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Anesthesiology Clinics Mar 2024Ophthalmic surgery encompasses a wide range of procedures addressing various ocular conditions. Although generally considered low risk, a thorough preoperative... (Review)
Review
Ophthalmic surgery encompasses a wide range of procedures addressing various ocular conditions. Although generally considered low risk, a thorough preoperative evaluation is still crucial in optimizing patient outcomes and ensuring safe surgical interventions. This review provides a comprehensive overview of the preoperative assessment and management of patients presenting for ophthalmic surgery, specifically focusing on cataract surgery. We discuss the role of routine preoperative testing, the assessment of intraocular factors, and the evaluation of systemic comorbidities and medications. The review emphasizes the importance of individualized decision-making based on patient-specific factors and collaborative efforts between ophthalmologists and the health-care team.
Topics: Humans; Cataract Extraction; Preoperative Care
PubMed: 38278587
DOI: 10.1016/j.anclin.2023.08.006 -
British Journal of Anaesthesia Jun 2024The changing ethical and legal landscape in the UK means that anaesthetists should routinely be discussing the risk of death during the consent process. To do this...
The changing ethical and legal landscape in the UK means that anaesthetists should routinely be discussing the risk of death during the consent process. To do this effectively means expanding anaesthetic preassessment services for children and young people, something that has been recognised as a priority, but which still needs investment and an appreciation of its value at the trust level.
Topics: Humans; Child; Informed Consent; Preoperative Care; Adolescent; United Kingdom; Anesthesia
PubMed: 38729742
DOI: 10.1016/j.bja.2024.03.005 -
Zeitschrift Fur Gerontologie Und... May 2024Fragility fractures are associated with high morbidity and mortality. An interdisciplinary collaboration and an individualized, patient-centered approach are essential... (Review)
Review
Fragility fractures are associated with high morbidity and mortality. An interdisciplinary collaboration and an individualized, patient-centered approach are essential to ensure an optimized preoperative period and to improve perioperative safety. Preoperative responsibilities of trauma surgery include in the first step the identification of fragility fractures and the necessity for geriatric involvement. Orthogeriatric co-management (OCM) focuses on the identification of the medical, functional and social needs of the patient. In the preoperative period attention is focussed on acute diseases in need of treatment that have a negative impact on the course of further treatment and the prevention of delirium.
Topics: Humans; Aged; Preoperative Care; Aged, 80 and over; Geriatric Assessment; Osteoporotic Fractures; Female; Male; Intersectoral Collaboration; Germany
PubMed: 38668778
DOI: 10.1007/s00391-024-02299-z -
European Urology Focus Jan 2024The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances... (Review)
Review
The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances in urological prehabilitation and how it can be used together with enhanced recovery after surgery and conventional rehabilitation protocols. Urological prehabilitation has primarily focused on improving urinary continence, erectile function, bone density, and lean body mass, with some promising results for all of these outcomes. Although all cancer patients should be considered for prehabilitation, older or medically frail individuals may derive the greatest benefit. PATIENT SUMMARY: This mini-review discusses prehabilitation as part of the care for cancer patients. Although the research on prehabilitation is evolving, current studies generally demonstrate that it may help to enhance a patient's strength and endurance before upcoming surgery or other treatments.
Topics: Male; Humans; Preoperative Care; Preoperative Exercise; Cancer Survivors; Neoplasms; Research
PubMed: 37996272
DOI: 10.1016/j.euf.2023.11.006 -
Diseases of the Colon and Rectum May 2024
Topics: Humans; Surgical Stomas; Preoperative Care
PubMed: 38319635
DOI: 10.1097/DCR.0000000000003010 -
The Surgical Clinics of North America Dec 2023Emergency surgery in patients with significant comorbidities benefits from a structured approach to preoperative evaluation, intra-operative intervention, and... (Review)
Review
Emergency surgery in patients with significant comorbidities benefits from a structured approach to preoperative evaluation, intra-operative intervention, and postoperative management. Providing goal concordant care is ideal using shared decision-making. When operation cannot achieve the patient's goal, non-operative therapy including Comfort Care is appropriate. When surgical therapy is offered, preoperative physiology-improving interventions are far fewer than in other phases. Reevaluation of clinical care progress helps define trajectory and inform goals of care. Palliative Care Medicine may be critical in supporting loved ones during a patient's critical illness. Outcome evaluation defines successful strategies and outline opportunities for improvement.
Topics: Humans; Emergencies; Palliative Care; Preoperative Care; Palliative Medicine
PubMed: 37838465
DOI: 10.1016/j.suc.2023.06.003 -
Anesthesiology Clinics Mar 2024Anesthesiologists are experiencing first-hand the aging population, given older patients more frequently presenting for surgery, often with geriatric syndromes... (Review)
Review
Anesthesiologists are experiencing first-hand the aging population, given older patients more frequently presenting for surgery, often with geriatric syndromes influencing their anesthetic management. The overall incidence and health burden of cancer morbidity and mortality are also rapidly increasing worldwide. This growth in the cancer population, along with the associated risk factors and comorbidities often accompanying a cancer diagnosis, underscores the need for anesthesiologists to become well versed in the preoperative evaluation and management of the adult patient with cancer. This article will focus on the unique challenges and opportunities for the anesthesiologist caring for the adult oncology patient presenting for surgery.
Topics: Adult; Humans; Aged; Preoperative Care; Neoplasms; Risk Factors; Morbidity; Aging
PubMed: 38278586
DOI: 10.1016/j.anclin.2023.07.004 -
Canadian Journal of Anaesthesia =... Aug 2023Patients with impaired functional capacity who undergo major surgery are at increased risk of postoperative morbidity including complications and increased length of...
PURPOSE
Patients with impaired functional capacity who undergo major surgery are at increased risk of postoperative morbidity including complications and increased length of stay. These outcomes have been associated with increased hospital and health system costs. We aimed to assess whether common preoperative risk indices are associated with postoperative cost.
METHODS
We conducted a health economic analysis focused on the subset of Measurement of Exercise Tolerance before Surgery (METS) study participants in Ontario, Canada. Participants were scheduled for major elective noncardiac surgery and underwent several preoperative assessments of cardiac risk, including physicians' subjective assessment, Duke Activity Status Index (DASI) questionnaire, peak oxygen consumption, and N-terminal pro-B-type natriuretic peptide concentration. Using linked health administrative data, postoperative costs were calculated for both one year and in-hospital. Using multiple regression models, we tested for association between the preoperative measures of cardiac risk and postoperative costs.
RESULTS
Our study included 487 patients (mean [standard deviation] age 68 [11] yr and 47.0% female) who underwent noncardiac surgery between 13 June 2013 and 8 March 2016. Overall, the median [interquartile range] cost incurred within one year postoperatively was CAD 27,587 [13,902-32,590], of which CAD 12,928 [10,253-12,810] were incurred in-hospital and CAD 14,497 [10,917-15,017] were incurred by 30 days. None of the four preoperative measures of cardiac risk assessment were associated with costs incurred in hospital or at one year postoperatively. This lack of strong association persisted in sensitivity analyses considering type of surgical procedure, burden of preoperative cost, and when costs were categorized as quantiles.
CONCLUSION
In patients undergoing major noncardiac surgery, common measures of functional capacity are not consistently associated with total postoperative cost. Until further data exist that differ from this analysis, clinicians and health care funders should not assume that preoperative measures of cardiac risk are associated with annual health care or hospital costs for such surgeries.
Topics: Humans; Female; Aged; Male; Postoperative Complications; Elective Surgical Procedures; Risk Assessment; Ontario; Health Care Costs; Preoperative Care
PubMed: 37430180
DOI: 10.1007/s12630-023-02519-x -
Obesity Surgery Aug 2023Preoperative oesophagogastroduodenoscopy (OGD) in bariatric surgery remains a controversial topic, with a large variety in practice globally. An electronic database... (Meta-Analysis)
Meta-Analysis Review
Preoperative oesophagogastroduodenoscopy (OGD) in bariatric surgery remains a controversial topic, with a large variety in practice globally. An electronic database search of Medline, Embase and PubMed was performed in an aim to categorise the findings of preoperative endoscopies in bariatric patients. A total of 47 studies were included in this meta-analysis resulting in 23,368 patients being assessed. Of patients assessed, 40.8% were found to have no novel findings, 39.7% had novel findings which did not affect surgical planning, 19.8% had findings that affected their surgery and 0.3% were ruled to not be suitable for bariatric surgery. Preoperative OGD is altering surgical planning in one-fifth of patients; however, further comparative studies are required to determine if each patient should undergo this procedure especially if asymptomatic.
Topics: Humans; Obesity, Morbid; Bariatric Surgery; Bariatrics; Preoperative Care; Endoscopy, Digestive System
PubMed: 37314649
DOI: 10.1007/s11695-023-06680-6 -
Transplantation Reviews (Orlando, Fla.) Apr 2024Frailty, malnutrition and sarcopenia lead to a significant increase in morbidity and mortality before and after liver transplantation (LT). Prehabilitation attempts to... (Review)
Review
BACKGROUND
Frailty, malnutrition and sarcopenia lead to a significant increase in morbidity and mortality before and after liver transplantation (LT). Prehabilitation attempts to optimize physical fitness of individuals before major surgeries. To date, little is known about its impact on patients awaiting LT.
AIMS
The aim of our scoping review was to describe whether prehabilitation in patients awaiting LT is feasible and safe, and whether it leads to a change in clinical parameters before or after transplantation.
METHODS
We performed a systematic review of the literature from 1946 to November 2023 to identify prospective studies and randomized controlled trials of adult LT candidates who participated in an exercise training program.
RESULTS
Out of 3262 citations initially identified, six studies were included. Studies were heterogeneous in design, patient selection, intervention, duration, and outcomes assessed. All studies were self-described as pilot or feasibility studies and had a sample size ranging from 13 to 33. Two studies were randomized controlled trials. Two study restricted to patients with cirrhosis who were eligible for liver transplantation or on the transplant list. Exercise programs lasted between 6 and 12 weeks. In terms of feasibility, proportion of eligible patients that were recruited was between 54 and 100%. Program completion ranged between 38 and 90%. Interventions appeared safe with 9 (9.2%) adverse events noted. In the intervention group, improvements were generally noted in peak oxygen consumption and workload, 6-min walking distance, and muscle strength. One study suggested a decrease in post-transplant hospital length of stay.
CONCLUSIONS
Overall, it appears that prehabilitation with exercise training is feasible, and safe in patients awaiting LT. Higher quality and larger studies are needed to confirm its impact on pre- and post-transplantation-related outcomes.
Topics: Adult; Humans; Liver Transplantation; Preoperative Exercise; Prospective Studies; Exercise; Exercise Therapy; Quality of Life; Preoperative Care; Postoperative Complications
PubMed: 38367398
DOI: 10.1016/j.trre.2024.100835