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Kokotovic D, Schucany A, Soylu L, Fenger AQ, Puggard I, Ekeloef S, Gögenur I, Burcharth J. Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02408-4. [PMID: 38177561 DOI: 10.1007/s00068-023-02408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Major emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation. PURPOSE To investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications. METHODS The study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test. RESULTS The study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien-Dindo (CD) grade ≥ 3. CONCLUSIONS In patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.
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Affiliation(s)
- Dunja Kokotovic
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
- Emergency Surgery Research Group (EMERGE) Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Aide Schucany
- Department of Gastrointestinal Surgery, North Zealand University Hospital, Hillerød, Denmark
| | - Liv Soylu
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Andreas Q Fenger
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Iben Puggard
- Department of Physiotherapy, Zealand University Hospital, Køge, Denmark
| | - Sarah Ekeloef
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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Schucany A, Helgstrand F, Kristensen SD. [Abdominal surgical treatment of extreme obesity in Denmark]. Ugeskr Laeger 2021; 183:V11200868. [PMID: 34356023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Increasing overweight is a rising issue worldwide. In 2017, 17% of the Danish population had a body mass index (BMI) > 40 kg/m2 also defined as extreme obesity. Bariatric surgery is the most effective long-term treatment and the status in Denmark is summarized in this review. The most common procedures are Roux-en-Y-gastric bypass and gastric sleeve which have led to excess weight loss (EWL) up to 70%. Regardless of these results, the increasing BMI presents a problem both technically and in regard to achieving a BMI within normal range. In preliminary studies Single anastomosis sleeve ileal bypass (SASI) has shown an EWL of up to 90% and a high resolution of diabetes 2. SASI may be the future of bariatric surgery in the super obese patients.
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Schacht SR, Lind MV, Mertz KH, Bülow J, Bechshøft R, Højfeldt G, Schucany A, Hjulmand M, Sidoli C, Andersen SB, Jensen M, Reitelseder S, Holm L, Tetens I. Development of a Mobility Diet Score (MDS) and Associations With Bone Mineral Density and Muscle Function in Older Adults. Front Nutr 2019; 6:114. [PMID: 31552255 PMCID: PMC6738326 DOI: 10.3389/fnut.2019.00114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/11/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction: Reduced bone mineral density (BMD) and muscle function is associated with increased risk of multiple health related issues. Diet may play a role in sustaining BMD and muscle function throughout old age, but much is still to be learned with regards to which specific food groups and dietary patterns that are important for such outcomes. The aim of the current study was to identify food groups important for both BMD and muscle function. Methods: A narrative review was performed on studies published on dietary patterns and their association with BMD and muscle function, respectively. Based on these findings, two dietary indices were constructed characterizing food groups associated with BMD and muscle function, respectively. Associations between adherence to these indices and BMD and muscle function were then investigated in a population of older community-dwelling Danes. Food groups found to be associated with both BMD and muscle function in our study population were suggested for inclusion into a common dietary index named the Mobility Diet Score. Results: In contrast to previous studies, adherence to a dietary index based on foods previously linked to BMD could not be established as important for BMD in our study population of 184 older individuals (53.3% men). We found that adhering to a dietary index characterized by higher intakes of whole grains, dairy products, fish, legumes, nuts, fruit, and vegetables is associated with faster 400 m walking speeds and an increased number of chair stands measured over a 30 s time period. Since no food group could be established as important for both BMD and muscle function in our study population, a Mobility Diet Score could not be established. However, based on our narrative review, the food groups commonly associated with improved BMD and muscle function are similar. Conclusion: Adherence to a dietary index characterized by high intakes of whole grains, dairy products, fish, legumes, nuts, fruit, and vegetables was not found to be associated with BMD in a group of community-dwelling older Danes. However, our results indicate that the adherence to such foods could be important in sustaining physical function in older individuals.
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Affiliation(s)
- Simon Rønnow Schacht
- Department of Nutrition, Exercise and Sports, Vitality - Centre for Good Older Lives, University of Copenhagen, Copenhagen, Denmark
| | - Mads Vendelbo Lind
- Department of Nutrition, Exercise and Sports, Vitality - Centre for Good Older Lives, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth Hudlebusch Mertz
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jacob Bülow
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Rasmus Bechshøft
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Grith Højfeldt
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Aide Schucany
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Morten Hjulmand
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Chiara Sidoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Søren Binder Andersen
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mikkel Jensen
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Reitelseder
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Holm
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Inge Tetens
- Department of Nutrition, Exercise and Sports, Vitality - Centre for Good Older Lives, University of Copenhagen, Copenhagen, Denmark
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Mertz KH, Reitelseder S, Jensen M, Lindberg J, Hjulmand M, Schucany A, Binder Andersen S, Bechshoeft RL, Jakobsen MD, Bieler T, Beyer N, Lindberg Nielsen J, Aagaard P, Holm L. Influence of between-limb asymmetry in muscle mass, strength, and power on functional capacity in healthy older adults. Scand J Med Sci Sports 2019; 29:1901-1908. [PMID: 31353627 DOI: 10.1111/sms.13524] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Numerous daily tasks such as walking and rising from a chair involve bilateral lower limb movements. During such tasks, lower extremity function (LEF) may be compromised among older adults. LEF may be further impaired due to high degrees of between-limb asymmetry. The present study investigated the prevalence of between-limb asymmetry in muscle mass, strength, and power in a cohort of healthy older adults and examined the influence of between-limb asymmetry on LEF. METHODS Two hundred and eight healthy older adults (mean age 70.2 ± 3.9 years) were tested for LEF (400 m walking and 30-seconds chair stand). Furthermore, maximal isometric and dynamic knee extensor strength, leg extensor power, and lower limb lean tissue mass (LTM) were obtained unilaterally. RESULTS Mean between-limb asymmetry in maximal muscle strength and power ranged between 10% and 13%, whereas LTM asymmetry was 3 ± 2.3%. Asymmetry in dynamic knee extensor strength was larger for women compared with men (15.0 ± 11.8% vs 11.1 ± 9.5%; P = .005) Leg strength and power were positively correlated with LEF (r2 = .43-.46, P < .001). The weakest leg was not a stronger predictor of LEF than the strongest leg. Between-limb asymmetry in LTM and isometric strength was negatively associated with LEF (LTM; r2 = .12, P = .005, isometric peak torque; r2 = 0.40, P = .03.) but dynamic strength and power were not. CONCLUSION The present study supports the notion that in order to improve or maintain LEF, healthy older adults should participate in training interventions that increase muscle strength and power, whereas the effects of reducing between-limb asymmetry in these parameters might be of less importance.
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Affiliation(s)
- Kenneth H Mertz
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Reitelseder
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Jensen
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jonas Lindberg
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Morten Hjulmand
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Aide Schucany
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Binder Andersen
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Rasmus L Bechshoeft
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
| | - Markus D Jakobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Theresa Bieler
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Nina Beyer
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jakob Lindberg Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Holm
- Institute of Sports Medicine Copenhagen and Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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