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He X, Dong M, Xiong H, Zhu Y, Ping F, Wang B, Kang Y. Prediction models for postoperative pulmonary complications in intensive care unit patients after noncardiac thoracic surgery. BMC Pulm Med 2024; 24:420. [PMID: 39210309 PMCID: PMC11360767 DOI: 10.1186/s12890-024-03153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/08/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Postoperative pulmonary complication (PPC) is a leading cause of mortality and poor outcomes in postoperative patients. No studies have enrolled intensive care unit (ICU) patients after noncardiac thoracic surgery, and effective prediction models for PPC have not been developed. This study aimed to explore the incidence and risk factors and construct prediction models for PPC in these patients. METHODS This study retrospectively recruited patients admitted to the ICU after noncardiac thoracic surgery at West China Hospital, Sichuan University, from July 2019 to December 2022. The patients were randomly divided into a development cohort and a validation cohort at a 70% versus 30% ratio. The preoperative, intraoperative and postoperative variables during the ICU stay were compared. Univariate and multivariate logistic regression analyses were applied to identify candidate predictors, establish prediction models, and compare the accuracy of the models with that of reported risk models. RESULTS A total of 475 ICU patients were enrolled after noncardiac thoracic surgery (median age, 58; 72% male). At least one PPC occurred in 171 patients (36.0%), and the most common PPC was pneumonia (153/475, 32.21%). PPC significantly increased the duration of mechanical ventilation (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (LOS) (p < 0.001), and rate of reintubation (p = 0.047) in ICU patients. Seven risk factors were identified, and then the prediction nomograms for PPC were constructed. At ICU admission, the area under the curve (AUC) was 0.766, with a sensitivity of 0.71 and specificity of 0.60; after extubation, the AUC was 0.841, with a sensitivity of 0.75 and specificity of 0.83. The models showed robust discrimination in both the development cohort and the validation cohort, and they were well calibrated and more accurate than reported risk models. CONCLUSIONS ICU patients who underwent noncardiac thoracic surgery were at high risk of developing PPCs. Prediction nomograms were constructed and they were more accurate than reported risk models, with excellent sensitivity and specificity. Moreover, these findings could help assess individual PPC risk and enhance postoperative management of patients.
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Affiliation(s)
- Xiangjun He
- Department of Critical Care Medicine, West China Hospital, Sichuan University and Institute of Critical Care Medicine, No. 17, Section 3, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, 610041, China
| | - Meiling Dong
- Department of Critical Care Medicine, West China Hospital, Sichuan University and Institute of Critical Care Medicine, No. 17, Section 3, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, 610041, China
| | - Huaiyu Xiong
- Department of Critical Care Medicine, West China Hospital, Sichuan University and Institute of Critical Care Medicine, No. 17, Section 3, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, 610041, China
| | - Yukun Zhu
- Department of Critical Care Medicine, West China Hospital, Sichuan University and Institute of Critical Care Medicine, No. 17, Section 3, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, 610041, China
| | - Feng Ping
- Department of Critical Care Medicine, West China Hospital, Sichuan University and Institute of Critical Care Medicine, No. 17, Section 3, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, 610041, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University and Institute of Critical Care Medicine, No. 17, Section 3, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, 610041, China.
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University and Institute of Critical Care Medicine, No. 17, Section 3, Renmin South Road, Wuhou District, Chengdu City, Sichuan Province, 610041, China.
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Timsina SR, Tanomkiat W, Geater SL, Ina N. Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung cancer patients. Thorac Cancer 2024; 15:1287-1295. [PMID: 38666456 PMCID: PMC11147667 DOI: 10.1111/1759-7714.15313] [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: 03/17/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Various cutoffs have been used to diagnose computed tomography (CT)-defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. METHODS In this cross-sectional study including 237 patients with lung cancer, the SMI was assessed using CT-determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT-defined low skeletal muscle mass in predicting PFL. RESULTS The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%-91.77%), specificity (11.39%-50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516-0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age - SMI + 21) was constructed, which achieved an AUC value of 0.748. CONCLUSION Fixed cutoffs for CT-defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer.
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Affiliation(s)
- Shiva Raj Timsina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Wiwatana Tanomkiat
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Sarayut L. Geater
- Unit of Respiratory and Respiratory Critical Care Medicine, Department of Medicine, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
| | - Natee Ina
- Department of Radiology, Faculty of MedicinePrince of Songkla UniversitySongklaThailand
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Minawala R, Faye AS. Sarcopenia as a Preoperative Risk Stratification Tool among Older Adults with Inflammatory Bowel Disease. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240003. [PMID: 38911683 PMCID: PMC11192537 DOI: 10.20900/agmr20240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Sarcopenia, defined as a loss of muscle mass and function, is a physiologic factor that has been implicated as a predictor of adverse postoperative outcomes in many older adult populations. However, data related to sarcopenia in older adults with inflammatory bowel disease (IBD) remain limited. Older adults with IBD are particularly vulnerable to adverse postoperative outcomes, in part, due to muscle depletion from systemic inflammation, malnutrition, and reduced physical activity. However, few patients undergo routine muscle evaluation as a part of preoperative assessment. Moreover, cut-off values for measures of sarcopenia in the literature are modeled after non-IBD populations. The lack of standardized measures and values for sarcopenia in the IBD patient population has led to heterogenous findings and a paucity of preoperative risk stratification tools. Therefore, we aim to explore the scope of sarcopenia as a preoperative risk stratification tool among older adults with IBD.
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Affiliation(s)
- Ria Minawala
- Department of Medicine, NYU School of Medicine, New York, NY 10016, USA
| | - Adam S. Faye
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10016, USA
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Pandey S, Bradley L, Del Fabbro E. Updates in Cancer Cachexia: Clinical Management and Pharmacologic Interventions. Cancers (Basel) 2024; 16:1696. [PMID: 38730648 PMCID: PMC11083841 DOI: 10.3390/cancers16091696] [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: 03/24/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Despite a better understanding of the mechanisms causing cancer cachexia (CC) and development of promising pharmacologic and supportive care interventions, CC persists as an underdiagnosed and undertreated condition. CC contributes to fatigue, poor quality of life, functional impairment, increases treatment related toxicity, and reduces survival. The core elements of CC such as weight loss and poor appetite should be identified early. Currently, addressing contributing conditions (hypothyroidism, hypogonadism, and adrenal insufficiency), managing nutrition impact symptoms leading to decreased oral intake (nausea, constipation, dysgeusia, stomatitis, mucositis, pain, fatigue, depressed mood, or anxiety), and the addition of pharmacologic agents when appropriate (progesterone analog, corticosteroids, and olanzapine) is recommended. In Japan, the clinical practice has changed based on the availability of Anamorelin, a ghrelin receptor agonist that improved lean body mass, weight, and appetite-related quality of life (QoL) compared to a placebo, in phase III trials. Other promising therapeutic agents currently in trials include Espindolol, a non-selective β blocker and a monoclonal antibody to GDF-15. In the future, a single therapeutic agent or perhaps multiple medications targeting the various mechanisms of CC may prove to be an effective strategy. Ideally, these medications should be incorporated into a multimodal interdisciplinary approach that includes exercise and nutrition.
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Affiliation(s)
- Sudeep Pandey
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.P.); (L.B.)
| | - Lauren Bradley
- Department of Internal Medicine, Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.P.); (L.B.)
| | - Egidio Del Fabbro
- Department of Medicine, Division of Palliative Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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Tamburini N, Dolcetti F, Fabbri N, Azzolina D, Greco S, Maniscalco P, Dolci G. Impact of Modified Frailty Index on Readmissions Following Surgery for NSCLC. Thorac Cardiovasc Surg 2024. [PMID: 38479424 DOI: 10.1055/a-2287-2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
BACKGROUND Analyzing the risk factors that predict readmissions can potentially lead to more individualized patient care. The 11-factor modified frailty index is a valuable tool for predicting postoperative outcomes following surgery. The objective of this study is to determine whether the frailty index can effectively predict readmissions within 90 days after lung resection surgery in cancer patients within a single health care institution. METHODS Patients who underwent elective pulmonary resection for nonsmall cell lung cancer (NSCLC) between January 2012 and December 2020 were selected from the hospital's database. Patients who were readmitted after surgery were compared to those who were not, based on their data. Propensity score matching was employed to enhance sample homogeneity, and further analyses were conducted on this newly balanced sample. RESULTS A total of 439 patients, with an age range of 68 to 77 and a mean age of 72, were identified. Among them, 55 patients (12.5%) experienced unplanned readmissions within 90 days, with an average hospital stay of 29.4 days. Respiratory failure, pneumonia, and cardiac issues accounted for approximately 67% of these readmissions. After propensity score matching, it was evident that frail patients had a significantly higher risk of readmission. Additionally, frail patients had a higher incidence of postoperative complications and exhibited poorer survival outcomes with statistical significance. CONCLUSION The 11-item modified frailty index is a reliable predictor of readmissions following pulmonary resection in NSCLC patients. Furthermore, it is significantly associated with both survival and postoperative complications.
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Affiliation(s)
- Nicola Tamburini
- Department of Thoracic Surgery, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Francesco Dolcetti
- Department of Thoracic Surgery, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Nicolò Fabbri
- Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Ferrara, Italy
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Salvatore Greco
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Pio Maniscalco
- Department of Thoracic Surgery, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Giampiero Dolci
- Department of Thoracic Surgery, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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Wada H, Suzuki H, Sakairi Y, Tanaka K, Sata Y, Toyoda T, Inage T, Matsui Y, Yoshino I. Can modified frailty index predict postoperative complication after lung cancer surgery? Gen Thorac Cardiovasc Surg 2024; 72:176-182. [PMID: 37474741 DOI: 10.1007/s11748-023-01962-3] [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: 06/08/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The impact of the modified frailty index (mFI) on postoperative complications after lung cancer surgery was investigated. METHODS Patients who underwent lung cancer surgery in 2017 were included. 30-day postoperative mortality and morbidity were evaluated according to their Clavien-Dindo classification. mFI values are presented as the sum of values of 11 included items. Logistic regression was used to assess the effect of mFI on postoperative severe complication incidence. RESULTS Among 190 patients considered, severe postoperative complications (Grade 3 or more) were observed in 30 (16%). No patients died within 30 days of surgery. The incidence of severe complications was 3.6% in patients with mFI of 0, 16.2% in patients with mFI of 1, 23.4% in patients with mFI of 2, and 31.6% in patients with mFI of 3 or more, and was correlated with the grade of mFI. Univariate and multivariate analyses showed that the high mFI was significantly predictive of postoperative complications. Frail patients of mFI ≥ 2 were at 3.0-fold greater risk of severe complications than non-frail patients of mFI 0 or 1. CONCLUSION mFI was associated with morbidity after lung cancer surgery. Preoperative frailty assessment and appropriate intervention to frail patients would be required to improve postoperative outcomes.
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Affiliation(s)
- Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, 286-8686, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yuki Sata
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takahide Toyoda
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yukiko Matsui
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, 286-8686, Japan
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Meyer M, Michalk K, Greimel F, Maderbacher G, Grifka J, Kappenschneider T. [SOG-Special Orthopedic Geriatrics : First interim results of a randomized controlled study on integrated orthogeriatric care in elective hip and knee arthroplasty]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:127-135. [PMID: 38236298 PMCID: PMC10844454 DOI: 10.1007/s00132-023-04466-3] [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: 12/08/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND To date, there are no adequate care concepts for geriatric patients undergoing elective orthopaedic surgery in Germany. The Special Orthopaedic Geriatrics (SOG) study evaluates for the first time in Germany the impact of comprehensive orthogeriatric co-management on the outcome of elderly patients with elective hip and knee replacements compared to standard orthopaedic care. METHODS The interim analysis of the ongoing study included 174 patients; 87 patients were randomized to the intervention group and 87 to the control group. The SOG care model consists of screening, preoperative assessment with preoperative intervention, fast-track surgery and multimodal perioperative care in the orthogeriatric team. The control group received standard orthopaedic care. Mobility, complications, and patient-reported outcome measures after surgery were compared. RESULTS The SOG group showed a clinically relevant improvement in mobility postoperatively compared to the control group at all time points (p < 0.01). The evaluation of complications showed a significant risk reduction for minor complications (p < 0.01), as well as a clear trend towards a risk reduction for major complications. Patient-reported outcome measures showed a significant improvement in joint function and general health-related quality of life both in the SOG group and the control group. CONCLUSION Integrated orthogeriatric care models such as SOG could improve the care of geriatric patients in elective orthopaedic surgery in the future and, above all, make it safer.
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Affiliation(s)
- Matthias Meyer
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Katrin Michalk
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Felix Greimel
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Günther Maderbacher
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Joachim Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Tobias Kappenschneider
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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Kappenschneider T, Bammert P, Maderbacher G, Greimel F, Holzapfel DE, Schwarz T, Götz J, Pagano S, Scharf M, Michalk K, Grifka J, Meyer M. The impact of elective total hip and knee arthroplasty on physical performance in orthogeriatric patients: a prospective intervention study. BMC Geriatr 2023; 23:763. [PMID: 37990164 PMCID: PMC10664286 DOI: 10.1186/s12877-023-04460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Osteoarthritis is a prevalent condition in older adults that leads to reduced physical function in many patients and ultimately requires hip or knee replacement. The aim of the study was to determine the impact of hip and knee arthroplasty on the physical performance of orthogeriatric patients with osteoarthritis. METHODS In this prospective study, we used data from 135 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Physical function, measured by the Short Physical Performance Battery (SPPB), was assessed preoperatively, 3 and 7 days postoperatively, 4-6 weeks and 3 months after hip and knee arthroplasty. For the statistical analysis, the Friedman test and post-hoc tests were used. RESULTS Of the 135 participants with a mean age of 78.5 ± 4.6 years, 81 underwent total hip arthroplasty and 54 total knee arthroplasty. In the total population, SPPB improved by a median of 2 points 3 months after joint replacement (p < 0.001). In the hip replacement group, SPPB increased by a median of 2 points 3 months after surgery (p < 0.001). At 3 months postoperatively, the SPPB increased by a median of 1 point in the knee replacement group (p = 0.003). CONCLUSION Elective total hip and knee arthroplasty leads to a clinically meaningful improvement in physical performance in orthogeriatric patients with osteoarthritis after only a few weeks. TRIAL REGISTRATION This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.
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Affiliation(s)
- Tobias Kappenschneider
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany.
| | - Philip Bammert
- Department of Health Economics, Technical University of Munich, Munich, Germany
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | | | - Timo Schwarz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Julia Götz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Stefano Pagano
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Markus Scharf
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Katrin Michalk
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
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Rozenberg D. Rehabilitation pre- and post thoracic surgery: Progress and future opportunities. Chron Respir Dis 2023; 20:14799731231165305. [PMID: 36941268 PMCID: PMC10031604 DOI: 10.1177/14799731231165305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Dmitry Rozenberg
- Division of Respirology, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Ajmera Transplant Center, Toronto General Hospital Research Institute, 7989University Health Network, Toronto, ON, Canada
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Kurita D, Sakurai T, Utsunomiya D, Kubo K, Fujii Y, Kanematsu K, Ishiyama K, Oguma J, Daiko H. Predictive Ability of the Five-time Chair Stand Test for Postoperative Pneumonia after Minimally Invasive Esophagectomy for Esophageal Cancer. Ann Surg Oncol 2022; 29:7462-7470. [PMID: 35802215 DOI: 10.1245/s10434-022-12002-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The revised sarcopenia guidelines proposed handgrip strength (HGS) and five-time chair stand test (5-CST) as the primary parameters of muscle function. HGS and 5-CST are associated with pulmonary function among community-dwelling people, although few reports have described an association between these parameters and surgical outcomes in carcinomas. We examined the predictive ability of 5-CST for postoperative pneumonia after minimally invasive esophagectomy (MIE) compared with that of HGS. METHODS This retrospective, single-center, observational study evaluated 222 male patients who underwent MIE for esophageal cancer between February 2018 and October 2020. Sarcopenia parameters included 5-CST, HGS, and skeletal muscle index. Postoperative pneumonia predictors were determined by using multivariate logistic regression analysis. We assessed the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) to analyze the predictive ability of 5-CST and HGS. RESULTS MIE was performed for squamous cell carcinoma (n = 179), adenocarcinoma (n = 38), and other cancers (n = 5). Forty-nine (22.1%) patients developed postoperative pneumonia. Multivariate logistic regression showed that age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.10; p = 0.027), 5-CST (OR, 1.19; 95% CI 1.00-1.40; p = 0.046), and recurrent laryngeal nerve palsy (RLNP) (OR, 3.37; 95% CI 1.60-7.10; p = 0.001) significantly predicted postoperative pneumonia. Category-free NRI and IDI showed that adding 5-CST in the prediction model with age and RLNP resulted in significantly greater reclassification and discrimination abilities than did HGS. CONCLUSIONS The 5-CST significantly predicted postoperative pneumonia after MIE. NRI and IDI analyses suggested that 5-CST had significantly better predictive ability for postoperative pneumonia than did HGS.
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Affiliation(s)
- Daisuke Kurita
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Toru Sakurai
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Daichi Utsunomiya
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kentaro Kubo
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yusuke Fujii
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kyohei Kanematsu
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koshiro Ishiyama
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Junya Oguma
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Xue W, Xinlan Z, Xiaoyan Z. Effectiveness of early cardiac rehabilitation in patients with heart valve surgery: a randomized, controlled trial. J Int Med Res 2022; 50:3000605211044320. [PMID: 35899970 PMCID: PMC9340911 DOI: 10.1177/03000605211044320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Complications of heart valve surgery lead to physical inactivity and produce harmful effects. This study aimed to investigate the role of a cardiac rehabilitation program and its long-term effect in patients after heart valve surgery. METHODS We performed a single-blind, randomized, controlled trial. Patients with heart valve surgery were randomly assigned to receive early cardiac rehabilitation (intervention group, 44 patients) or the usual care (control group, 43 patients). The intervention group performed sitting, standing, and walking exercises, followed by endurance training. The control group received usual care and did not engage in any physical activity. Physical function was assessed by the Short Physical Performance Battery (SPPB) and other measurement tools. RESULTS The intervention group showed a significant beneficial effect regarding physical capacity as shown by the SPPB and the 6-minute walking test at hospital discharge, and a better long-term effect was achieved at 6 months compared with the control group. An improvement in physical function (e.g., the SPPB) after hospital discharge predicted follow-up mortality (odds ratio = 0.416, 95% confidence interval: 0.218-0.792). CONCLUSION Early cardiac rehabilitation appears to be an effective approach to improve the physical function and survival of patients with heart valve surgery.
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Affiliation(s)
- Wei Xue
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhang Xinlan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zheng Xiaoyan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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de Fátima Ribeiro Silva C, Ohara DG, Matos AP, Pinto ACPN, Pegorari MS. Short Physical Performance Battery as a Measure of Physical Performance and Mortality Predictor in Older Adults: A Comprehensive Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010612. [PMID: 34682359 PMCID: PMC8535355 DOI: 10.3390/ijerph182010612] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/04/2023]
Abstract
The association between the Short Physical Performance Battery (SPPB) score and several adverse health outcomes, including mortality, has been reported in the scientific literature. We conducted a comprehensive literature review of studies on the relationship between SPPB and mortality. The current paper synthesizes the characteristics and main findings of longitudinal studies available in the literature that investigated the role of the SPPB in predicting mortality in older adults. The studies (n = 40) are from North America, South America, Europe, and Asia; the majority (n = 16) were conducted with community-dwelling older adults and reported an association between lower SPPB scores and a higher risk of mortality, and between higher SPPB scores and higher survival. Nevertheless, few studies have analyzed the accuracy of the instrument to predict mortality. The only study that established cut-off points was conducted with older adults discharged from an acute care hospital. Although an SPPB score lower than 10 seems to predict all-cause mortality, further studies showing cut-off points in specific settings and loco-regional specificities are still necessary.
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13
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Argillander TE, Heil TC, Melis RJF, van Duijvendijk P, Klaase JM, van Munster BC. Preoperative physical performance as predictor of postoperative outcomes in patients aged 65 and older scheduled for major abdominal cancer surgery: A systematic review. Eur J Surg Oncol 2021; 48:570-581. [PMID: 34629224 DOI: 10.1016/j.ejso.2021.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/02/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Abdominal cancer surgery is associated with considerable morbidity in older patients. Assessment of preoperative physical status is therefore essential. The aim of this review was to describe and compare the objective physical tests that are currently used in abdominal cancer surgery in the older patient population with regard to postoperative outcomes. METHODS Medline, Embase, CINAHL and Web of Science were searched until 31 December 2020. Non-interventional cohort studies were eligible if they included patients ≥65 years undergoing abdominal cancer surgery, reported results on objective preoperative physical assessment such as Cardiopulmonary Exercise Testing (CPET), field walk tests or muscle strength, and on postoperative outcomes. RESULTS 23 publications were included (10 CPET, 13 non-CPET including Timed Up & Go, grip strength, 6-minute walking test (6MWT) and incremental shuttle walk test (ISWT)). Meta-analysis was precluded due to heterogeneity between study cohorts, different cut-off points, and inconsistent reporting of outcomes. In CPET studies, ventilatory anaerobic threshold and minute ventilation/carbon dioxide production gradient were associated with adverse outcomes. ISWT and 6MWT predicted outcomes in two studies. Tests addressing muscle strength and function were of limited value. No study compared different physical tests. DISCUSSION CPET has the ability to predict adverse postoperative outcomes, but it is time-consuming and requires expert assessment. ISWT or 6MWT might be a feasible alternative to estimate aerobic capacity. Muscle strength and function tests currently have limited value in risk prediction. Future research should compare the predictive value of different physical instruments with regard to postoperative outcomes in older surgical patients.
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Affiliation(s)
- T E Argillander
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands; Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands; University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - T C Heil
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R J F Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - J M Klaase
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B C van Munster
- University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Przkora R, Sibille K, Victor S, Meroney M, Leeuwenburgh C, Gardner A, Vasilopoulos T, Parvataneni HK. Blood flow restriction exercise to attenuate postoperative loss of function after total knee replacement: a randomized pilot study. Eur J Transl Myol 2021; 31. [PMID: 34459574 PMCID: PMC8495367 DOI: 10.4081/ejtm.2021.9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
Aging well is directly associated with a healthy lifestyle. The focus of this paper is to relate that attenuation of postoperative loss of muscle function after a total knee arthroplasty (TKA) is an important consideration. Because patients usually do not tolerate standard high-resistance exercise in the preoperative or postoperative period, they often experience a decline in strength and function. Therefore, we tested the feasibility and acceptability of an alternative low-resistance exercise protocol with blood flow restriction (BFR) using a tourniquet in the preoperative period for patients awaiting TKA. We recruited patients undergoing a TKA and randomized six to the BFR exercise for 4 weeks prior to surgery and four to standard of care (no exercise). We measured physical function using the Short Physical Performance Battery (SPPB), the 6-Minute Walk Test (6MWT), leg strength (peak torque), and pain (numerical pain score) 4 to 5 weeks preoperatively and 2 weeks postoperatively. The clinical management, e.g., anesthetic management, did not differ between groups. No complications were observed. Our findings demonstrate the feasibility and acceptability of the BFR intervention. Although preliminary and not powered for comparison, the BFR group demonstrated less decline in SPPB following surgery (−2.2, 95%CI:−4.4,0.1) compared to the no exercise group (−4.8, 95%CI:−7.8,−1.7). No differences were noted for the 6MWT, leg strength, and pain measurements. We conclude that preoperative low-resistance exercise using the BFR is feasible and acceptable, and this test warrants investigation as an intervention to potentially attenuate the postoperative loss of physical function after TKA.
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Affiliation(s)
- Rene Przkora
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Kimberly Sibille
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA; Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida.
| | - Sandra Victor
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Matthew Meroney
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida, USA; Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, Florida.
| | - Anna Gardner
- Department of Applied Physiology and Kinesiology, University of Florida College of Health and Human Performance, Gainesville, Florida.
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA; Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
| | - Hari K Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
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Przkora R, Sibille K, Victor S, Meroney M, Leeuwenburgh C, Gardner A, Vasilopoulos T, Parvataneni HK. Assessing the feasibility of using the short physical performance battery to measure function in the immediate postoperative period after total knee replacement. Eur J Transl Myol 2021; 31. [PMID: 33840178 PMCID: PMC8274223 DOI: 10.4081/ejtm.2021.9673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/01/2021] [Indexed: 12/27/2022] Open
Abstract
Measurements of physical function after total knee arthroplasty (TKA) are uncertain and require investments for special equipment, space, and staff. Therefore, we evaluated the Short Physical Performance Battery (SPPB) 4 to 6 weeks preoperatively and 2 weeks following TKA as this test battery addresses lower extremity strength, coordination, and balance, without additional special investments. For context, we also employed the Six-Minute Walk test (6MWT) and peak torque knee extension. Our analysis consisted of three women and one man, with average ages of 68.3±3.9 years. Patients showed a decrease in all functional measurements: SPPB (mean change: -4.8±1.9, 44% decrease), 6MWT (-0.37±.21 m/s, 34% decrease), and peak torque (-11.8±8.8°/s, 68% decrease). Our findings suggest the SPPB is feasible and can be integrated easily in daily clinical practice.
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Affiliation(s)
- Rene Przkora
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Kimberly Sibille
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida; Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida.
| | - Sandra Victor
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Matthew Meroney
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida; Department of Anatomy and Cell Biology, University of Florida College of Medicine, Gainesville, Florida.
| | - Anna Gardner
- Department of Applied Physiology and Kinesiology, University of Florida College of Health and Human Performance, Gainesville, Florida.
| | | | - Hari K Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida.
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