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Su H, Yu S, Huang H, Lin S, Zhou H, Chen L, Xiang S, Hu X, Gong Y, Li J, Li J, Tong P, Xu T. Importance of hip capsular repair in total hip arthroplasty (THA) via the posterior lateral approach: a five year retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2024; 48:2567-2577. [PMID: 39212693 DOI: 10.1007/s00264-024-06293-3] [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] [Received: 06/12/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This study aims to assess the impact of repairing the hip joint capsule during posterior-lateral approach total hip arthroplasty (THA) on postoperative hip joint function and late dislocation incidence. METHODS A retrospective cohort study included 413 patients, divided into experimental (hip joint capsule repair, n = 204) and control (hip joint capsule excision, n = 209) groups. Patients were followed for five years, evaluating postoperative hip range of motion (ROM), dislocation rate, VAS and HHS scores, inflammatory and coagulation markers, hospitalization, blood loss, and body composition. Statistical analysis included the Student's t-test, Chi-square test, and logistic regression for dislocation risk factors. RESULTS Joint capsule repair improved postoperative hip flexion and extension within six months and at two years postoperatively, internal and external rotation within three months, and abduction and adduction throughout the entire follow-up period (P < 0.05). Capsular repair also reduced early and late dislocation rates (P < 0.05). Significant differences in HHS and VAS scores, inflammatory and coagulation indicators, hospitalization, blood loss, and body composition were noted (P < 0.05). Multivariate logistic regression indicated hip joint repair, rheumatoid arthritis, epilepsy, and sarcopenia as dislocation risk factors (P < 0.05). CONCLUSIONS Capsular repair during posterior-lateral THA improves postoperative hip function and mobility while reducing dislocation rates, blood loss, pain, inflammation, and economic burden. Patients with rheumatoid arthritis, epilepsy, or sarcopenia require individualized planning and enhanced postoperative care to minimize complications.
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Affiliation(s)
- Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Shenxu Yu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Hua Huang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Shineng Lin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Haojing Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Sicheng Xiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Xinyu Hu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Junyan Li
- Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Ju Li
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China.
| | - Taotao Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, 310053, Zhejiang Province, China.
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Ali KA, He L, Deng X, Pan J, Huang H, Li W. Assessing the predictive value of pre- and post-operative inflammatory markers in patients undergoing total knee arthroplasty. J Orthop Surg Res 2024; 19:614. [PMID: 39343946 PMCID: PMC11440765 DOI: 10.1186/s13018-024-05104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/22/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Total Knee Arthroplasty (TKA) has proven highly effective in improving quality of life for patients with severe knee conditions. Despite advancements, surgical complications such as periprosthetic joint infections (PJIs) pose risks. The potential predictive value of pre- and post-operative inflammatory markers like neutrophil-to-lymphocyte ratio (NLR), D-dimer, and albumin levels on surgical outcomes is garnering attention. There is a growing interest in leveraging these markers to enhance patient selection and outcome prediction in the context of TKA.Focusing on the natural course of these markers, and the incidence of PJIs and to refine perioperative care strategies, improve patient outcomes, and identify high-risk patients for targeted intervention. METHODS The study included 94 patients who underwent total knee arthroplasty (TKA) between 2019 and 2023. Blood tests were conducted before surgery and at 1, 3, 7, and 15 days after surgery to assess various parameters including white blood cell count, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein, D-dimers, total protein, albumin, and total cholesterol values and ratios. RESULTS Following total knee arthroplasty (TKA), key observations in blood markers included a sharp rise in white blood cell (WBC) counts from 5.81 to 10.22 (*10^9/L) on the first day post-surgery, with levels returning close to preoperative values by day-15. Neutrophil counts similarly increased from 3.46 to 8.50 (*10^9/L) on day-1, decreasing to 4.01 by day-15. Hemoglobin levels significantly decreased from 115.70 g/L to 90.62 by day-3 before improving to 100.30 by day-15. C-reactive protein (CRP) levels also saw a significant rise from 6.15 mg/L to a peak of 47.07 on day-3, then reducing to 10.55 by day-15, indicating a response to inflammation. CONCLUSION Following total knee arthroplasty (TKA), a significant initial postoperative increase in white blood cell count, neutrophils, and C-reactive protein levels, indicative of an acute inflammatory response, before returning towards baseline values by day 15. Hemoglobin levels displayed a notable dip post-surgery, gradually improving by the study's end. These patterns emphasize the dynamic nature of inflammatory and hematological responses after TKA, highlighting their potential role in predicting surgical outcomes and guiding postoperative care.
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Affiliation(s)
- Khan Akhtar Ali
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - LingXiao He
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xinyue Deng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jumei Pan
- Department of Hospice Care of Linfen Road Community Health Care Center, Jing An District, Shanghai, 200435, China
| | - Hui Huang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenkai Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Germano J, Baichoo N, Germano A, Scuderi G. Patient Perception of Preoperative Nutrition and Recovery After Orthopaedic Surgery. J Arthroplasty 2024; 39:2221-2224. [PMID: 38636677 DOI: 10.1016/j.arth.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Mounting evidence supports the use of nutritional supplementation to improve patient outcomes. The intent of this study was to utilize an anonymous questionnaire to determine patients' baseline knowledge, attitude, and belief regarding nutrition before total hip (THA) or total knee arthroplasty (TKA). METHODS After receiving Institutional Review Board approval, an anonymous questionnaire was administered to 300 patients, comprising 184 women (61.3%) and 116 men (38.6%), averaging 67 years (range, 39 to 89). There were 238 TKAs (79.3%), 12 revision TKAs (4%), 44 THAs (14.6%), and 6 revision THAs (2%). RESULTS Almost all (99.6%) subjects recognized the importance of preoperative nutrition. Most (83.0%) claimed that they knew what to eat preoperatively to optimize their surgical outcomes and expressed high levels of self-reported confidence (98.6%). Women were more likely to report having knowledge of preoperative nutrition (P = .05), and advanced education levels were linked to higher confidence (P = .002). Only 169 (56.3%) subjects reported knowing what supplements to take. When asked, 84% of subjects stated that they would purchase a nutrition program if recommended by their surgeon. Most studies show that an improved diet and appropriate supplementation can optimize nutritional status and potentially improve surgical outcomes. CONCLUSIONS The results of this study confirm that most patients do not know how to achieve optimal nutrition. Therefore, we believe there is a need for patient education on preoperative nutrition and its benefits.
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Affiliation(s)
- James Germano
- Orlin and Cohen Orthopedic Group, Garden City, New York
| | - Nadia Baichoo
- Orlin and Cohen Orthopedic Group, Garden City, New York
| | | | - Giles Scuderi
- Northwell Health Physician Partners Orthopaedic Institute at Lennox Hill, New York, New York
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Hagiyama A, Yamamoto N, Watanabe J, Tsuge T, Nakashima Y, Nakao S, Sato H, Yorifuji T. Efficacy of Protein and Essential Amino Acid Supplementation in Lower Limb Surgeries: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e69212. [PMID: 39398772 PMCID: PMC11469702 DOI: 10.7759/cureus.69212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2024] [Indexed: 10/15/2024] Open
Abstract
This study aimed to examine the efficacy and safety of protein and/or essential amino acid (EAA) supplementation in all lower limb surgeries using systematic reviews and meta-analysis of randomized controlled trials (RCTs). We included RCTs that assessed the efficacy of protein and/or EAA supplementation in lower limb surgeries. On June 2, 2023, we searched EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The primary outcomes were mobility, patient-reported outcomes (PRO), and acute kidney injury (AKI). The secondary outcomes were exercise capacity, muscle strength, muscle mass, and all adverse events. We performed meta-analyses using the random-effects model. We assessed the risk of bias using the Cochrane risk-of-bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We included 12 RCTs (622 patients). These studies included four on hip fracture surgery, three on total hip arthroplasty, and five on total knee arthroplasty. Protein and/or EAA supplementation may slightly improve PRO (standard mean difference 0.51, 95% confidence interval (CI): 0.22 to 0.80, low certainty of evidence). Nevertheless, it may not improve mobility (mean difference 0.07 m/s, 95% CI: -0.01 to 0.16, low certainty of evidence). No adverse events including AKI were reported. Muscle strength may have increased (standard mean difference 0.31, 95% CI: 0.02 to 0.61, very low certainty of evidence). However, exercise capacity (mean difference 5.43 m, 95% CI: -35.59 to 46.45, very low certainty of evidence) and muscle mass (standard mean difference -0.08, 95% CI: -0.49 to 0.33, very low certainty of evidence) were not improved. While protein and/or EAA supplementation in lower limb surgeries may improve PRO, it is unlikely to affect mobility. Despite this, the medical team and patients might still consider protein and/or EAA supplementation a useful option.
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Affiliation(s)
- Akikazu Hagiyama
- Division of Physical Medicine and Rehabilitation, Okayama University Hospital, Okayama, JPN
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Osaka, JPN
| | - Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Osaka, JPN
| | - Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, JPN
- Center for Community Medicine, Jichi Medical University, Shimotsuke, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Osaka, JPN
| | - Takahiro Tsuge
- Department of Rehabilitation, Kurashiki Medical Center, Kurashiki, JPN
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Osaka, JPN
| | - Yuki Nakashima
- Department of Clinical Practice and Support, Division of Rehabilitation, Hiroshima University Hospital, Hiroshima, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Osaka, JPN
| | - Shuri Nakao
- Division of Rehabilitation Medicine, Shimane University Hospital, Izumo, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Osaka, JPN
| | - Hiroki Sato
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, JPN
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama, JPN
- Department of Systematic Reviewers, Scientific Research WorkS Peer Support Group, Osaka, JPN
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, JPN
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Park CH, Lee SH, Lee R, Kim DY, Cho MR, Song SK. Effects of body mass index on mortality in elderly patients with hip fractures. Medicine (Baltimore) 2024; 103:e39157. [PMID: 39093801 PMCID: PMC11296480 DOI: 10.1097/md.0000000000039157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024] Open
Abstract
Hip fractures remain a substantial health concern, particularly among elderly individuals with osteoporosis, leading to high global mortality rates. This study aimed to analyze the association between body mass index (BMI) and postoperative mortality in patients who underwent surgery for hip fractures. A total of 680 patients treated at a single institution between January 2018 and December 2022 were included. Factors such as age, BMI, sex, Charlson Comorbidity Index (CCI), preoperative hemoglobin levels, American Society of Anesthesiologists score, anesthesia method, duration of surgery, and time from injury to surgery were assessed. Underweight status, male sex, higher CCI, and general anesthesia were significantly associated with 1-year and in-hospital mortality. Notably, underweight individuals exhibited a higher risk of mortality than normal-weight individuals, and female patients had lower mortality rates. This study underscores the importance of considering BMI, along with other demographic and clinical factors, in predicting postoperative mortality among patients with hip fractures, aiding the development of tailored management strategies to improve outcomes and reduce complications in this vulnerable patient population.
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Affiliation(s)
- Chan-Hee Park
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Republic of Korea
| | - Seung-Hoon Lee
- School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Rim Lee
- School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Dong-Young Kim
- Department of Orthopaedic Surgery, Gumi Hyundai Hospital, Gumi, Republic of Korea
| | - Myung-Rae Cho
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Suk-Kyoon Song
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
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Jones-Rastelli RB, Amin MR, Balou M, Herzberg EG, Molfenter S. Alterations in Swallowing Six Weeks After Primary Anterior Cervical Discectomy and Fusion (ACDF). Dysphagia 2024; 39:684-696. [PMID: 38157009 DOI: 10.1007/s00455-023-10649-z] [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: 08/01/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
This aim of this study is to characterize the nature and pathophysiology of dysphagia after ACDF surgery by precisely and comprehensively capturing within-subject changes on videofluoroscopy between preoperative and postoperative time points. 21 adults undergoing planned primary ACDF procedures were prospectively recruited and enrolled. Participants underwent standardized preoperative and six-week postoperative videofluoroscopic swallow studies. Videos were blindly rated using the Penetration-Aspiration Scale (PAS) and analysis of total pharyngeal residue (%C2-42), swallowing timing, kinematics, and anatomic change was completed. Linear mixed-effects modeling was used to explore the relationships between possible predictor variables and functional outcomes of interest that changed across timepoints. There was no change in PAS scores across timepoints. Total pharyngeal residue (%C2-C42) was increased postoperatively (p < 0.001). Our statistical model revealed significant main effects for timepoint (p = 0.002), maximum pharyngeal constriction area (MPCAN) (p < 0.001), and maximum thickness of posterior pharyngeal (PPWTMAX) (p = 0.004) on the expression of total pharyngeal residue. There were significant two-way interactions for timepoint and MPCAN (p = 0.028), timepoint and PPWTMAX (p = 0.005), and MPCAN and PPWTMAX (p = 0.010). Unsurprisingly, we found a significant three-way interaction between these three predictors (p = 0.027). Our findings suggest that in planned ACDF procedures without known complications, swallowing efficiency is more likely to be impaired than airway protection six weeks after surgery. The manifestation of impaired swallowing efficiency at this timepoint appears to be driven by a complex relationship between reduced pharyngeal constriction and increased prevertebral edema.
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Affiliation(s)
- R Brynn Jones-Rastelli
- NYU Swallowing Research Lab, Department of Communication Sciences and Disorders, NYU Steinhardt, New York University, 665 Broadway, New York, NY, USA.
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Matina Balou
- Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Erica G Herzberg
- Department of Rehabilitation Medicine, NYU Langone Rusk Rehabilitation Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Sonja Molfenter
- NYU Swallowing Research Lab, Department of Communication Sciences and Disorders, NYU Steinhardt, New York University, 665 Broadway, New York, NY, USA
- Department of Rehabilitation Medicine, NYU Langone Rusk Rehabilitation Center, NYU Grossman School of Medicine, New York, NY, USA
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Negro M, Crisafulli O, D'Antona G. Effects of essential amino acid (EAA) and glutamine supplementation on skeletal muscle wasting in acute, subacute, and postacute conditions. Clin Nutr ESPEN 2024; 62:224-233. [PMID: 38843393 DOI: 10.1016/j.clnesp.2024.05.023] [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: 12/04/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
Under optimal physiological conditions, muscle mass maintenance is ensured by dietary protein, which balances the amino acid loss during the post-absorption period and preserves the body's protein homeostasis. Conversely, in critical clinical conditions (acute, subacute or postacute), particularly those related to hypomobility or immobility, combined with malnutrition, and local/systemic inflammation, the loss of muscle mass and strength can be quantitatively significant. A decline of more than 1% in muscle mass and of more than 3% in muscle strength has been registered in subjects with aged 20-37 yr after just five days of bed rest, similarly to those observed during one year of age-related decline in individuals over the age of 50. Loss of muscle mass and strength can have a dramatic effect on subjects' functional capacities, on their systemic metabolic control and on the amino acid reserve function, all of which are fundamental for the maintenance of other organs' and tissues' cell processes. References available indicate that the average 1%-2% reduction per day of muscle mass in patients in the intensive care unit (ICU) could represent an independent predictor of hospital mortality and physical disability in the five years following hospitalization. After just a few days or weeks of administration, supplementation with EAAs and glutamine has shown significant effects in maintaining muscle size and strength, which are typically negatively affected by some acute/subacute or postacute critical conditions (muscle recovery after surgery, oncology patients, ICU treatments), especially in the elderly or in those with pre-existing degenerative diseases. In this review, we focused on the theoretical bases and the most relevant clinical studies of EAA and glutamine supplementation as a single compound, with the aim of clarifying whether their combined use in a blend (EAAs-glutamine) could be potentially synergistic to prevent disease-related muscle wasting and its impact on the duration and quality of patients' clinical course.
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Affiliation(s)
- Massimo Negro
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Oscar Crisafulli
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Giuseppe D'Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS) - Sport Medicine Centre, University of Pavia, Voghera, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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McGinley JJ, Dabis J, Morrison T, Podvin C, Ellis HB, Ulman S. Greater Post-Operative Nutrition Risks Identified in Pediatric and Adolescent Patients after Anterior Cruciate Ligament Reconstruction Regardless of Age and Sex. Nutrients 2024; 16:2379. [PMID: 39125260 PMCID: PMC11314380 DOI: 10.3390/nu16152379] [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: 06/25/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Systematic detection of risky nutrition behaviors after sports surgery may better promote healing for return-to-sport. The purpose of this study was to assess nutritional behavior differences between patients following anterior cruciate ligament reconstruction (ACLR) and following other lower-extremity orthopedic surgeries. One pediatric sports medicine center was reviewed for a custom Sports Nutrition Assessment for Consultation, which investigates nutrition-related risk factors for youth athletes at their first post-operative visit. Patients reported "Yes" or "No" to eight questions, after which they were offered a nutrition consultation for any response indicating risk. A total of 243 post-ACLR and 242 non-ACLR patients were reviewed. The post-ACLR patients more often reported a change in appetite (p = 0.021), recent weight changes (p = 0.011), a desire to better understand nutrition (p = 0.004), and recommendations to change their body composition (p = 0.032). More post-ACLR patients were identified for a nutrition consultation (p = 0.002), though an equal percentage accepted the consultation between groups. Age and sex were not determined to be significant confounders after matched sub-analysis. The post-ACLR patients more often reported nutrition risks, specifically weight-related issues, regardless of age or sex. Sports surgeons should regularly inquire about nutrition-related concerns with patients and refer to sports dietitians for recovery nutrition support as needed, particularly after ACLR.
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Affiliation(s)
- James J. McGinley
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, 5700 Dallas Parkway, Frisco, TX 75034, USA; (J.J.M.); (J.D.); (T.M.); (C.P.); (H.B.E.)
| | - Jessica Dabis
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, 5700 Dallas Parkway, Frisco, TX 75034, USA; (J.J.M.); (J.D.); (T.M.); (C.P.); (H.B.E.)
| | - Taylor Morrison
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, 5700 Dallas Parkway, Frisco, TX 75034, USA; (J.J.M.); (J.D.); (T.M.); (C.P.); (H.B.E.)
| | - Caroline Podvin
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, 5700 Dallas Parkway, Frisco, TX 75034, USA; (J.J.M.); (J.D.); (T.M.); (C.P.); (H.B.E.)
| | - Henry B. Ellis
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, 5700 Dallas Parkway, Frisco, TX 75034, USA; (J.J.M.); (J.D.); (T.M.); (C.P.); (H.B.E.)
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Sophia Ulman
- Center for Excellence in Sports Medicine, Scottish Rite for Children Orthopedic and Sports Medicine Center, 5700 Dallas Parkway, Frisco, TX 75034, USA; (J.J.M.); (J.D.); (T.M.); (C.P.); (H.B.E.)
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
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García Sánchez F, Mudarra García N. Evaluation of postoperative results after a presurgical optimisation programme. Perioper Med (Lond) 2024; 13:73. [PMID: 39010120 PMCID: PMC11247769 DOI: 10.1186/s13741-024-00430-7] [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: 05/23/2023] [Accepted: 06/24/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Presurgical optimisation programmes decrease the risk of postoperative complications, reduce hospital stays and speed up patient recovery. They usually involve a multidisciplinary team addressing physical, nutritional and psychosocial issues. The objective of this study was to assess the results of implementing a presurgical optimisation programme led by a liaison nurse in patients undergoing major surgery in a primary general hospital. METHODS An observational, retrospective, descriptive, cross-sectional, comparative study based on the revision of patients' health records undergoing major surgery between January 2019 and December 2022. Patients entering the presurgical optimisation programme (intervention group) were compared with patients receiving usual medical care (control group). The presurgical optimisation programme consisted of oral nutritional supplementation, physical exercise, strengthening of lung capacity and psychological and emotional support. Frequency (%) of surgery complications and use of healthcare resources (duration of hospitalisation, time spent in the intensive care unit (ICU), and readmission) at day 30 were recorded. Descriptive statistics were applied. RESULTS Two hundred eleven patients (58.5% men, mean age: 65.76 years (SD 11.5), 75.2%. non-smokers; mean body mass index (BMI): 28.32 (SD 5.38); mean Nutritional Risk Score (NRS) 3.71 (SD 1.35; oncology diagnosis: 88.6%) were included: 135 in the intervention group, and 76 in the control group. The average duration of the presurgical optimisation programme was 20 days (SD 5). Frequency of postoperative complications was 25% (n = 33) in the intervention group and 52.6% (n = 40) in the control group (p < 0.001) [odds ratio (OR) = 3.4; 95% confidence interval (CI) (1.8; 6.2)]. 14.5% (n = 19) of patients in the intervention group and 34.2% (n = 26) in the control group had remote postoperative complications [OR = 3.1; 95% CI (1.6; 6.2)]. Patients in the intervention group spent fewer days in the hospital [mean 8.34 (SD 6.70) vs 11.63 (SD 10.63)], and there were fewer readmissions at 30 days (7.6% vs 19.7%) compared with the control group. CONCLUSIONS A presurgical optimisation programme led by a liaison nurse decreases the rate of immediate and late surgical complications and reduces hospital stays and readmissions in patients undergoing major surgery.
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Affiliation(s)
- Francisco García Sánchez
- Surgical Prehabilitation Unit, Infanta Cristina University Hospital., Avenida 9 de Junio 2. Parla., Madrid, 28981, Spain.
- IDIPHISA. Medical Department. Faculty of Medicine, University Complutense of Madrid, Madrid, Spain.
| | - Natalia Mudarra García
- Surgical Prehabilitation Unit, Infanta Cristina University Hospital., Avenida 9 de Junio 2. Parla., Madrid, 28981, Spain
- IDIPHISA. Nurse Department. Faculty of Nurse. University Complutense of Madrid, Madrid, Spain
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Su H, Huang H, Xiang S, Gong Y, Zhou H, Chen L, Zhang Z, Tong P, Xu T. Clinical Efficacy of Intra-articular Tranexamic Acid Injection in the Management of Hemophilia with Total Hip Arthroplasty: A 24-month Retrospective Cohort Study. Orthop Surg 2024; 16:1673-1683. [PMID: 38828803 PMCID: PMC11216832 DOI: 10.1111/os.14126] [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: 01/11/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Total hip arthroplasty (THA) effectively treats end-stage hemophilic hip arthropathy. Given hemophilia's unique characteristics, perioperative bleeding remains a significant risk for patients undergoing THA. Tranexamic acid (TXA), an efficient antifibrinolytic agent, may benefit the outcomes of THA for patients with hemophilia (PWH). This study aims to explore the clinical efficacy of intra-articular injection of TXA in treating perioperative bleeding in PWH and assess its additional clinical benefits. METHODS The retrospective study comprised data of PWH who received THA from January 2015 to December 2021 in the research center. A total of 59 individuals were included in the study, divided into a TXA group (n = 31) and a non-TXA group (n = 28). We compared various parameters, including total blood loss (TBL), visible blood loss (VBL), occult blood loss (OBL), intraoperative coagulation factor VIII (FVIII) consumption, perioperative total FVIII consumption, hemoglobin (HB), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), length of hospital stay, hospitalization costs, length of surgery, total protein, activated partial thromboplastin time (APTT), D-dimer, rate of joint swelling, hip joint range of motion (ROM), visual analogue scale (VAS), and Harris hip joint function scale (HHS) between the two groups. Follow-up assessments were conducted for up to 24 months. A Student's t test was utilized for the statistical analysis. RESULTS This study demonstrated that intra-articular TXA effectively reduced TBL (1248.19 ± 439.88 mL, p < 0.001), VBL (490.32 ± 344.34 mL, p = 0.003), and OBL (757.87 ± 381.48 mL, p = 0.004) in PWH who underwent THA. TXA demonstrated effectiveness in reducing VAS scores on POD1, POD7, and POD14 and joint swelling rates on POD1, POD7, POD14, and at discharge (p < 0.05). Additionally, the TXA group achieved higher HHS ratings at all follow-up time points (p < 0.05), showing superior hip joint mobility, lower postoperative inflammation levels, reduced factor VIII consumption during surgery, and less postoperative nutritional loss. No statistically significant differences were observed between the two groups in terms of hospital stay, hospitalization costs, surgery duration, and coagulation indicators. CONCLUSION Intra-articular injection of TXA reduces perioperative bleeding in PWH undergoing THA while also improving joint mobility, post-operative rehabilitation, and quality of life. This may provide value for the future application of TXA in PWH.
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Affiliation(s)
- Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Hua Huang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Sicheng Xiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Haojing Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Zhongyi Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Taotao Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
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11
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Podvin C, Morrison T, Dabis J, McGinley JJ, Ellis HB, Wilson PL, Ulman S. Trends in Nutrition-Related Risk Factors Identified Post-Operatively in Patients Treated for a Lower-Extremity Injury. Nutrients 2024; 16:1847. [PMID: 38931202 PMCID: PMC11206554 DOI: 10.3390/nu16121847] [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: 05/23/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
This study investigated trends within a custom Sports Nutrition Assessment for Consultation (SNAC) survey designed to identify nutrition-related risk factors among post-operative lower-extremity youth athletes. Athletes aged 8-18 years who completed the SNAC at a sports medicine institution after lower-extremity surgery were reviewed for associations between SNAC questions and age/sex differences. Of 477 patients (15.0 ± 2.0 years; 47.8% female), 319 (66.9%) answered 'yes' to at least one question and were identified for a consult, though 216 (64.3%) declined. The most frequent questions to prompt a consult were a desire to better understand nutrition for recovery (41.5%) and regularly skipping at least one meal a day (29.8%). Inter-question responses were often significantly related, especially regarding appetite changes, weight changes, and/or meal-skipping. While consult acceptance was not significantly different between sex/age, males were more likely to report a desire to better understand nutrition (p = 0.004) and a weight change (p = 0.019), and females were more likely to report struggling with dizziness/fatigue (p < 0.001). Additionally, older athletes reported an appetite change (p = 0.022), meal-skipping (p = 0.002), a desire to better understand nutrition (p < 0.001), a weight change (p < 0.001), and an effort/recommendation to change their body composition/weight (p = 0.005). These findings demonstrate a link between risky nutrition behaviors and physical detriments.
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Affiliation(s)
- Caroline Podvin
- Center for Excellence in Sports Medicine, Scottish Rite for Children, 5700 Dallas Parkway, Frisco, TX 75034, USA; (C.P.); (T.M.); (J.D.); (J.J.M.); (H.B.E.); (P.L.W.)
| | - Taylor Morrison
- Center for Excellence in Sports Medicine, Scottish Rite for Children, 5700 Dallas Parkway, Frisco, TX 75034, USA; (C.P.); (T.M.); (J.D.); (J.J.M.); (H.B.E.); (P.L.W.)
| | - Jessica Dabis
- Center for Excellence in Sports Medicine, Scottish Rite for Children, 5700 Dallas Parkway, Frisco, TX 75034, USA; (C.P.); (T.M.); (J.D.); (J.J.M.); (H.B.E.); (P.L.W.)
| | - James J. McGinley
- Center for Excellence in Sports Medicine, Scottish Rite for Children, 5700 Dallas Parkway, Frisco, TX 75034, USA; (C.P.); (T.M.); (J.D.); (J.J.M.); (H.B.E.); (P.L.W.)
| | - Henry B. Ellis
- Center for Excellence in Sports Medicine, Scottish Rite for Children, 5700 Dallas Parkway, Frisco, TX 75034, USA; (C.P.); (T.M.); (J.D.); (J.J.M.); (H.B.E.); (P.L.W.)
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Philip L. Wilson
- Center for Excellence in Sports Medicine, Scottish Rite for Children, 5700 Dallas Parkway, Frisco, TX 75034, USA; (C.P.); (T.M.); (J.D.); (J.J.M.); (H.B.E.); (P.L.W.)
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Sophia Ulman
- Center for Excellence in Sports Medicine, Scottish Rite for Children, 5700 Dallas Parkway, Frisco, TX 75034, USA; (C.P.); (T.M.); (J.D.); (J.J.M.); (H.B.E.); (P.L.W.)
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
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12
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Pliannuom S, Pinyopornpanish K, Buawangpong N, Wiwatkunupakarn N, Mallinson PAC, Jiraporncharoen W, Angkurawaranon C. Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49482. [PMID: 38865706 PMCID: PMC11208838 DOI: 10.2196/49482] [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: 06/06/2023] [Revised: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. OBJECTIVE This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. METHODS We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). CONCLUSIONS Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.
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Affiliation(s)
- Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Poppy Alice Carson Mallinson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
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13
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Chimoriya R, Naylor J, Mitlehner K, Adie S, Harris I, Bell-Higgs A, Brosnahan N, Piya MK. Remote Delivery of Partial Meal Replacement for Weight Loss in People Awaiting Arthroplasty. J Clin Med 2024; 13:3227. [PMID: 38892938 PMCID: PMC11172571 DOI: 10.3390/jcm13113227] [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: 04/22/2024] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Obesity is linked to higher rates of complications; lower absolute recovery of mobility, pain, and function; and increased costs of care following total knee or hip arthroplasty (TKA, THA). The aim of this prospective cohort study was to evaluate the effectiveness of a 12-week partial meal replacement (PMR) weight loss program for people awaiting TKA or THA and living with obesity (body mass index (BMI) ≥ 30 kg/m2). Methods: The intervention was delivered remotely and included a 12-week PMR plan of 1200 calories/day, incorporating two meal replacement shakes/soups and a third suitable simple meal option. The intervention support was provided through online group education sessions, one-to-one teleconsultation with a dietitian, and access to a structured PMR App with functions for goal setting and providing educational content on diet, physical activity, and behaviour changes. Results: Of the 182 patients approached, 29 provided consent to participate, 26 participants commenced the program, and 22 participants completed the 12-week PMR plan. Completers exhibited statistically significant weight loss from baseline to 12 weeks, with a paired difference of 6.3 kg (95% CI: 4.8, 7.7; p < 0.001), with 15 out of 22 (68.2%) participants achieving at least 5% weight loss. Statistically significant reductions in HbA1c and low density lipoprotein (LDL) were observed at 12 weeks compared to baseline. Moreover, a significant increase in the proportion of participants in the action and maintenance phases of the readiness to change diet, physical activity, and weight were observed at 12 weeks. The majority of program completers (18 out of 22) expressed willingness to pay for the service if offered on a long-term basis following the arthroplasty. Conclusions: This study's findings demonstrated that significant weight loss is achievable for people living with obesity awaiting arthroplasty following a 12-week PMR weight loss program. The remote delivery of the intervention was feasible and well accepted by people awaiting TKA or THA.
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Affiliation(s)
- Ritesh Chimoriya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia;
| | - Justine Naylor
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia; (J.N.); (I.H.)
| | - Kimberly Mitlehner
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia;
| | - Sam Adie
- School of Clinical Medicine, University of New South Wales Medicine & Health, St George & Sutherland Clinical Campuses, Sydney, NSW 2217, Australia;
| | - Ian Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia; (J.N.); (I.H.)
| | - Anna Bell-Higgs
- Counterweight Limited, London W1W 7LT, UK; (A.B.-H.); (N.B.)
| | - Naomi Brosnahan
- Counterweight Limited, London W1W 7LT, UK; (A.B.-H.); (N.B.)
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G12 8QQ, UK
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Camden and Campbelltown Hospitals, Campbelltown, NSW 2560, Australia
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14
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Knopp KB. Nutrition to Enhance Metabolic-Bariatric Surgery Outcomes. Obes Surg 2024; 34:1975-1982. [PMID: 38530551 DOI: 10.1007/s11695-024-07159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Gender-specific post-surgical goals for 12-month percent body fat (%BF) based on World Health Organization (WHO) obesity thresholds and for lean mass-sparing were published as preliminary body composition (BC) guidelines to address a knowledge gap in metabolic-bariatric surgery (MBS). Other studies' %BF outcomes inconsistently fell below obesity thresholds; none described nutrition practices. To help practitioners positively influence patients' BC and weight changes, this study describes the team-supported process of conducting serial body composition analysis (sBCA) concomitantly with the evidence-based nutrition practices applied to generate the preliminary guidelines. METHODS Guidelines were generated using the cumulative outcomes of separate, original research board-approved Roux-en-Y Gastric Bypass and Sleeve Gastrectomy studies. One dietitian assessed BC using the same bioimpedance machine, educated patients, and collected data from patients aged 18 and older in a 532-bed nonprofit acute-care institution in Northeast Ohio, USA, from May, 2007, through November, 2016. Essential to pre- and postoperative education was the "Nutrition Goal Checklist," an evidence-based synopsis of imperative practices. Body composition was assessed on initial visit, presurgically, and postoperative months 3, 6, and 12, generating individual patient handouts of progressive weight and BC changes with coordinating %BF graphs. Serial assessment enabled intervention toward meeting BC goals. RESULTS For genders in both surgeries, the described process influenced highly significant fat mass reduction, transitioning %BF below obesity thresholds. Lean mass-sparing outcomes supported the suggested preliminary guidelines. CONCLUSIONS Utilizing sBCA with evidence-based nutrition practices consistently generated outcomes to formulate preliminary BC guidelines following MBS. Further research is needed to solidify formal guidelines.
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15
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Laviano A. Senescence: A new kid in the block of the metabolic response to surgical trauma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107048. [PMID: 37666720 DOI: 10.1016/j.ejso.2023.107048] [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: 08/01/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
Tumor growth is associated to chronic metabolic changes which inform the clinical phenotype and the outcome of patients with cancer. Surgery further triggers a cascade of acute neuro-immune responses leading to hypermetabolic and catabolic state. The metabolic mechanisms associated to surgical stress are well described. Preventive and therapeutic strategies have been developed, yet they appear not to benefit all surgical patients with cancer, even in the presence of a similar tumor type as well surgical procedures. Recent studies show that aging is associated with enrichment of senescent cells in different organs and tissues. Senescent cells are characterized by a specific senescence-associated secretory phenotype (SASP), which limits the potential for resilience of tissues and organs. Enhancement of the metabolic and functional recovery of patients with cancer undergoing surgery may therefore require additional therapies addressing SASP and senescent cells. Preliminary results obtained in experimental models recommend to further explore the role of senescence in mediating the metabolic changes and tissue resistance to efficient recovery.
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Affiliation(s)
- Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, viale dell'Università 37, 00185, Rome, Italy.
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16
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Hansen MC, Uhrenfeldt L, Ingstad K, Pedersen PU. Educational nutritional intervention to prevent loss of health-related quality of life among older adults after a surgical treatment: design of a randomised controlled trial. Trials 2024; 25:262. [PMID: 38622729 PMCID: PMC11017647 DOI: 10.1186/s13063-024-08096-8] [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: 07/31/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Disease-related malnutrition after a hospital stay has major consequences for older adults, the healthcare system and society. This study aims to develop and test the effectiveness of an educational video to prevent loss of health-related quality of life among live-at-home older adults after surgical treatment in a hospital. METHOD This randomised controlled trial will occur at a regional hospital in Norway. Participants will be live-at-home adults aged 65 years and older. They will be recruited from three different surgical departments after a surgical procedure. Individuals with a body mass index below 24 and a home address in one of nine selected municipalities will be eligible for inclusion. Participants will be randomly assigned to either the intervention group or the control group. Those assigned to the intervention group will obtain access to a 6-min educational video 5 days after being discharged from the hospital. The control group will not obtain access to the video. The primary outcome will be health-related quality of life using the Norwegian Rand 36-Item Short Form Health Survey. Furthermore, we will measure body composition, number of readmissions and nutritional knowledge at inclusion and 3-month follow-up. DISCUSSION This randomised controlled trial is expected to provide insight into whether an educational video can improve the nutritional status of older adults following a surgical procedure and discharge from the hospital. The findings will be useful for assessing how videos offering nutritional advice to older adults who have undergone a surgical procedure can improve their health-related quality of life, reduce loss of function, prevent readmission to hospital and reduce healthcare costs. TRIAL REGISTRATION ClinicalTrials.gov NCT05950373. Registered on 11 July 2023.
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Affiliation(s)
| | - Lisbeth Uhrenfeldt
- Institute for Regional Health Research, Southern Danish University, Ortopedic dep., Lillebaelt University Hospital, Odense, Denmark
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Preben U Pedersen
- Department of Clinical Medicine, Centre of Clinical Guidelines, Aalborg University, Aalborg, Denmark
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17
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Tedesco A, Sharma AK, Acharya N, Rublev G, Hashmi S, Wu HH, Lee YP, Scolaro J, Bhatia N. The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery: A Review of Postoperative Outcomes. JBJS Rev 2024; 12:01874474-202404000-00004. [PMID: 38619394 DOI: 10.2106/jbjs.rvw.23.00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
» Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.» Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status.» Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery.» Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools.» Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.
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Affiliation(s)
- Amanda Tedesco
- School of Medicine, University of California, Irvine, Irvine, California
| | - Abhinav K Sharma
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nischal Acharya
- School of Medicine, University of California, Irvine, Irvine, California
| | - George Rublev
- David Tvildiani Medical University, Tbilisi, Georgia
| | - Sohaib Hashmi
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Yu-Po Lee
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - John Scolaro
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
| | - Nitin Bhatia
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, California
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18
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Rhim HC, Schon JM, Xu R, Nolan D, Ahn J, Short K, Schon LC. Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255136. [PMID: 38812567 PMCID: PMC11135079 DOI: 10.1177/24730114241255136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jason M. Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Raylin Xu
- Harvard Medical School, Boston, MA, USA
| | - David Nolan
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA, USA
- Sports Physical Therapy Service, Massachusetts General Hospital, Boston, MA, USA
| | - Jiyong Ahn
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kelly Short
- Center for Restorative Therapies, Mercy Medical Center, Baltimore, MD, USA
| | - Lew C. Schon
- Director of Orthopaedic Innovation, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, New York University Langone Health, NY, USA
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19
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Bohlen KE, Bieger R. [Unicondylar knee arthroplasty-trigger for outpatient arthroplasty]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:284-290. [PMID: 38451275 DOI: 10.1007/s00132-024-04485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Abstract
The combination of a reduction in surgical trauma in unicondylar knee arthroplasty compared to total knee arthroplasty and the introduction of a standardised enhanced recovery concept leads to a pre-, peri- and postoperative improvement in the patient's condition, which results in a reduction of the length of stay in hospital. In healthy, motivated patients, day-case or outpatient surgical treatment is possible under these circumstances.
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Affiliation(s)
- Karina E Bohlen
- Allgemeine Orthopädie und Zentrum für Endoprothetik, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland.
| | - Ralf Bieger
- Zentrum für Knie‑, Hüft‑, Schulter- und Ellenbogenchirurgie, Schön Klinik München Harlaching, München, Deutschland
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20
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Jazayeri R, Anil U, Zuckerman JD. The Role of Amino Acid Supplementation in Orthopaedic Surgery. J Am Acad Orthop Surg 2024; 32:162-168. [PMID: 38165904 DOI: 10.5435/jaaos-d-23-00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/08/2023] [Indexed: 01/04/2024] Open
Abstract
The nutritional status of patients undergoing orthopaedic surgery has started to garner increasing attention in published literature. Notable previous evidence has demonstrated the negative effect of malnutrition on outcomes after orthopaedic procedures. Although there has been increased recognition of malnutrition as a risk factor for suboptimal outcomes, the use of nutritional supplementation to mitigate those risks is not well understood. The purpose of this review of most current literature on the topic is to introduce and elucidate the role of amino acid supplementation as a countermeasure to muscle loss and improvement of nutritional status in orthopaedic patients to improve results and outcomes after orthopaedic surgery.
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Affiliation(s)
- Reza Jazayeri
- From the Department of Sports Medicine, Permanente Medical Group Los Angeles, Los Angeles, CA (Jazayeri), the Department of Orthopedic Surgery, NYU Langone Health (Dr. Anil, Dr. Zuckerman), New York, NY
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21
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Yu C, Chunmei L, Caiping S. A multicenter cross-sectional survey of the knowledge, attitude, and behaviour of nurses regarding dysphagia after anterior cervical spine surgery: a prospective multicentre study. BMC Nurs 2024; 23:74. [PMID: 38281978 PMCID: PMC10823728 DOI: 10.1186/s12912-023-01690-2] [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: 11/22/2023] [Accepted: 12/25/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The incidence of dysphagia after anterior cervical spine surgery is high, which directly affects the quality of life of patients after surgery. The knowledge, attitude, and behavior of nurses can affect the identification and management of patients after anterior cervical spine surgery. Therefore, we need a survey to understand the current status of nurses' knowledge, attitude, and behavior towards dysphagia after anterior cervical spine surgery. OBJECTIVE To investigate the knowledge, attitude, and behaviour of orthopaedic nurses towards patients with dysphagia after anterior cervical spine surgery and provide recommendations for management and intervention. METHOD An online cross-sectional survey was conducted between March and June 2023, which among 894 orthopaedic nurses from 36 tertiary hospitals in Chongqing using a questionnaire. The questionnaire included general information and knowledge, attitudes, and behaviours related to the management of dysphagia after anterior cervical surgery. RESULTS The orthopaedic nurses' mean score for dysphagia-related knowledge was 16.1 ± 3.640 (out of a total score of 30). The orthopaedic nurses' mean score for dysphagia-related attitude was 32.5 ± 4.623 (out of a total score of 40). The orthopaedic nurses' mean score for dysphagia-related behaviour was 43.6 ± 11.513 (out of a total score of 60). The results of statistical analysis showed that the dysphagia after anterior cervical spine surgery -related knowledge scores differed significantly among the nurses according to, education level, and training (P < 0.05). Correlation analysis showed that there was a positive correlation between the knowledge, attitude, and behaviour scores of neurological nurses and swallowing disorders after anterior cervical surgery (P < 0.05). CONCLUSION Targeted knowledge and skills training should be carried out to improve the rules and regulations for dysphagia after anterior cervical spine surgery. Multidisciplinary team cooperation is needed, and dietary service processes and management standards should be improved to improve the management ability of orthopaedic nurses for dysphagia after anterior cervical spine surgery.
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Affiliation(s)
- Chen Yu
- Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Luo Chunmei
- Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China
| | - Song Caiping
- Xinqiao Hospital, The Army Medical University, Chongqing, 400037, China.
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22
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McNaughton MA, Quinlan-Colwell A, Lyons MT, Arkin LC. Acute Perioperative Pain Management of the Orthopaedic Patient: Guidance for Operationalizing Evidence Into Practice. Orthop Nurs 2024; 43:10-22. [PMID: 38266259 DOI: 10.1097/nor.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Orthopaedic surgery often results in pain, with less than half of patients reporting adequate relief. Unrelieved acute pain occurring after surgery increases the risk of negative sequelae, including delayed healing, increased morbidity, pulmonary complications, limited rehabilitation participation, anxiety, depression, increased length of stay, prolonged duration of opioid use, and the development of chronic pain. Interventions that are individualized, evidence-informed, and applied within an ethical framework improve healthcare delivery for patients, clinicians, and healthcare organizations. Recommendations for using the principles of effective pain management from preoperative assessment through discharge are detailed, including recommendations for addressing barriers and challenges in applying these principles into clinical practice.
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Affiliation(s)
- Molly A McNaughton
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Ann Quinlan-Colwell
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Mary T Lyons
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Laura C Arkin
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
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23
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Clark RC, Alving-Trinh A, Becker M, Leach GA, Gosman A, Reid CM. Moving the needle: a narrative review of enhanced recovery protocols in breast reconstruction. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:414. [PMID: 38213812 PMCID: PMC10777219 DOI: 10.21037/atm-23-1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/07/2023] [Indexed: 01/13/2024]
Abstract
Background and Objective After a relatively late introduction to the literature in 2015, enhanced recovery protocols for breast reconstruction have flourished into a wealth of reports. Many have since described unique methodologies making improved offerings with superior outcomes attainable. This is a particularly interesting procedure for the study of enhanced recovery as it encompasses two dissident approaches. Compared to implant-based reconstruction, autologous free-flap reconstruction has demonstrated superiority in a range of long-term metrics at the expense of historically increased peri-operative morbidity. This narrative review collates reports of recovery protocols for both approaches and examines methodologies surrounding the key pieces of a comprehensive pathway. Methods All primary clinical reports specifically describing enhanced recovery protocols for implant-based and autologous breast reconstruction through 2022 were identified by systematic review of PubMed and Embase libraries. Twenty-five reports meeting criteria were identified, with ten additional reports included for narrative purpose. Included studies were examined for facets of innovation from the pre-hospital setting through outpatient follow-up. Notable findings were described in the context of a comprehensive framework with attention paid to clinical and basic scientific background. Considerations for implementation were additionally discussed. Key Content and Findings Of 35 included studies, 29 regarded autologous reconstruction with majority focus on reduction of peri-operative opioid requirements and length of stay. Six regarded implant-based reconstruction with most discussing pathways towards ambulatory procedures. Eighty percent of included studies were published after the 2017 consensus guidelines with many described innovations to this baseline. Pathways included considerations for pre-hospital, pre-operative, intra-operative, inpatient, and outpatient settings. Implant-based studies demonstrated that safe ambulatory care is accessible. Autologous studies demonstrated a trend towards discharge before post-operative day three and peri-operative opioid requirements equivalent to those of implant-based reconstructions. Conclusions Study of enhanced recovery after breast reconstruction has inspired paradigm shift and pushed limits previously not thought to be attainable. These protocols should encompass a longitudinal care pathway with optimization through patient-centered approaches and multidisciplinary collaboration. This framework should represent standard of care and will serve to expand availability of all methods of breast reconstruction.
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Affiliation(s)
- Robert Craig Clark
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Miriam Becker
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Garrison A Leach
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Amanda Gosman
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Chris M Reid
- Division of Plastic Surgery, UC San Diego School of Medicine, La Jolla, CA, USA
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24
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Zink TM, Kent SE, Choudhary AN, Kavolus JJ. Nutrition in Surgery: An Orthopaedic Perspective. J Bone Joint Surg Am 2023; 105:1897-1906. [PMID: 37856576 DOI: 10.2106/jbjs.23.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.
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Affiliation(s)
- Thomas M Zink
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Suzanne E Kent
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | | | - Joseph J Kavolus
- Tufts University School of Medicine, Boston, Massachusetts
- Newton-Wellesley Orthopedic Associates, Newton, Massachusetts
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25
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AlQahtani FA, Kuriadom ST, Jaber M, Rama Varma S, AlShanably A, Bishawi K. Nutritional state of orthognathic surgery patients: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101549. [PMID: 37422263 DOI: 10.1016/j.jormas.2023.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Is to systematically review the available evidence of the patient's nutritional state before and after orthognathic surgery METHODS: The protocol to the International Prospective Register of Systematic Reviews (PROSPERO; registration No. CRD42020177156). RESULTS The search strategy yielded a total of 43 articles from all databases. Of the 43 articles, 13 were excluded after an examination of the titles and abstracts, and full-text articles of the remaining 30 studies were reviewed independently for eligibility. Of these 30 studies, 23 were excluded because they did not meet the inclusion criteria. Finally, a total of 7 studies met the inclusion criteria and were processed for critical review CONCLUSION: Patient's body weight and body mass index (BMI) decreases after orthognathic surgery. No significant changes in body fat percentage were observed. The estimated blood loss and the need for blood transfusion increased. No significant changes were observed in hemoglobin levels, lymphocyte counts, total cholesterol levels, and cholinesterase levels between the pre-operative and postoperative periods. Increments in serum albumin levels and total protein counts were observed after orthognathic surgery.
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Affiliation(s)
| | - Sam Thomas Kuriadom
- Associate Professor, College of Dentistry, Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Mohamed Jaber
- Professor, College of Dentistry, Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Sudhir Rama Varma
- Assistant Professor, College of Dentistry, Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
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26
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Reider L, Owen EC, Dreyer HC, Fitton LS, Willey MC. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep 2023; 21:710-718. [PMID: 38019345 DOI: 10.1007/s11914-023-00836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
PURPOSEOF REVIEW To summarize what is known about the deleterious effect of hip fracture on muscle mass and strength as well as the scientific evidence for post-surgical nutrition supplementation to maintain muscle and improve function. RECENT FINDINGS This review provides a discussion of the relationship between muscle mass, strength, and physical function following hip fracture, briefly describes the approaches to measuring lean mass, discusses prevalence of sarcopenia and malnutrition among older men and women with hip fracture, and reviews the effects of essential amino acids on muscle. Loss of muscle mass and strength following hip fracture is substantial with consequences for recovery of functional independence. EAA-based nutrition supplementation, which directly effects muscle, has potential to improve outcomes.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Street, Room 648, Baltimore, MD, 21205, USA.
| | | | - Hans C Dreyer
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, USA
| | - Lori S Fitton
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael C Willey
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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27
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Prem PN, Kurian GA. Cardiac damage following renal ischemia reperfusion injury increased with excessive consumption of high fat diet but enhanced the cardiac resistance to reperfusion stress in rat. Heliyon 2023; 9:e22273. [PMID: 38053866 PMCID: PMC10694322 DOI: 10.1016/j.heliyon.2023.e22273] [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: 07/13/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
Renal ischemia-reperfusion (IR) injury inflicts remote cardiac dysfunction. Studies on rats fed with a high-fat diet (HD) showed contradictory results: some demonstrated increased sensitivity of the heart and kidney to IR injury, while others reported resistance. In this study, we examined cardiac dysfunction and compromised cardiac tolerance associated with renal IR in HD and standard diet (SD) fed rats. Male Wistar rats fed with HD or SD diet for 16 weeks were subjected to either renal sham or IR protocol (bilateral clamping for 45 min and reperfusion for 24 h). The hearts isolated from these rats were further subjected to normal perfusion or IR procedure to study cardiac response. Renal IR surgery negatively affected cardiac function with substantial changes in the cardiac tissues, like mitochondrial dysfunction, elevated oxidative stress, and inflammation. HD-fed rat hearts exhibited hypertrophy at the end of 16 weeks, and the consequential impact on the heart was higher in the animals underwent renal IR surgery than with sham surgery. However, the IR induction in the isolated heart from renal sham or renal IR operation showed significant tissue injury resistance and better physiological recovery in HD-fed rats. However, in SD-fed rats, only hearts from renal IR-operated rats showed resistance to cardiac IR, whereas hearts from renal sham-operated rats were more susceptible to IR damage. The augmented IR resistance in the heart with prior renal surgery was due to preserved mitochondrial bioenergetics function, reduced oxidative stress, and activation of the PI3K/AKT signaling axis.
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Affiliation(s)
- Priyanka N. Prem
- Vascular Biology Lab. School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, Tamil Nadu, India
| | - Gino A. Kurian
- Vascular Biology Lab. School of Chemical and Biotechnology, SASTRA Deemed University, Tirumalaisamudram, Thanjavur, Tamil Nadu, India
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28
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Wang A, Wen C, Zhang Y. Letter to Editor regarding article, "Comparison study of periprosthetic bone remodeling between simultaneous bilateral total hip arthritis and unilateral total hip arthritis: a matched cohort study". INTERNATIONAL ORTHOPAEDICS 2023; 47:2891-2892. [PMID: 37688604 DOI: 10.1007/s00264-023-05972-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Anqi Wang
- School of Clinical Medicine, Jining Medical University, Jining, 272067, Shandong, China
| | - Caining Wen
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China
| | - Yuanmin Zhang
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China.
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29
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Flore G, Deledda A, Fosci M, Lombardo M, Moroni E, Pintus S, Velluzzi F, Fantola G. Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6899. [PMID: 37835169 PMCID: PMC10573058 DOI: 10.3390/ijerph20196899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Obesity is a crucial health problem because it leads to several chronic diseases with an increased risk of mortality and it is very hard to reverse with conventional treatment including changes in lifestyle and pharmacotherapy. Bariatric surgery (BS), comprising a range of various surgical procedures that modify the digestive tract favouring weight loss, is considered the most effective medical intervention to counteract severe obesity, especially in the presence of metabolic comorbidities. The Enhanced Recovery After Bariatric Surgery (ERABS) protocols include a set of recommendations that can be applied before and after BS. The primary aim of ERABS protocols is to facilitate and expedite the recovery process while enhancing the overall effectiveness of bariatric procedures. ERABS protocols include indications about preoperative fasting as well as on how to feed the patient on the day of the intervention, and how to nourish and hydrate in the days after BS. This narrative review examines the application, the feasibility and the efficacy of ERABS protocols applied to the field of nutrition. We found that ERABS protocols, in particular not fasting the patient before the surgery, are often not correctly applied for reasons that are not evidence-based. Furthermore, we identified some gaps in the research about some practises that could be implemented in the presence of additional evidence.
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Affiliation(s)
- Giovanna Flore
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Andrea Deledda
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Michele Fosci
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy;
| | - Enrico Moroni
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Stefano Pintus
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Fernanda Velluzzi
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Giovanni Fantola
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
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Sorimachi K, Moriyama N, Hatashita S, Miyajima H, Shigemoto S, Takagi K, Hirano H, Ito M, Iseki K, Yasumura S. Association of the Number of Teeth With Physical Function and Length of Hospital Stay After Hip Fracture Surgery: A Prospective Observational Study at a Tertiary Hospital in Japan. Cureus 2023; 15:e47297. [PMID: 38022003 PMCID: PMC10656494 DOI: 10.7759/cureus.47297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Although lower-extremity muscle strength is associated with physical function, there are challenges in assessing the muscle strength of patients after hip surgery due to pain or limited cognitive function. The number of teeth is a characteristic that can be easily examined. Although the relationship between the number of teeth and physical function has been reported in recent years, there are no reports examining the relationship with prognosis in patients with hip fractures. Therefore, this study aimed to investigate the relationship between the number of teeth and physical function and length of hospital stay after hip fracture surgery and to evaluate the predictive efficacy of the number of teeth on postoperative prognosis. METHODS This prospective cohort study was conducted in a tertiary clinical care facility. Patients aged ≥65 years who underwent hip surgery were included. A total of 101 patients (mean age: 85.1±8.0 years) were included. The factor analyzed was the number of teeth at admission. Patients were divided into two groups according to the number of teeth: those with ≥20 and those with ≤19 teeth. The outcomes were knee extension muscle strength-to-weight ratio at two weeks postoperatively and the length of hospital stay. A multiple regression analysis was performed to determine the association between the two groups. RESULTS Of 101 patients, 79 (78.2%) had ≤19 teeth, whereas 22 (21.8%) had ≥20 teeth. The mean muscle strength-to-weight ratio and length of hospital stay were 0.26±0.11 kgf/kg and 57.5±31.4 days, respectively. Multiple regression analysis revealed that the number of teeth was significantly associated with the muscle strength-to-weight ratio (β=-0.26, p=0.04) but not with the duration of hospitalization (β=0.17, p=0.09). CONCLUSIONS We suggest that assessment of the number of teeth at admission may be a useful predictor of patient physical function.
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Affiliation(s)
- Kotaro Sorimachi
- Department of Public Health/Department of Emergency and Critical Care Medicine, Fukushima Medical University School of Medicine, Fukushima, JPN
- Department of Traumatology and Reconstructive Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Nobuaki Moriyama
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, JPN
| | - Satoshi Hatashita
- Department of Traumatology and Reconstructive Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
- Department of Traumatology and Reconstructive Surgery, Fukushima Medical University, Fukushima, JPN
| | - Hisashi Miyajima
- Clinical Unit of Dentistry and Oral Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Shimpei Shigemoto
- Clinical Unit of Dentistry and Oral Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Kaori Takagi
- Rehabilitation Center, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Hiroko Hirano
- Department of Nursing, Aizu Chuo Hospital, Aizuwakamatsu, JPN
| | - Masayuki Ito
- Department of Traumatology and Reconstructive Surgery, Aizu Chuo Hospital, Aizuwakamatsu, JPN
- Department of Traumatology and Reconstructive Surgery, Fukushima Medical University, Fukushima, JPN
| | - Ken Iseki
- Department of Emergency and Critical Care Medicine, Fukushima Medical University School of Medicine, Fukushima, JPN
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, JPN
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Chuang FK, Yeh TT, Hung CC, Hsu CL, Shih JT, Shen PH. Effects of malnutrition on outcomes of patients with femoral head osteonecrosis undergoing total hip arthroplasty: A population-based study. Nutr Clin Pract 2023; 38:1104-1114. [PMID: 37492993 DOI: 10.1002/ncp.11042] [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: 02/07/2023] [Revised: 05/24/2023] [Accepted: 06/17/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the impact of malnutrition on in-hospital outcomes in patients undergoing total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). METHODS This population-based retrospective study extracted data of patients undergoing THA for ONFH in the US National Inpatient Sample between 2005 and 2018. Factors associated with in-hospital mortality, medical and surgical complications, unfavorable discharge, and prolonged hospital stay were determined by logistic regression analysis. RESULTS A total of 72,304 adults ≥18 years old with nontraumatic ONFH admitted for primary THA were included. Malnutrition was detected in 7152 (9.9%) patients using validated discharge codes. In-hospital mortality was 0.8% vs 0.1% for patients who were malnourished vs nonmalnourished. After adjusting for confounders, malnutrition was significantly associated with an increased risk of in-hospital death (adjusted odds ratio [aOR], 4.67; 95% CI, 2.43-8.97), medical complications (aOR, 1.49; 95% CI, 1.32-1.68), surgical complications (aOR, 1.78; 95% CI, 1.61-1.96), unfavorable discharge (aOR, 1.24; 95% CI, 1.11-1.39), and prolonged hospital stay (aOR, 1.90; 95% CI, 1.67-2.16) compared with adequate nutrition. Malnutrition was also associated with higher total hospital costs (adjusted β = $9620; 95% CI, 7.87-11.36). Furthermore, the association between malnutrition, any medical or surgical complications, and unfavorable discharge was stronger in patients younger than 50 years than those ≥50 years old. CONCLUSIONS In US patients undergoing primary THA for ONFH, malnutrition increases the risk of unfavorable in-hospital outcomes. This patient subgroup may require special attention and better strategies to improve perioperative care.
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Affiliation(s)
- Fu-Kai Chuang
- Penghu Branch, Tri-service General Hospital, Tri-service General Hospital, National Defense Medical Center, Magong City, Republic of China
| | - Tsu-Te Yeh
- Department of Orthopaedic Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Chun-Chi Hung
- Department of Orthopaedic Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Chun-Liang Hsu
- Department of Orthopaedic Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Jen-Ta Shih
- Department of Orthopaedic Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Republic of China
| | - Pei-Hung Shen
- Department of Orthopaedic Surgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Republic of China
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Morrison-Jones V, West M. Post-Operative Care of the Cancer Patient: Emphasis on Functional Recovery, Rapid Rescue, and Survivorship. Curr Oncol 2023; 30:8575-8585. [PMID: 37754537 PMCID: PMC10527900 DOI: 10.3390/curroncol30090622] [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: 06/30/2023] [Revised: 08/16/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
A cancer diagnosis and its subsequent treatments are life-changing events, impacting the patient and their family. Treatment options available for cancer care are developing at pace, with more patients now able to achieve a cancer cure. This is achieved through the development of novel cancer treatments, surgery, and modern imaging, but also as a result of better understanding treatment/surgical trauma, rescue after complications, perioperative care, and innovative interventions like pre-habilitation, enhanced recovery, and enhanced post-operative care. With more patients living with and beyond cancer, the role of survivorship and quality of life after cancer treatment is gaining importance. The impact cancer treatments can have on patients vary, and the "scars" treatments leave are not always visible. To adequately support patients through their cancer journeys, we need to look past the short-term interactions they have with medical professionals and encourage them to consider their lives after cancer, which often is not a reflection of life before a cancer diagnosis.
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Affiliation(s)
- Victoria Morrison-Jones
- Hepato-Biliary Surgery Unit, University Hospitals Southampton, Tremona Road, Southampton SO16 6YD, UK;
| | - Malcolm West
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Complex Cancer and Exenterative Service, University Hospitals Southampton, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospitals Southampton, Tremona Road, Southampton SO16 6YD, UK
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Al-Thani H, Wahlen BM, El-Menyar A, Asim M, Nassar LR, Ahmed MN, Nabir S, Mollazehi M, Abdelrahman H. Acute Changes in Body Muscle Mass and Fat Depletion in Hospitalized Young Trauma Patients: A Descriptive Retrospective Study. Diseases 2023; 11:120. [PMID: 37754316 PMCID: PMC10528496 DOI: 10.3390/diseases11030120] [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: 08/12/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
Background: Loss of muscle mass, and its strength, is associated with adverse outcomes in many medical and surgical conditions. Trauma patients may get malnourished during their hospital course due to many interrelated contributing factors. However, there is insufficient knowledge on the acute muscle and fat changes in young trauma patients in the early days post-admission. Objective: to explore the diagnosis, feeding status, and outcome of muscle mass loss among young abdominal polytrauma patients. Methods: It was a retrospective study including hospitalized abdominal trauma patients who underwent an abdominal computerized tomographic (CT) examination initially and a follow-up one week later. CT scan-based automatic and manual analysis of the muscles and fat of the abdominal region was calculated and compared. Also, we evaluated the feeding and nutritional values to explore the adequacy of the provided calories and proteins and the potential influence of enteral feeding on the CT-based parameters for muscle loss and fat depletion. Results: There were 138 eligible subjects with a mean age of 32.8 ± 13.5 years; of them, 92% were males. Operative interventions were performed on two-thirds of the patients, including abdominal surgery (43%), orthopedic surgeries (34%), and neurosurgical procedures (8.1%). On admission, 56% received oral feeding, and this rate slightly increased to 58.4% after the first week. Enteral feed was prescribed for the remaining, except for two patients. The percentage of change in the total psoas muscle area was significantly reduced after one week of admission in patients on enteral feed as compared to those in the oral feeding group (p = 0.001). There were no statistically significant differences in the percentages of changes in the CT scan findings except for the total psoas muscle area (p = 0.001) and para-spinal muscle area (p = 0.02), which reduced significantly in the those who underwent laparotomy as compared to those who did not need laparotomy. Trauma patients who underwent emergency abdominal surgery lost muscle and fat over time. Conclusions: Loss of muscle mass and body fat is not uncommon among young trauma patients. Patients who underwent laparotomy are more likely to be affected. Further larger studies are needed to assess the specific features in the younger trauma population and how far this can be influenced by the nutrition status and its impact on the clinical outcomes. It could be early or impending stages of sarcopenia linked to trauma patients, or just acute changes in the muscle and fat, that need further investigation and follow-up after hospital discharge.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma & Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Bianca M. Wahlen
- Department of Anesthesiology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
- Department of Clinical Medicine, Weill Cornell Medicine, Doha P.O. Box 24144, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Lena Ribhi Nassar
- Department of Dietetics and Nutrition, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Mohamed Nadeem Ahmed
- Department of Radiology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (M.N.A.); (S.N.)
| | - Syed Nabir
- Department of Radiology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (M.N.A.); (S.N.)
| | - Monira Mollazehi
- Trauma Registry, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
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Cheng X, Chen W, Yan J, Yang Z, Li C, Wu D, Wang T, Zhang Y, Zhu Y. Association of preoperative nutritional status evaluated by the controlling nutritional status score with walking independence at 180 days postoperatively: a prospective cohort study in Chinese older patients with hip fracture. Int J Surg 2023; 109:2660-2671. [PMID: 37226868 PMCID: PMC10498878 DOI: 10.1097/js9.0000000000000497] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Malnutrition is significantly associated with unfavorable outcomes, but there is little high-level evidence to elucidate the association of malnutrition with losing walking independence (LWI) after hip fracture surgery. This study aimed to assess the association between preoperative nutritional status evaluated by the Controlling Nutritional Status (CONUT) score and walking independence at 180 days postoperatively in Chinese older hip fracture patients. METHODS This prospective cohort study included 1958 eligible cases from the SSIOS database. The restricted cubic spline was used to assess the dose-effect relationship between the CONUT score and the recovery of walking independence. Propensity score matching was performed to balance potential preoperative confounders, and multivariate logistic regression analysis was applied to assess the association between malnutrition and LWI with perioperative factors for further adjustment. Furthermore, inverse probability treatment weighting and sensitivity analyses were performed to test the robustness of the results and the Fine and Gray hazard model was applied to adjust the competing risk of death. Subgroup analyses were used to determine potential population heterogeneity. RESULTS The authors found a negative relationship between the preoperative CONUT score and recovery of walking independence at 180 days postoperatively, and that moderate-to-severe malnutrition evaluated by the CONUT score was independently associated with a 1.42-fold (95% CI, 1.12-1.80; P =0.004) increased risk of LWI. The results were overall robust. And in the Fine and Gray hazard model, the result was still statistically significant despite the apparent decrease in the risk estimate from 1.42 to 1.21. Furthermore, significant heterogeneities were observed in the subgroups of age, BMI, American Society of Anesthesiologists score, Charlson's comorbidity index, and surgical delay ( P for interaction < 0.05). CONCLUSION Preoperative malnutrition is a significant risk factor for LWI after hip fracture surgery, and nutrition screening on admission would generate potential health benefits.
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Affiliation(s)
- Xinqun Cheng
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People Republic of China
| | - Wei Chen
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People Republic of China
| | - Jincheng Yan
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
| | - Zhenbang Yang
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
| | - Chengsi Li
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
| | - Dongwei Wu
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
| | - Tianyu Wang
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
| | - Yingze Zhang
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People Republic of China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, the 3rd Hospital of Hebei Medical University
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People Republic of China
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Briguglio M, Wainwright TW, Southern K, Riso P, Porrini M, Middleton RG. Healthy Eating for Elective Major Orthopedic Surgery: Quality, Quantity, and Timing. J Multidiscip Healthc 2023; 16:2081-2090. [PMID: 37521366 PMCID: PMC10377616 DOI: 10.2147/jmdh.s415116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
Improvements to enhanced recovery pathways in orthopedic surgery are reducing the time that patients spend in the hospital, giving an increasingly vital role to prehabilitation and/or rehabilitation after surgery. Nutritional support is an important tenant of perioperative medicine, with the aim to integrate the patient's diet with food components that are needed in greater amounts to support surgical fitness. Regardless of the time available between the time of contemplation of surgery and the day of admission, a patient who eats healthy is reasonably more suitable for surgery than a patient who does not meet the daily requirements for energy and nutrients. Moreover, a successful education for healthy food choices is one possible way to sustain the exercise therapy, improve recovery, and thus contribute to the patient's long-term health. The expected benefits presuppose that the patient follows a healthy diet, but it is unclear which advice is needed to improve dietary choices. We present the principles of healthy eating for patients undergoing major orthopedic surgery to lay the foundations of rational and valuable perioperative nutritional support programs. We discuss the concepts of nutritional use of food, requirements, portion size, dietary target, food variety, time variables of feeding, and the practical indications on what the last meal to be consumed six hours before the induction of anesthesia may be together with what is meant by clear fluids to be consumed until two hours before. Surgery may act as a vital "touch point" for some patients with the health service and is therefore a valuable opportunity for members of the perioperative team to promote optimal lifestyle choices, such as the notion and importance of healthy eating not just for surgery but also for long-term health benefit.
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Affiliation(s)
- Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Laboratory of Nutritional Sciences, Milan, Italy
| | - Thomas W Wainwright
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, UK
- University Hospitals Dorset, NHS Foundation Trust, Poole, UK
| | - Kate Southern
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, UK
- Nuffield Health Bournemouth Hospital, Bournemouth, UK
| | - Patrizia Riso
- University of Milan, Department of Food, Environmental and Nutritional Sciences (DeFENS), Milan, Italy
| | - Marisa Porrini
- University of Milan, Department of Food, Environmental and Nutritional Sciences (DeFENS), Milan, Italy
| | - Robert G Middleton
- Bournemouth University, Orthopaedic Research Institute, Bournemouth, UK
- University Hospitals Dorset, NHS Foundation Trust, Poole, UK
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Minetama M, Kawakami M, Teraguchi M, Enyo Y, Nakagawa M, Yamamoto Y, Sakon N, Matsuo S, Nakatani T, Nakagawa R, Nagata W, Nakagawa Y. Branched-chain amino acids plus vitamin D supplementation promote increased muscle strength following lumbar surgery for lumbar spinal stenosis: a randomized trial. Spine J 2023; 23:962-972. [PMID: 36940921 DOI: 10.1016/j.spinee.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND CONTEXT Adequate nutrition is essential to address the surgical stress response and mitigate loss of muscle mass, strength, and functionality in older adults with lumbar spinal stenosis (LSS). However, it is unknown whether amino acids and/or vitamin D are beneficial in older adults following lumbar surgery for LSS. PURPOSE To evaluate whether branched-chain amino acids (BCAA) plus vitamin D supplementation could attenuate the loss of muscle mass and strength, accelerate the return of functional mobility, and improve clinical outcomes following lumbar surgery for LSS. STUDY DESIGN/SETTING A single-center, single-blind randomized controlled trial. PATIENT SAMPLE Eighty patients who received lumbar surgery for LSS. OUTCOME MEASURES The primary outcome was the Zurich claudication questionnaire (ZCQ), and secondary outcomes included knee muscle strength, muscle mass measured by bioelectrical impedance analysis, gait speed and a timed up-and-go test (TUG) at 12 weeks postoperatively. Follow-up assessment was performed for the ZCQ at 52 weeks postoperatively. METHODS Patients ingested the supplementation (BCAA group: BCAA plus vitamin D, Nonamino acid group: nonamino acid) twice daily for 3 weeks from the day after surgery, and received two hours of postoperative inpatient rehabilitation 5 times a week. RESULTS No significant differences were observed in the mean changes on the ZCQ between the two groups at 12 weeks and 52 weeks. At 2 weeks postoperatively, the nonamino acid group showed significant deterioration compared with the BCAA group for strengths of knee extensor and knee flexor (p < .01). At 12 weeks, the BCAA group showed significant improvements in knee extensor strength and knee flexor strength compared with the nonamino acid group (p <.01). There were no significant differences in mean changes of muscle mass, maximum gait speed, and TUG at 12 weeks between two groups. CONCLUSIONS BCAA plus vitamin D supplementation did not improve LSS-related clinical outcomes after lumbar surgery for LSS, even though muscle strength increased. Future studies should focus on long-term outcomes for muscle mass and physical function, including development of sarcopenia and frailty.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan; Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yoshio Enyo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Ryota Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Wakana Nagata
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
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Solie BS, Eggleston GG, Schwery NA, Doney CP, Kiely MT, Larson CM. Clinic and Home-Based Exercise with Blood Flow Restriction Resolves Thigh Muscle Atrophy after Anterior Cruciate Ligament Reconstruction with the Bone-Patellar Tendon-Bone Autograft: A Case Report. Healthcare (Basel) 2023; 11:1885. [PMID: 37444719 DOI: 10.3390/healthcare11131885] [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: 04/17/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) results in thigh muscle atrophy. Of the various interventions proposed to mitigate thigh muscle atrophy, exercise with blood flow restriction (BFR) appears safe and effective. Some literature suggests daily exposure to exercise with BFR may be indicated during the early phase of ACLR rehabilitation; this case report outlines the methodology utilized to prescribe clinic- and home-based BFR within an outpatient rehabilitation program. A 15-year-old male soccer player suffered a left knee injury involving the anterior cruciate ligament and both menisci. He underwent ACLR and completed exercise with BFR as part of his clinic- and home-based rehabilitation program, which included practical blood flow restriction during home-based rehabilitation. After 16 weeks of rehabilitation, surgical limb thigh girth values were objectively larger than the non-surgical limb (surgical, 52.25 cm; non-surgical 50 cm), as well as the multi-frequency bioelectrical impedance analysis of his lower-extremity lean body mass (surgical limb, 10.37 kg; non-surgical limb, 10.02 kg). The findings of this case report suggest that the inclusion of clinic- and home-based BFR within an outpatient rehabilitation program may be indicated to resolve thigh muscle atrophy early after ACLR.
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Affiliation(s)
- Braidy S Solie
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Nicole A Schwery
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
| | | | - Michael T Kiely
- Training HAUS, 2645 Viking Circle, Suite #200, Eagan, MN 55121, USA
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Phillips JLH, Ennis HE, Jennings JM, Dennis DA. Screening and Management of Malnutrition in Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:319-325. [PMID: 36812414 DOI: 10.5435/jaaos-d-22-01035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/24/2023] Open
Abstract
Malnutrition is an increasingly prevalent problem in patients undergoing total joint arthroplasty (TJA). Increased risks associated with TJA in the setting of malnourishment have been well documented. Standardized scoring systems in addition to laboratory parameters such as albumin, prealbumin, transferrin, and total lymphocyte count have been developed to identify and evaluate malnourished patients. Despite an abundance of recent literature, there is no consensus on the best approach for screening TJA patients from a nutritional standpoint. Although there are a variety of treatment options, including nutritional supplements, nonsurgical weight loss therapies, bariatric surgery, and the involvement of dieticians and nutritionists, the effect of these interventions on TJA outcomes has not been well characterized. This overview of the most current literature aims to provide a clinical framework for approaching nutrition status in arthroplasty patients. A comprehensive understanding of the tools available for managing malnourishment will facilitate improved arthroplasty care.
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Affiliation(s)
- Jessica L H Phillips
- From the Colorado Joint Replacement (Phillips, Ennis, Jennings, and Dennis), the Department of Mechanical and Materials Engineering, University of Denver (Jennings and Dennis), the Department of Orthopaedics, University of Colorado School of Medicine (Dennis), Denver, CO, and the Department of Biomedical Engineering, University of Tennessee, Knoxville, TN (Dennis)
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Martindale RG. Novel nutrition strategies to enhance recovery after surgery. JPEN J Parenter Enteral Nutr 2023; 47:476-481. [PMID: 36938940 DOI: 10.1002/jpen.2485] [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: 05/24/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 03/21/2023]
Abstract
Surgery and traumatic injury set off a cascade of metabolic changes that are becoming better understood. Recently, strategies and protocols have been developed for optimizing outcomes, and this has yielded beneficial results. This brief review evaluates three specific nutrition or metabolic interventions in the postoperative setting that attempt to optimize outcomes. We limited this to three subspecialty areas including oncologic surgery, orthopedic surgery, and cardiac surgery. These agents included fish oils, factors to prevent dysbiosis, and resistance exercise and its role in enhancing protein update. Where these novel agents fit into the basic tenets of postoperative nutrition interventions does not change the narrative: deliver graduated early enteral feeding to attenuate the metabolic response to surgical stress, maintain the gastrointestinal mucosal barrier, use immune/metabolic modulation to enhance immune response while attenuating excessive inflammation, and support the microbiome.
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Affiliation(s)
- Robert G Martindale
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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40
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Raval MV, Brockel MA, Kolaček S, Simpson KE, Spoede E, Starr KNP, Wulf KL. Key Strategies for Optimizing Pediatric Perioperative Nutrition-Insight from a Multidisciplinary Expert Panel. Nutrients 2023; 15:nu15051270. [PMID: 36904269 PMCID: PMC10005187 DOI: 10.3390/nu15051270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Adequate nutrition is an essential factor in healing and immune support in pediatric patients undergoing surgery, but its importance in this setting is not consistently recognized. Standardized institutional nutrition protocols are rarely available, and some clinicians may be unaware of the importance of assessing and optimizing nutritional status. Moreover, some clinicians may be unaware of updated recommendations that call for limited perioperative fasting. Enhanced recovery protocols have been used in adult patients undergoing surgery to ensure consistent attention to nutrition and other support strategies in adult patients before and after surgery, and these are now under evaluation for use in pediatric patients as well. To support better adoption of ideal nutrition delivery, a multidisciplinary panel of experts in the fields of pediatric anesthesiology, surgery, gastroenterology, cardiology, nutrition, and research have gathered and reviewed current evidence and best practices to support nutrition goals in this setting.
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Affiliation(s)
- Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Box 63, Chicago, IL 60611, USA
- Correspondence:
| | - Megan A. Brockel
- Department of Anesthesiology, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Sanja Kolaček
- Referral Centre for Pediatric Gastroenterology and Nutrition, University Children’s Hospital Zagreb, 10000 Zagreb, Croatia
| | | | - Elizabeth Spoede
- Pediatric Clinical Dietitian, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Kathryn N. Porter Starr
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC 27708, USA
- Durham VA Health Care System, Durham, NC 27705, USA
| | - Karyn L. Wulf
- Abbott Nutrition, Abbott Laboratories, Columbus, OH 43219, USA
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Giraldo-Vallejo JE, Cardona-Guzmán MÁ, Rodríguez-Alcivar EJ, Kočí J, Petro JL, Kreider RB, Cannataro R, Bonilla DA. Nutritional Strategies in the Rehabilitation of Musculoskeletal Injuries in Athletes: A Systematic Integrative Review. Nutrients 2023; 15:819. [PMID: 36839176 PMCID: PMC9965375 DOI: 10.3390/nu15040819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
It is estimated that three to five million sports injuries occur worldwide each year. The highest incidence is reported during competition periods with mainly affectation of the musculoskeletal tissue. For appropriate nutritional management and correct use of nutritional supplements, it is important to individualize based on clinical effects and know the adaptive response during the rehabilitation phase after a sports injury in athletes. Therefore, the aim of this PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science PERSiST-based systematic integrative review was to perform an update on nutritional strategies during the rehabilitation phase of musculoskeletal injuries in elite athletes. After searching the following databases: PubMed/Medline, Scopus, PEDro, and Google Scholar, a total of 18 studies met the inclusion criteria (Price Index: 66.6%). The risk of bias assessment for randomized controlled trials was performed using the RoB 2.0 tool while review articles were evaluated using the AMSTAR 2.0 items. Based on the main findings of the selected studies, nutritional strategies that benefit the rehabilitation process in injured athletes include balanced energy intake, and a high-protein and carbohydrate-rich diet. Supportive supervision should be provided to avoid low energy availability. The potential of supplementation with collagen, creatine monohydrate, omega-3 (fish oils), and vitamin D requires further research although the effects are quite promising. It is worth noting the lack of clinical research in injured athletes and the higher number of reviews in the last 10 years. After analyzing the current quantitative and non-quantitative evidence, we encourage researchers to conduct further clinical research studies evaluating doses of the discussed nutrients during the rehabilitation process to confirm findings, but also follow international guidelines at the time to review scientific literature.
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Affiliation(s)
- John E. Giraldo-Vallejo
- Grupo de Investigación NUTRAL, Facultad de Ciencias de Nutrición y Alimentos, Universidad CES, Medellín 050021, Colombia
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
| | - Miguel Á. Cardona-Guzmán
- Grupo de Investigación NUTRAL, Facultad de Ciencias de Nutrición y Alimentos, Universidad CES, Medellín 050021, Colombia
| | - Ericka J. Rodríguez-Alcivar
- Grupo de Investigación NUTRAL, Facultad de Ciencias de Nutrición y Alimentos, Universidad CES, Medellín 050021, Colombia
| | - Jana Kočí
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Department of Education, Faculty of Education, Charles University, 11636 Prague, Czech Republic
| | - Jorge L. Petro
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería 230002, Colombia
| | - Richard B. Kreider
- Exercise & Sport Nutrition Laboratory, Human Clinical Research Facility, Texas A&M University, College Station, TX 77843, USA
| | - Roberto Cannataro
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Galascreen Laboratories, Department of Pharmacy, Health, and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Diego A. Bonilla
- Grupo de Investigación NUTRAL, Facultad de Ciencias de Nutrición y Alimentos, Universidad CES, Medellín 050021, Colombia
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Department of Education, Faculty of Education, Charles University, 11636 Prague, Czech Republic
- Sport Genomics Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
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Cao C, Xing H, Cao F, Du Z, Wang G, Wang X. Three-dimensional printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager: A case report. Medicine (Baltimore) 2023; 102:e32507. [PMID: 36637956 PMCID: PMC9839266 DOI: 10.1097/md.0000000000032507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Because of the complicated anatomy and considerable change in size and morphology with age in teenagers, the appropriate internal fixator of coronal shear fracture of distal humerus is difficult to choose, and therefore, the fixation of this kind of fracture is difficult and controversial. Furthermore, distal humeral fractures in teenagers often involve the epiphysis, the rigid fixation of fracture and the simultaneous minimally invasive and protection of the epiphysis are contradictory. Coronal shear fractures of the distal humerus in teenagers are great challenge for orthopedic surgeons. Three-dimensional (3D) printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager is a potential satisfactory choice in the treatment of the complex fractures. PATIENT CONCERNS A teenager suffered from an elbow joint injury due to a fall while running, resulting in pain, swelling and limited movement of the elbow joint. The epiphyseal has not closed in this patient, conventional surgical procedures have great traumatic and invasive, and to some extent affect bone growth in children. DIAGNOSES Coronal shear fracture of right distal humerus according to computed tomography scan. INTERVENTIONS We used 3D printing technology to design an internal fixation device for this patient, which was to treat the distal humeral coronal shear fracture in a teenager via an anterior approach to the elbow joint, and finally the child was instructed to perform immediate postoperative functional exercises and rehabilitation. OUTCOMES Radiographic reexamination performed 1 day and 2 month after the operation showed that the internal fixation was in good position, no fracture displacement. the patient was instructed to perform active flexion and extension internal and external rotation of the right elbow 6 weeks postoperatively. The Mayo elbow function score was excellent 5 months postoperatively. The range of motion of the elbow was (15°-130°). LESSONS The treatment of coronal shear fractures of the distal humerus in teenager is controversial at present. This report 3D printing technology designed customized plate in treatment of such fractures showed satisfactory results, which provides a feasible method for the treatment of fractures without suitable internal fixation devices in the future.
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Affiliation(s)
- Changpeng Cao
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Haiyang Xing
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Faxin Cao
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Zhipeng Du
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Gang Wang
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
- * Correspondence: Gang Wang, Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Jilin University, Changchun City, Jilin Province, China (e-mail: )
| | - Xiyao Wang
- China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
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Chalamgari A, Hey G, Dave A, Liu A, Nanduru A, Lucke-Wold B. Nutritional Optimization for Post-Spinal Surgery Recovery. JOURNAL OF CLINICAL TRIALS AND REGULATIONS 2023; 5:1-16. [PMID: 37143932 PMCID: PMC10156085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Adequate nutritional intake is a key component of uncomplicated recovery from spinal surgery. Though much in the literature exists regarding its importance, specific dietary regimens for spinal surgery remain understudied, and little is available in compiling both preoperative and postoperative nutritional recommendations for patients. The complexity that may exist with these recommendations -- especially in the context of patients with diabetes or those who use substances -- has led in recent years to the development of protocols such as Enhanced Recovery After Surgery (ERAS), which gives providers a guideline upon which to base their nutritional counselling. More innovative regimens, such as the use of bioelectrical impedance analyses to assess nutritional status, have also emerged, resulting in a vast array of dietary recommendations and protocols for spinal surgery. In the following paper, we aim to compile a few of these guidelines, comparing various preoperative and postoperative nutritional strategies as well as making note of special considerations, like patients with diabetes or those who use substances. We also work to overview several such dietary "protocols" available in the literature, with a special focus on ERAS and more recent regimens like the Northwestern High-Risk Spine Protocol. We briefly mentioned preclinical work on novel nutritional recommendations as well. Ultimately, we hope to highlight the importance of nutrition in spinal surgery and address the need for greater cohesion of dietary strategies already in existence.
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Affiliation(s)
- Anjalika Chalamgari
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Grace Hey
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Akanksha Dave
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Annika Liu
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
| | - Aparna Nanduru
- Post Graduate Student, School of Medicine, George Washington University, Washington, D.C., United States
| | - Brandon Lucke-Wold
- Post Graduate Student, Department of Neurosurgery, University of Florida, Florida, United States
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Social Determinants of Health Disparities are Associated with Increased Costs, Revisions, and Infection in Patients Undergoing Arthroscopic Rotator Cuff Repair. Arthroscopy 2022; 39:673-679.e4. [PMID: 37194108 DOI: 10.1016/j.arthro.2022.10.011] [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: 03/14/2022] [Revised: 09/23/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to use a national claims database to assess the impact of pre-existing social determinants of health disparities (SDHD) on postoperative outcomes following rotator cuff repair (RCR). METHODS A retrospective review of the Mariner Claims Database was used to capture patients undergoing primary RCR with at least 1 year of follow-up. These patients were divided into two cohorts based on the presence of a current or previous history of SDHD, encompassing educational, environmental, social, or economic disparities. Records were queried for 90-day postoperative complications, consisting of minor and major medical complications, emergency department (ED) visits, readmission, stiffness, and 1-year ipsilateral revision surgery. Multivariate logistic regression was employed to assess the impact of SDHD on the assessed postoperative outcomes following RCR. RESULTS 58,748 patients undergoing primary RCR with a SDHD diagnosis and 58,748 patients in the matched control group were included. A previous diagnosis of SDHD was associated with an increased risk of ED visits (OR 1.22, 95% CI 1.18-1.27; P < .001), postoperative stiffness (OR 2.53, 95% CI 2.42-2.64; P < .001), and revision surgery (OR 2.35, 95% CI 2.13-2.59; P < .001) compared to the matched control group. Subgroup analysis revealed educational disparities had the greatest risk for 1-year revision (OR 3.13, 95% CI 2.53-4.05; P < .001). CONCLUSIONS The presence of a SDHD was associated with an increased risk of revision surgery, postoperative stiffness, emergency room visits, medical complications, and surgical costs following arthroscopic RCR. Overall, economic and educational SDHD were associated with the greatest risk of 1-year revision surgery. LEVEL OF EVIDENCE III, retrospective cohort study.
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Chaudhary NK, Sunuwar DR, Sharma R, Karki M, Timilsena MN, Gurung A, Badgami S, Singh DR, Karki P, Bhandari KK, Pradhan PMS. The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:819. [PMID: 36042436 PMCID: PMC9424836 DOI: 10.1186/s12891-022-05766-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Femur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery. METHODS This study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student's two-sample t-test to compare the outcomes between the two groups. RESULTS All the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7-5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3-6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1-9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8-7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2-13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6-12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group. CONCLUSIONS The uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting. TRIAL REGISTRATION NCT04838366, first registered on 09/042021 ( https://clinicaltrials.gov/ct2/show/NCT04838366 ).
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Affiliation(s)
| | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Armed Police Force Hospital, Kathmandu, Nepal
| | | | | | | | | | | | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Prabesh Karki
- Greentara College of Health Sciences, Lalitpur, Nepal
| | | | - Pranil Man Singh Pradhan
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Inoue T, Takeuchi I, Iida Y, Takahashi K, Nagano F, Miyazaki S, Shirado K, Yoshimura Y, Momosaki R, Maeda K, Wakabayashi H. Disease-specific Nutritional Physical Therapy: A Position Paper by the Japanese Association of Rehabilitation Nutrition (Secondary Publication). JMA J 2022; 5:252-262. [PMID: 35611233 PMCID: PMC9090541 DOI: 10.31662/jmaj.2021-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
Nutritional disorders diminish the effectiveness of physical therapy. The pathogenesis of nutritional disorders, such as sarcopenia, frailty, and cachexia, differs from disease to disease. Disease-specific nutrition can maximize the function, activity, participation, and quality of life for patients undergoing physical therapy, a practice known as nutritional physical therapy. Understanding and practicing disease-specific nutritional physical therapy is essential to meet patients' diverse needs and goals with any disease. Thus, the physical therapist division of the Japanese Association of Rehabilitation Nutrition, with advice from the Japanese Society of Nutrition and Swallowing Physical Therapy, developed this review. It discusses the impact of disease-specific nutritional physical therapy on sarcopenia and frailty in community-dwelling older adults, obesity and metabolic syndrome, critical illness, musculoskeletal diseases, stroke, respiratory diseases, cardiovascular diseases, diabetes, renal disease, cancer, and sports.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Izumi Takeuchi
- Department of Rehabilitation, Suizenji Tohya Hospital, Kumamoto, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Aichi, Japan
| | - Kohei Takahashi
- Department of Rehabilitation, Tamura Surgical Hospital, Kanagawa, Japan
| | - Fumihiko Nagano
- Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | | | - Kengo Shirado
- Department of Rehabilitation, Iizuka Hospital, Fukuoka, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Graduate School of Medicine, Tokyo, Japan
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LIN F, WAN Q, ZHANG G, SU L, LUO C, SHUI Y, ZENG S, ZHANG L. Pulmonary edema after shoulder arthroscopy in an old female under general anesthesia. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.52321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Fei LIN
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Qihai WAN
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, China
| | - Gang ZHANG
- Sichuan Provincial Orthopedic Hospital,, China
| | - Li SU
- Sichuan Provincial Orthopedic Hospital,, China
| | | | - Yunhua SHUI
- Sichuan Provincial Orthopedic Hospital,, China
| | - Si ZENG
- Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, China
| | - Lan ZHANG
- Sichuan Provincial Orthopedic Hospital,, China
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Antonescu I, Haines KL, Agarwal S. Role of Nutrition in the Elderly Surgical Patient – Review of the Literature and Current Recommendations. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-021-00367-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Travica N, Ried K, Hudson I, Scholey A, Pipingas A, Sali A. The effects of cardiovascular and orthopaedic surgery on vitamin concentrations: a narrative review of the literature and mechanisms of action. Crit Rev Food Sci Nutr 2021:1-31. [PMID: 34619992 DOI: 10.1080/10408398.2021.1983762] [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: 10/20/2022]
Abstract
Given the rise in worldwide chronic diseases, supplemented by an aging population, the volume of global major surgeries, encompassing cardiac and orthopedic procedures is anticipated to surge significantly. Surgical trauma can be accompanied by numerous postoperative complications and metabolic changes. The present review summarized the results from studies assessing the effects of orthopedic and cardiovascular surgery on vitamin concentrations, in addition to exploring the possible mechanisms associated with changes in concentrations. Studies have revealed a potentially severe depletion in plasma/serum concentrations of numerous vitamins following these surgeries acutely. Vitamins C, D and B1 appear particularly vulnerable to significant depletions, with vitamin C and D depletions consistently transpiring into inadequate and deficient concentrations, respectively. The possible multifactorial mechanisms impacting postoperative vitamin concentrations include changes in hemodilution and vitamin utilization, redistribution, circulatory transport and absorption. For a majority of vitamins, there has been a lack of investigation into the effects of both, cardiac and orthopedic surgery. Additionally, studies were predominantly restricted to short-term postoperative investigations, primarily performed within the first postoperative week of surgery. Overall, results indicated that further examination is necessary to determine the severity and clinical significance of the possible depletions in vitamin concentrations that ensue cardiovascular and orthopedic surgery.
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Affiliation(s)
- Nikolaj Travica
- Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,The National Institute of Integrative Medicine, Melbourne, Australia
| | - Karin Ried
- The National Institute of Integrative Medicine, Melbourne, Australia.,Honorary Associate Professor, Discipline of General Practice, University of Adelaide, South Australia, Australia.,Torrens University, Melbourne, Australia
| | - Irene Hudson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,Digital Health, CRC, College of STEM, Mathematical Sciences, Royal Melbourne Institute of Technology (RMIT), Melbourne, Australia.,School of Mathematical and Physical Science, University of Newcastle, Newcastle, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Avni Sali
- The National Institute of Integrative Medicine, Melbourne, Australia
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