured by using the General Social Alienation Scale, Depression Anxiety and Stress Scale, and a single standardized question, respectively. RESULTS The prevalence of SoA was 52.3% (95% confidence interval: 48.1-56.5%). Factors associated with higher levels of SoA were religious belief (β = 1.960, P = .024), monthly family income<4000 RMB (β = 1.405, P = .022), unemployment (β = 1.217, P = .039), fair or poor physical health (β = 2.202, P = .002), never and sometimes receiving community support (β = 2.297, P < .001 and β = 3.417, P < .001), perceiving a low possibility of a cure for COVID-19 (β = 2.379, P < .001), and affirmative and unsure fear of COVID-19 patients (β = 2.025, P = .007 and β = 1.101, P = .027). After adjusting for sociodemographic and pandemic-related variables, a one-SD increment in the SoA score was significantly associated with depressive symptoms (Odd Ratio [OR] = 5.59, P < .001) and poor sleep quality (Odd Ratio = 2.00, P < .001). CONCLUSION Over half of the older adults who experienced lockdown felt alienated, and SoA was independently associated with their depressive symptoms and PSQ. Efforts are warranted to address SoA in older adults who experienced lockdown during the pandemic.
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Affiliation(s)
- Wen-Cai Chen
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Si-Jing Chen
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
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Aggarwal G, Scott M, Peden CJ. Emergency Laparotomy. Anesthesiol Clin 2022; 40:199-211. [PMID: 35236580 DOI: 10.1016/j.anclin.2021.11.010] [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] [Indexed: 06/14/2023]
Abstract
Emergency laparotomy is a high-risk surgical procedure with mortality and morbidity up to 10 times higher than for a similar procedure performed electively. An enhanced recovery approach has been shown to improve outcomes. A focus on rapid correction of underlying deranged acute physiology and proactive management of conditions associated with aging such as frailty and delirium are key. Patients are at high risk of complications and prevention and avoidance of failure to rescue are essential to improve outcomes. Other enhanced recovery components such as opioid-sparing analgesia and early postoperative mobilization are beneficial.
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Affiliation(s)
- Geeta Aggarwal
- Royal Surrey Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
| | - Michael Scott
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Surgical Outcomes Research Centre, University College London, London, UK
| | - Carol J Peden
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Clinical Quality the Blue Cross Blue Shield Association, Chicago, IL 60601, USA
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Zhang QQ, Li L, Zhong BL. Prevalence of Insomnia Symptoms in Older Chinese Adults During the COVID-19 Pandemic: A Meta-Analysis. Front Med (Lausanne) 2021; 8:779914. [PMID: 34869501 PMCID: PMC8634335 DOI: 10.3389/fmed.2021.779914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The ongoing COVID-19 pandemic has disproportionately affected the sleep health of older adults, but the limited number of studies on insomnia symptoms of older Chinese adults differed in terms of screener of insomnia, sample size, and prevalence, making mental health planning for this population difficult. This meta-analysis estimated the prevalence of insomnia symptoms in older Chinese adults during the COVID-19 pandemic. Methods: Both Chinese (CNKI, Wanfang, VIP) and English (PubMed, EmBase, PsycInfo) databases were systematically searched to identify cross-sectional studies containing data on the prevalence of insomnia symptoms in older Chinese adults during the pandemic. Risk of bias (RoB) of included studies was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Results: Nine studies with a total of 27,207 older Chinese adults were included. RoB scores of these studies ranged between zero and six. The pooled prevalence rates of insomnia symptoms and moderate and severe insomnia symptoms were 24.6% [95% confidence interval (CI): 19.5–30.5%] and 11.1% (95% CI: 7.2–16.9%), respectively. In subgroup analysis, significantly higher prevalence rates were observed in studies defining insomnia symptoms as “Insomnia Severity Index (ISI) ≥ 8” than in those defining them as “ISI ≥ 15” (32.6 vs. 15.6%, P < 0.001) and in older adults living in the COVID-19 epicenter than in those living in other places (35.2 vs. 23.3%, P = 0.006). Conclusion: Nearly one out of every four older Chinese adults suffered from insomnia symptoms during the pandemic. Mental health services for this population during the pandemic should include supportive activities aimed at improving mental well-being, periodic assessment of insomnia symptoms, and psychiatric assessment and treatment when necessary.
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Affiliation(s)
- Qian-Qian Zhang
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Lan Li
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Bao-Liang Zhong
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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