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Frontiers in Oncology 2023Malnutrition is common in patients undergoing surgery for cancers and is a risk factor for postoperative outcomes. Body composition provides information for precise...
BACKGROUND
Malnutrition is common in patients undergoing surgery for cancers and is a risk factor for postoperative outcomes. Body composition provides information for precise nutrition intervention in perioperative period for improving patients' postoperative outcomes.
OBJECTION
The aim was to determine changes in parameters of body composition and nutritional status of cancer patients during perioperative period.
METHODS
A total of 92 patients diagnosed with cancer were divided into gastrointestinal and non-gastrointestinal cancer group according to different cancer types. The patients body composition assessed by bioelectrical impedance vector analysis (BIVA) on the day before surgery, postoperative day 1 and 1 day before discharge. The changes between two groups were compared and the correlation between body composition and preoperative serum nutritional indexes was analyzed.
RESULTS
The nutritional status of all patients become worse after surgery, and phase angle (PA) continued to decrease in the perioperative period. Fat-free mass (FFM), fat-free mass index (FFMI), skeletal muscle mass (SMM), extracellular water (ECW), total body water (TBW), hydration, and body cell mass (BCM) rise slightly and then fall in the postoperative period in patients with gastrointestinal cancer, and had a sustained increase in non-gastrointestinal patients, respectively (<0.05). Postoperative body composition changes in patients with gastrointestinal cancer are related to preoperative albumin, pre-albumin, hemoglobin, and C-reactive protein (<0.05), whereas postoperative body composition changes in patients with non-gastrointestinal cancer are related to age (<0.05).
CONCLUSIONS
Significant changes in body composition both in patients with gastrointestinal cancer and non-gastrointestinal cancer during perioperative period are observed. Changes in body composition for the cancer patients who undergoing surgery are related to age and preoperative serum nutrition index.
PubMed: 37736552
DOI: 10.3389/fonc.2023.1132972 -
BMC Anesthesiology Dec 2023Laparoscopic radical resection of gastrointestinal cancer is associated with a high incidence of postoperative catheter-related bladder discomfort (CRBD). Studies on the... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of magnesium sulfate perioperative infusion on postoperative catheter-related bladder discomfort in male patients undergoing laparoscopic radical resection of gastrointestinal cancer: a prospective, randomized and controlled study.
BACKGROUND
Laparoscopic radical resection of gastrointestinal cancer is associated with a high incidence of postoperative catheter-related bladder discomfort (CRBD). Studies on the benefits of magnesium sulfate intravenous infusion during the perioperative period post-laparoscopic surgery are yet lacking.
METHODS
A total of 88 gastrointestinal cancer male patients scheduled for laparoscopic radical resection were randomly divided into two groups: normal saline (control) and magnesium. In the magnesium group, a 40 mg/kg loading dose of intravenous magnesium sulfate was administered for 10 min just after the induction of anesthesia, followed by continuous intravenous infusion of 15 mg/kg/h magnesium sulfate until the end of the surgery; the control group was administered the same dose of normal saline. Subsequently, 2 μg/kg sufentanil was continuously infused intravenously by a postoperative patient-controlled intravenous analgesia (PCIA) device. The primary outcome was the incidence of CRBD at 0 h after the surgery. The secondary outcomes included incidence of CRBD at 1, 2, and 6 h postsurgery, the severity of CRBD at 0, 1, 2, and 6 h postsurgery. Remifentanil requirement during surgery, sufentanil requirement within 24 h postsurgery, the postoperative numerical rating scale (NRS) score at 48 h after the surgery, magnesium-related side effects and rescue medication (morphine) requirement were also assessed.
RESULTS
The incidence of CRBD at 0, 1, 2, and 6 h postoperatively was lower in the magnesium group than the control group (0 h: P = 0.01; 1 h: P = 0.003; 2 h: P = 0.001; 6 h: P = 0.006). The incidence of moderate to severe CRBD was higher in the control group at postoperative 0 and 1 h (0 h: P = 0.002; 1 h: P = 0.028), remifentanil requirement during surgery were significantly lower in the magnesium group than the control group. Sufentanil requirements during the 24 h postoperative period were significantly lower in the magnesium group than the control group. The NRS score was reduced in the magnesium group compared to the control group in the early postoperative period. Magnesium-related side effects and rescue medication (morphine) did not differ significantly between the two groups.
CONCLUSIONS
Intravenous magnesium sulfate administration reduces the incidence and severity of CRBD and remifentanil requirement in male patients undergoing radical resection of gastrointestinal cancer. Also, no significant side effects were observed.
TRIAL REGISTRATION
Chictr.org.cn ChiCTR2100053073. The study was registered on 10/11/2021.
Topics: Humans; Male; Magnesium Sulfate; Urinary Bladder; Sufentanil; Magnesium; Remifentanil; Prospective Studies; Saline Solution; Pain, Postoperative; Urinary Catheters; Postoperative Period; Double-Blind Method; Laparoscopy; Morphine Derivatives; Neoplasms
PubMed: 38042781
DOI: 10.1186/s12871-023-02346-z -
Brazilian Journal of Cardiovascular... Oct 2023Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP). (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP).
OBJECTIVE
The aim of this study was to compare the plasma concentration of EMP between patients undergoing aortic valve replacement with conventional bioprosthesis implantation and Perceval™ S (LivaNova) and to evaluate its impact on the inflammatory response in the short-term follow-up.
METHODS
This is a randomized clinical trial with 24 patients submitted to isolated aortic valve replacement divided into two groups: Perceval™ S (Group P) and conventional bioprostheses (Group C). Incidence of severe SIRS (three or more criteria) in the first 48 hours postoperatively, EMP release profile, interleukins (IL) 6 and 8, C-reactive protein, and procalcitonin were analyzed preand postoperatively at 24 hours and three months.
RESULTS
There were 24 patients (12 in each group), mean age was 69.92±5.17 years, 83.33% were female, the incidence of severe SIRS was 66.7% and 50% in groups C and P, respectively (P=0.68), and EMP showed a significant increase in the 24-hour postoperative period (P≤0.001) and subsequent decrease in the three-month postoperative period (P≤0.001), returning to baseline levels. For IL-6 and IL-8, there was a greater increase in group C at 24 hours postoperatively (P=.0.02 and P<0.001).
CONCLUSION
The incidence of severe SIRS was similar in both groups, with significantly higher levels of IL-6 and IL-8, at the 24-hour postoperative period, in group C, however with higher levels of EMP in group P, and subsequent return to baseline levels at the three-month postoperative period in both groups.
Topics: Humans; Female; Middle Aged; Aged; Male; Heart Valve Prosthesis Implantation; Aortic Valve Stenosis; Interleukin-6; Interleukin-8; Aortic Valve; Heart Valve Prosthesis; Bioprosthesis; Prosthesis Design; Systemic Inflammatory Response Syndrome; Treatment Outcome; Retrospective Studies
PubMed: 37889214
DOI: 10.21470/1678-9741-2023-0111 -
Current Health Sciences Journal 2023This study investigates the prognostic significance of carcinoembryonic antigen (CEA) levels in predicting early postoperative mortality in patients who have undergone...
INTRODUCTION
This study investigates the prognostic significance of carcinoembryonic antigen (CEA) levels in predicting early postoperative mortality in patients who have undergone colorectal cancer surgery.
METHODS
Between 2017 and 2022, total of 325 patients were enrolled in the study, and their preoperative serum CEA levels were measured. Relevant clinical and operative data were extracted and correlations between CEA levels and postoperative mortality was analysed.
RESULTS
Among the surgical cases, 180 patients (55.3%) exhibited elevated CEA levels. Within the early postoperative period of 30 days, 14 patients (4.3%) succumbed, comprising 8 cases (2.4%) of colon cancer and 6 cases (1.8%) of rectal cancer. Notably, only 3 cases (0.9%), consisting of 1 (0.3%) colon cancer and 2 (0.6%) rectal cancer cases, were associated with an elevated CEA level. However, no statistically significant correlations were observed between CEA levels and early postoperative mortality.
CONCLUSIONS
Our findings indicate that increased CEA levels may not serve as a reliable non-invasive marker for identifying patients at high risk of early mortality in the context of colo-rectal cancer surgery.
PubMed: 38559837
DOI: 10.12865/CHSJ.49.04.14 -
Journal of Craniovertebral Junction &... 2023The objectives of our study were to (1) determine if physical therapy (PT) impacts patient-reported outcomes (PROMs) after lumbar decompression surgery and (2) determine...
OBJECTIVES
The objectives of our study were to (1) determine if physical therapy (PT) impacts patient-reported outcomes (PROMs) after lumbar decompression surgery and (2) determine if PT impacts postsurgical readmissions or reoperations after lumbar decompression surgery.
METHODS
Patients 18 years of age who underwent primary one- or two-level lumbar decompression at our institution were identified. Patient demographics, surgical characteristics, surgical outcomes (all-cause 90 days readmissions and 90 days surgical readmissions), and patient-reported outcomes (PROMs) were compared between the groups. Multivariate linear regression was utilized to determine the individual predictors of 90 days readmissions and PROMs at the 1-year postoperative point. Alpha was set at < 0.05.
RESULTS
Of the 1003 patients included, 421 attended PT postoperatively. On univariate analysis, PT attendance did not significantly impact 90-day surgical reoperations ( = 0.225). Although bivariate analysis suggests that attendance of PT is associated with worse improvement in physical function ( = 0.041), increased preoperative Visual Analogue Scale leg pain (0 = 0.004), and disability ( = 0.006), as measured by the Oswestry Disability Index, our multivariate analysis, which accounts for confounding variables found there was no difference in PROM improvement and PT was not an independent predictor of 90-day all-cause readmissions ( = 0.06). Instead, Charlson Comorbidity Index ( = 0.025) and discharge to a skilled nursing facility ( = 0.013) independently predicted greater 90-day all-cause readmissions.
CONCLUSIONS
Postoperative lumbar decompression PT attendance does not significantly affect clinical improvement, as measured by PROMs or surgical outcomes including all-cause 90 days readmissions and 90-day surgical readmissions.
PubMed: 37860023
DOI: 10.4103/jcvjs.jcvjs_61_23 -
Pain Physician Jul 2023Postoperative pain after hip arthroscopy remains a major cause of patient dissatisfaction in the immediate postoperative period. Adequate postoperative analgesia is... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postoperative pain after hip arthroscopy remains a major cause of patient dissatisfaction in the immediate postoperative period. Adequate postoperative analgesia is associated with increased patient satisfaction, earlier mobilization, and decreased opioid consumption.
OBJECTIVES
Therefore, there is a need for safe, reliable, and opioid- and motor-sparing methods of achieving postoperative analgesia following hip arthroscopy. We evaluated the efficacy of pericapsular nerve group (PENG) block vs fascia iliaca block (FIB) in reducing postoperative pain and analgesic consumption in the first 24 hours following hip arthroscopy.
STUDY DESIGN
A prospective randomized double-blinded control clinical trial.
SETTING
At the arthroscopy unit of the orthopedic department of Assiut University Hospitals, Assiut, Egypt from 2019 to 2022.
METHODS
Forty-three patients comprising 18 women and 25 men scheduled for hip arthroscopy were randomized to receive a preoperative block with PENG or FIB from March 2019 to March 2022. The mean age was 27.9 years (standard deviation [SD], 6.2 years; range, 18-42 years) and the mean body mass index was 25.13 kg/m2 (SD, 5.08 kg/m2). Patients were randomized into 2 groups: group A comprising 20 patients that received FIB; and group B comprising 23 patients that received PENG block. The efficacies of FIB and PENG block were evaluated using Visual Analog Scale scores.
RESULTS
Statistically significant differences in median pain scores and mean at rest pain scores were observed between the 2 groups at all measured time points following surgery (i.e., 6, 12, 18, and 24 hours). Further, dynamic pain scores (with hip flexion) scores significantly differed between the 2 groups at 24 hours postoperatively (P = 0.001). PENG block significantly decreased postoperative opioid use compared to FIB. Total opioid use in the 24-hour postoperative period was lower in the PENG group compared to the FIB group (16.5 ± 9.9 vs 27.5 ± 9.6; P < 005).
LIMITATIONS
Different hip pathologies and different interventions lead to different outcomes. Also, a larger sample size and longer follow-up duration are required.
CONCLUSIONS
PENG block may represent the ideal regional anesthesia modality for hip arthroscopy as an alternative to more conventional regional nerve blocks, such as FIB, femoral nerve block, and lumbar plexus block. PENG block is reproducible, easily performed in the preoperative setting, and appears to spare motor function while providing prolonged sensory analgesia.
Topics: Male; Humans; Female; Adult; Analgesics, Opioid; Femoral Nerve; Arthroscopy; Prospective Studies; Nerve Block; Pain, Postoperative
PubMed: 37535774
DOI: No ID Found -
Polski Przeglad Chirurgiczny Oct 2023<b><br>Introduction:</b> Aquafilling, a widely used soft-tissue filler since 2005, shows multiple adverse effects, necessitating the development of...
<b><br>Introduction:</b> Aquafilling, a widely used soft-tissue filler since 2005, shows multiple adverse effects, necessitating the development of effective methods for its removal. We present a surgical method for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and elaborate and discuss the advantages of this method.</br> <b><br>Aim:</b> The aim of this study was to present a surgical method for removal of Aquafilling (soft-tissue filler) present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and to elaborate the advantages of this proposed technique.</br> <b><br>Materials and methods:</b> The surgical Aquafilling removal method described here was used in 25 patients (age, 21-53 years). The technique was used to remove Aquafilling present in the breasts (14 patients), breasts with migration to the chest and/or the abdomen (7 patients), and the buttocks (3 patients). The detailed course of Aquafilling removal surgery and postoperative treatment for these three types of cases is described.</br> <b><br>Results:</b> Surgical removal of Aquafilling with the described method did not cause any of the previously described ailments in each patient, excluding one patient who only showed significant pain reduction in both breasts preceding each menstruation cycle.</br> <b><br>Conclusions:</b> The method described herein can be recommended for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and buttocks, since it allowed thorough Aquafilling removal and decreased the local inflammatory state and the risk of potential carcinogenesis.</br>.
Topics: Female; Humans; Young Adult; Adult; Middle Aged; Abdominal Cavity; Buttocks; Postoperative Period
PubMed: 38629282
DOI: 10.5604/01.3001.0053.3999 -
BMC Musculoskeletal Disorders Aug 2023This study aimed to examine the validity of the timed up and go test (TUGT), which is a representative, objective, and functional assessment that can evaluate walking... (Observational Study)
Observational Study
PURPOSE
This study aimed to examine the validity of the timed up and go test (TUGT), which is a representative, objective, and functional assessment that can evaluate walking speed, strength, and balance, and determine the significant factors associated with physical dysfunction in the early postoperative period in patients with soft tissue sarcomas (STSs).
METHODS
This retrospective, single-center, observational study conducted at the National Cancer Center Hospital included 54 patients with STSs in the thigh who underwent surgery. The Musculoskeletal Tumor Society (MSTS) score, which subjectively evaluates the affected limb, was evaluated at discharge, and TUGT was performed preoperatively and at discharge. Higher scores indicated good limb function in the MSTS score and poor performance in the TUGT. Spearman's correlation analysis was performed to identify the relationship between the MSTS score and TUGT. A receiver operating characteristic curve was used to calculate the cut-off value of the change in pre- and postoperative TUGT for an MSTS score of ≥ 80%. To examine the significant factors associated with physical dysfunction, multivariate regression analysis was performed using the change in pre- and postoperative TUGT as the dependent variable.
RESULTS
Postoperative TUGT and the change in pre- and postoperative TUGT were significantly associated with the MSTS score. The cut-off value for the change in pre- and postoperative TUGT for acceptable affected lower-limb function was 3.7 s. Furthermore, quadriceps muscle resection was significantly associated with the change in pre- and postoperative TUGT in the early postoperative period.
CONCLUSIONS
TUGT could be a useful objective evaluation tool for postoperative patients with STSs. The cut-off value for the change in TUGT can be used to monitor postoperative recovery. If recovery is prolonged, a rehabilitation program can be designed according to the severity of the functional impairment in muscle strength, balance, or gait. In addition, sufficient information should be obtained regarding the presence or absence of quadriceps resection, which has a significant impact on postoperative performance.
Topics: Humans; Thigh; Postural Balance; Retrospective Studies; Time and Motion Studies; Lower Extremity; Sarcoma; Soft Tissue Neoplasms
PubMed: 37596604
DOI: 10.1186/s12891-023-06797-w -
Brain & Spine 2023Incidental durotomy (ID) is an intraoperative event associated to prolonged bed rest and hospital stay, antibiotic use, higher patient dissatisfaction, and leg pain...
INTRODUCTION
Incidental durotomy (ID) is an intraoperative event associated to prolonged bed rest and hospital stay, antibiotic use, higher patient dissatisfaction, and leg pain among other complications of its postoperative course. Several repair techniques and postsurgical care have been proposed for its management. This study was designed to develop an agreed protocol in cases of ID among Orthopaedic Surgeons (OS) and Neurosurgeons (NS) integrated into a Spinal Surgery Unit.
RESEARCH QUESTION
Incidental durotomies management protocol.
MATERIALS AND METHODS
From 997 eligible cases operated in Hospital del Mar (Barcelona, Spain) from April 2018 to March 2022, demographic, clinical, surgical and postoperative data was collected for statistical analysis from the morbidity and mortality database, with 79 identified IDs. Redo procedures were significantly associated to OS, and cervical and anterior/lateral approaches to NS, both groups were not comparable.
RESULTS
ID occurred in 7.9% of cases, more frequently after the lockdown (p=0.03), in females (p=0.04), during posterior approaches (p=0.003), and less frequently in the cervical spine (p=0.009). IDs were linked to postoperative infections (p< 0.001) and nerve root damage (p< 0.001). Patients without ID evolved more satisfactorily during the postoperative period (p=0.002), and those with CSF leak (20/79) spent on bed rest more than twice the time as those without (p<0.001). Multivariable logistic regression showed strong association between posterior approaches and ID, between complicated postoperative courses and ID.
DISCUSSION AND CONCLUSIONS
ID is linked to an adverse postoperative recovery, and it should be primarily repaired under microscope, with early mobilization of patients after surgery.
PubMed: 38020997
DOI: 10.1016/j.bas.2023.102682 -
Journal of Thoracic Disease Feb 2024Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with elevated morbidity and mortality. Although current prediction models have limited... (Review)
Review
Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with elevated morbidity and mortality. Although current prediction models have limited efficacy, several perioperative interventions can reduce patients' risk of POAF. These begin with preoperative medications, including beta-blockers and amiodarone. Moreover, patients should be screened for preexisting atrial fibrillation (AF) so that concomitant surgical ablation and left atrial appendage occlusion can be performed in appropriate candidates. Intraoperative interventions such as posterior pericardiectomy can reduce mediastinal fluid accumulation, which is a trigger for POAF. Furthermore, many preventive strategies for POAF are implemented in the immediate postoperative period. Initiating beta-blockers, amiodarone, or both is reasonable for most patients. Overdrive atrial pacing, colchicine, and steroids have been used by some, although the evidence base is less robust. For patients with POAF, rate-control and rhythm-control strategies have comparable outcomes. Decision-making regarding anticoagulation should recognize that the stroke risk associated with POAF appears to be lower than that for general nonvalvular AF. The evidence that oral anticoagulation reduces stroke risk is less clear for POAF patients than for patients with general nonvalvular AF. Given that POAF tends to be shorter-lived and is associated with greater bleeding risks in the perioperative period, decisions regarding anticoagulation should be individualized. Finally, wearable technology and machine learning algorithms for better predicting and managing POAF appear to be coming soon. These technologies and a comprehensive clinical program could meaningfully reduce the incidence of this common complication.
PubMed: 38505057
DOI: 10.21037/jtd-23-1626