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Global Spine Journal Jan 2022Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVES
Synthesize previous studies evaluating clinical utility of preoperative Hb/Hct and HbA1c in patients undergoing common spinal procedures: anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), and lumbar decompression (LD).
METHODS
We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on preoperative Hb/Hct and HbA1c and post-operative outcomes in adult patients undergoing ACDF, PCF, PLF, or LD surgeries.
RESULTS
Total of 4,307 publications were assessed. Twenty-one articles met inclusion criteria.
PCF AND ACDF
Decreased preoperative Hb/Hct were significant predictors of increased postoperative morbidity, including return to operating room, pulmonary complications, transfusions, and increased length of stay (LOS). For increased HbA1c, there was significant increase in risk of postoperative infection and cost of hospital stay.
PLF
Decreased Hb/Hct was reported to be associated with increased risk of postoperative cardiac events, blood transfusion, and increased LOS. Elevated HbA1c was associated with increased risk of infection as well as higher visual analogue scores (VAS) and Oswestry disability index (ODI) scores.
LD
LOS and total episode of care cost were increased in patients with preoperative HbA1c elevation.
CONCLUSION
In adult patients undergoing spine surgery, preoperative Hb/Hct are clinically useful predictors for postoperative complications, transfusion rates, and LOS, and HbA1c is predictive for postoperative infection and functional outcomes. Using Hct values <35-38% and HbA1c >6.5%-6.9% for identifying patients at higher risk of postoperative complications is most supported by the literature. We recommend obtaining these labs as part of routine pre-operative risk stratification.
LEVEL OF EVIDENCE
III.
PubMed: 33472418
DOI: 10.1177/2192568220979821 -
Journal of Clinical Anesthesia Dec 2021Preoperative assessment is a standard evaluation, traditionally done in-person in a preanesthesia clinic, for patients who will be undergoing a procedure involving... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Preoperative assessment is a standard evaluation, traditionally done in-person in a preanesthesia clinic, for patients who will be undergoing a procedure involving anesthesia. Given the increased adoption of virtual care during the coronavirus disease 2019 (COVID-19) pandemic, the purpose of this systematic review and meta-analysis is to review the effectiveness of virtual preoperative assessment for the evaluation of surgical patients.
DESIGN
Systematic review and meta-analysis.
SETTING
MEDLINE (Ovid), MEDLINE InProcess/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched from the initial coverage of the respective database to May 2021. A manual citation search of Google Scholar and PubMed was conducted to identify missed articles. Continued literature surveillance was done through July 2021.
PATIENTS
Patients aged 18 years and older undergoing virtual preoperative anesthesia assessment.
INTERVENTIONS
Virtual preoperative assessment.
MEASUREMENTS
Surgery cancellation rates, patient experience, resources saved, staff experience, success in using the data collected to diagnose and manage patients.
MAIN RESULTS
Fifteen studies (n = 31,496 patients) were included in this review. The average age of patients was 58 ± 15 years, and 47% were male. Virtual preoperative assessment resulted in similar surgery cancellation rates compared to in-person evaluation, with a pooled cancellation rate of 2% (95% confidence interval [CI]: 1-3%). Most studies reported a positive patient experience, with a pooled estimate of 90% (95% CI, 81-95%). There was a high success rate in using the information collected with virtual care, in the range of 92-100%, to diagnose and manage patients resulting in time and cost savings in the range of 24-137 min and $60-67 per patient.
CONCLUSIONS
This systematic review and meta-analysis demonstrates the utility of virtual care for preoperative assessment of surgical patients. Virtual preanesthesia evaluation had similar surgery cancellation rates, high patient satisfaction, and reduced costs compared to in-person evaluation.
Topics: Adult; Aged; COVID-19; Humans; Male; Middle Aged; Pandemics; Patient Satisfaction; Preoperative Care; SARS-CoV-2
PubMed: 34649158
DOI: 10.1016/j.jclinane.2021.110540 -
Transplantation Reviews (Orlando, Fla.) Dec 2023Orthotopic liver transplantation (OLT) is a major surgery often associated with significant bleeding. We conducted a systematic review to explore the association between... (Review)
Review
BACKGROUND
Orthotopic liver transplantation (OLT) is a major surgery often associated with significant bleeding. We conducted a systematic review to explore the association between preoperative fibrinogen level and intraoperative blood products transfusion, blood loss and clinical outcomes in patients undergoing OLT.
METHODS
We included observational studies conducted in patients undergoing an OLT mostly for end-stage liver disease that reported an association between the preoperative fibrinogen level and our outcomes of interest. Our primary outcome was the intraoperative red blood cell (RBC) transfusion requirements. Our secondary outcomes were intraoperative blood loss, intraoperative transfusion of any blood product, postoperative RBC transfusion, postoperative thrombotic or hemorrhagic complications, and mortality. We used a standardized search strategy. We reported our results mostly descriptively but conducted meta-analyses using random-effect models when judged feasible.
RESULTS
We selected 24 cohort studies reporting at least one of our outcomes. We found that a high preoperative fibrinogen level was associated with fewer intraoperative RBC and other blood products transfusions, and lower blood loss. We also found a lower overall survival in patients with a higher fibrinogen level (pooled hazard ratio [95% CI] of 1.50 [1.23 to 1.84]; 5 studies, n = 1012, I = 48%). Only one study formally explored a fibrinogen level threshold effect. Overall, reporting was heterogeneous, and risk of bias was variable mostly because of uncontrolled confounding.
CONCLUSION
A higher preoperative fibrinogen level was associated with fewer intraoperative RBC and other blood products transfusions, lower blood loss, and higher mortality. Further studies may help clarify observed associations and inform guidelines.
Topics: Humans; Liver Transplantation; Blood Transfusion; Erythrocyte Transfusion; Fibrinogen; End Stage Liver Disease
PubMed: 37778295
DOI: 10.1016/j.trre.2023.100797 -
British Journal of Anaesthesia Jul 2021In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of evidence and strength of association between perioperative lymphopaenia across different surgical procedures and mortality/morbidity has not been examined by systematic review or meta-analysis.
METHODS
We searched MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane databases from their inception to June 29, 2020 for observational studies reporting lymphocyte count and in-hospital mortality rate in adults. We defined preoperative lymphopaenia as a lymphocyte count 1.0-1.5×10 L. Meta-analysis was performed using either fixed or random effects models. Quality was assessed using the Newcastle-Ottawa Scale. The I index was used to quantify heterogeneity. The primary outcome was in-hospital mortality rate and mortality rate at 30 days.
RESULTS
Eight studies met the inclusion criteria for meta-analysis, comprising 4811 patients (age range, 46-91 yr; female, 20-79%). These studies examined preoperative lymphocyte count exclusively. Studies were of moderate to high quality overall, ranking >7 using the Newcastle-Ottawa Scale. Preoperative lymphopaenia was associated with a threefold increase in mortality rate (risk ratio [RR]=3.22; 95% confidence interval [CI], 2.19-4.72; P<0.01, I=0%) and more frequent major postoperative complications (RR=1.33; 95% CI, 1.21-1.45; P<0.01, I=6%), including cardiovascular morbidity (RR=1.77; 95% CI, 1.45-2.15; P<0.01, I=0%), infections (RR=1.45; 95% CI, 1.19-1.76; P<0.01, I=0%), and acute renal dysfunction (RR=2.66; 95% CI, 1.49-4.77; P<0.01, I=1%).
CONCLUSION
Preoperative lymphopaenia is associated with death and complications more frequently, independent of the type of surgery.
PROSPERO REGISTRY NUMBER
CRD42020190702.
Topics: Elective Surgical Procedures; Hospital Mortality; Humans; Lymphopenia; Morbidity; Postoperative Complications; Preoperative Care; Prospective Studies
PubMed: 33795133
DOI: 10.1016/j.bja.2021.02.023 -
BMC Geriatrics Mar 2023Postoperative delirium (POD) is a common postoperative complication associated with multiple adverse consequences on patient outcomes and higher medical expenses.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postoperative delirium (POD) is a common postoperative complication associated with multiple adverse consequences on patient outcomes and higher medical expenses. Preoperative anxiety has been suggested as a possible precipitating factor for the development of POD. As such, we aimed to explore the association between preoperative anxiety and POD in older surgical patients.
METHODS
Electronic databases including MEDLINE (via PubMed), EMBASE (via Embase.com), Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete; via EBSCOhost) and clinical trial registries were systematically searched to identify prospective studies examining preoperative anxiety as a risk factor for POD in older surgical patients. We used Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies to assess the quality of included studies. The association between preoperative anxiety and POD was summarized with odds ratios (ORs) and 95% confidence intervals (CIs) using DerSimonian-Laird random-effects meta-analysis.
RESULTS
Eleven studies were included (1691 participants; mean age ranging between 63.1-82.3 years). Five studies used a theoretical definition for preoperative anxiety, with the Anxiety subscale of Hospital Anxiety and Depression Scale (HADS-A) as the instrument being most often used. When using dichotomized measures and within the HADS-A subgroup analysis, preoperative anxiety was significantly associated with POD (OR = 2.17, 95%CI: 1.01-4.68, I = 54%, Tau = 0.4, n = 5; OR = 3.23, 95%CI: 1.70-6.13, I = 0, Tau = 0, n = 4; respectively). No association was observed when using continuous measurements (OR = 0.99, 95%CI: 0.93-1.05, I = 0, Tau = 0, n = 4), nor in the subgroup analysis of STAI-6 (six-item version of state scale of Spielberger State-Trait Anxiety Inventory, OR = 1.07, 95%CI: 0.93-1.24, I = 0, Tau = 0, n = 2). We found the overall quality of included studies to be moderate to good.
CONCLUSIONS
An unclear association between preoperative anxiety and POD in older surgical patients was found in our study. Given the ambiguity in conceptualization and measurement instruments used for preoperative anxiety, more research is warranted in which a greater emphasis should be placed on how preoperative anxiety is operationalized and measured.
Topics: Humans; Aged; Aged, 80 and over; Emergence Delirium; Delirium; Prospective Studies; Anxiety; Postoperative Complications; Risk Factors
PubMed: 36997928
DOI: 10.1186/s12877-023-03923-0 -
Journal of Clinical Anesthesia Jun 2022The optimal methods of preoperative assessment and prehabilitation specific to patients with obesity undergoing non-bariatric surgery have not been described. We... (Review)
Review
STUDY OBJECTIVE
The optimal methods of preoperative assessment and prehabilitation specific to patients with obesity undergoing non-bariatric surgery have not been described. We investigated two questions: 1) which methods of preoperative assessment in patients with obesity are associated with improved patient management, and 2) which methods of prehabilitation in patients with obesity are associated with improved patient outcomes?
DESIGN
Systematic review.
SETTING
Preoperative assessment and optimisation, and postoperative outcomes.
PATIENTS
Patients with obesity scheduled for surgery of any type.
INTERVENTIONS
We searched six electronic databases for clinical studies addressing either preoperative assessment or preoperative optimisation.
MEASUREMENTS
The primary outcome measure for the assessment review was any impact on preoperative disease diagnosis or progression, or postoperative complications. The primary outcome measure for the prehabilitation review was any postoperative change in disease or health status, or any medical or surgical complications.
MAIN RESULTS
Twenty one papers were included in the assessment review (total of 5090 participants) and twenty five for prehabilitation (30,170 participants). Approximately two thirds of papers reported on bariatric surgery populations. In the assessment review, studies reported on either the preoperative detection of comorbidities or the prediction of postoperative complications. The only assessment tool with any suggestion of benefit was polysomnography. A range of methods of prehabilitation were found for question 2. Forty eight percent of papers reported improvement in some or all study outcomes. The most successful intervention was exercise, with 4 of 5 exercise-based trials showing improvement in either some or all postoperative outcomes.
CONCLUSIONS
There is a limited body of work addressing preoperative assessment and prehabilitation specific to surgical patients with obesity, especially when undergoing non-bariatric surgery. Preoperative polysomnography was shown to improve both the diagnosis of obstructive sleep apnoea and the prediction of postoperative complications. Half of the prehabilitation studies showed evidence of benefit. From this review, we were unable to make strong recommendations as to best practice in patients with obesity presenting for non-bariatric surgery.
Topics: Bariatric Surgery; Exercise; Humans; Obesity; Postoperative Complications; Preoperative Care; Preoperative Exercise
PubMed: 35152081
DOI: 10.1016/j.jclinane.2022.110676 -
Cureus Apr 2023Pheochromocytoma (PCC) is a neuroendocrine tumor that may present with headaches, palpitations, and hypertension, and if left unresected, it can lead to serious... (Review)
Review
Pheochromocytoma (PCC) is a neuroendocrine tumor that may present with headaches, palpitations, and hypertension, and if left unresected, it can lead to serious complications and fatal cardiac mortality. Adequate preoperative management can decrease the risk of intraoperative complications. In this systematic review, we address and discuss what has been published in the literature about the optimization of pheochromocytoma preoperative care via various types of telemedicine (TM). We searched health research databases PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Library, and Google Scholar for literature on various types of TM employed for PCC preoperative management. We searched peer-reviewed literature in the English language published in the literature until November 5, 2022, using medical subject heading (MeSh) terms in PubMed like "telemedicine" and "pheochromocytoma." We used "telemedicine" or "telehealth" and "pheochromocytoma" in other databases. We considered all types of TM, including synchronous, asynchronous, and remote patient monitoring. Our search yielded five publications in PubMed, 59 results in Google Scholar, and none in the Cochrane Library. After excluding duplicates and evaluating the articles for relevance, five papers were selected for this review. Studies came from the United States and Italy. Findings from these studies suggested safe outcomes and reduced costs compared to what is traditionally followed in physical settings. Overall, this systematic review shows the convenience and safety of TM use for a broad spectrum of patients. Further studies are needed to consolidate these findings. Moreover, guidelines on patients' selection and procedures for safe and effective TM care for patients with PCC are required.
PubMed: 37255909
DOI: 10.7759/cureus.38290 -
Impact of preoperative uni- or multimodal prehabilitation on postoperative morbidity: meta-analysis.BJS Open Nov 2023Postoperative complications occur in up to 43% of patients after surgery, resulting in increased morbidity and economic burden. Prehabilitation has the potential to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postoperative complications occur in up to 43% of patients after surgery, resulting in increased morbidity and economic burden. Prehabilitation has the potential to increase patients' preoperative health status and thereby improve postoperative outcomes. However, reported results of prehabilitation are contradictory. The objective of this systematic review is to evaluate the effects of prehabilitation on postoperative outcomes (postoperative complications, hospital length of stay, pain at postoperative day 1) in patients undergoing elective surgery.
METHODS
The authors performed a systematic review and meta-analysis of RCTs published between January 2006 and June 2023 comparing prehabilitation programmes lasting ≥14 days to 'standard of care' (SOC) and reporting postoperative complications according to the Clavien-Dindo classification. Database searches were conducted in PubMed, CINAHL, EMBASE, PsycINFO. The primary outcome examined was the effect of uni- or multimodal prehabilitation on 30-day complications. Secondary outcomes were length of ICU and hospital stay (LOS) and reported pain scores.
RESULTS
Twenty-five studies (including 2090 patients randomized in a 1:1 ratio) met the inclusion criteria. Average methodological study quality was moderate. There was no difference between prehabilitation and SOC groups in regard to occurrence of postoperative complications (OR = 1.02, 95% c.i. 0.93 to 1.13; P = 0.10; I2 = 34%), total hospital LOS (-0.13 days; 95% c.i. -0.56 to 0.28; P = 0.53; I2 = 21%) or reported postoperative pain. The ICU LOS was significantly shorter in the prehabilitation group (-0.57 days; 95% c.i. -1.10 to -0.04; P = 0.03; I2 = 46%). Separate comparison of uni- and multimodal prehabilitation showed no difference for either intervention.
CONCLUSION
Prehabilitation reduces ICU LOS compared with SOC in elective surgery patients but has no effect on overall complication rates or total LOS, regardless of modality. Prehabilitation programs need standardization and specific targeting of those patients most likely to benefit.
Topics: Humans; Preoperative Exercise; Databases, Factual; Morbidity; Pain, Postoperative; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 38108466
DOI: 10.1093/bjsopen/zrad129 -
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 -
International Journal of Colorectal... Dec 2022Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized.
METHODS
MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects.
RESULTS
The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: - 0.48 days, 95% CI: - 0.84 to - 0.12, p = 0.008) and stool (SMD: - 0.50 days, 95% CI: - 0.86 to - 0.14, p = 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: - 0.51 days, 95% CI: - 0.88 to - 0.14, p = 0.007). There was no difference in postoperative morbidity and patient well-being between both groups.
CONCLUSIONS
Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols.
Topics: Female; Humans; Middle Aged; Male; Diet, Carbohydrate Loading; Colorectal Surgery; Preoperative Care; Randomized Controlled Trials as Topic; Insulin; Length of Stay; Postoperative Complications
PubMed: 36472671
DOI: 10.1007/s00384-022-04288-3