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Anesthesiology Sep 2023
Topics: Humans; Postoperative Care; Preoperative Care; Postoperative Period
PubMed: 37402270
DOI: 10.1097/ALN.0000000000004637 -
World Journal of Gastroenterology Jun 2022Patients with Crohn's disease (CD) are at a considerable risk for intestinal surgery. Approximately 25% of patients with CD will undergo an intestinal resection within... (Review)
Review
Patients with Crohn's disease (CD) are at a considerable risk for intestinal surgery. Approximately 25% of patients with CD will undergo an intestinal resection within 10 years of diagnosis. Postoperative complications after CD surgery have been reported in 20%-47% of the patients. Both general and CD-related risk factors are associated with postoperative complications, and comprise non-modifiable ( age) and potentially modifiable risk factors ( malnutrition). Prehabilitation focuses on the preoperative period with strategies designed to optimize modifiable risk factors concerning the physical and mental condition of the individual patient. The aim of prehabilitation is to enhance postoperative recovery and return to or even improve preoperative functional capacity. Preoperative improvement of nutritional status, physical fitness, cessation of smoking, psychological support, and critical revision of preoperative use of CD medication are important strategies. Studies of the effect on postoperative outcome in CD patients are scarce, and guidelines lack recommendations on tailored management. In this opinion review, we review the current evidence on the impact of screening and management of nutritional status, physical fitness, CD medication and laboratory values on the postoperative course following an intestinal resection in CD patients. In addition, we aim to provide guidance for individualized multimodal prehabilitation in clinical practice concerning these modifiable factors.
Topics: Crohn Disease; Digestive System Surgical Procedures; Humans; Postoperative Complications; Preoperative Care; Preoperative Exercise
PubMed: 35979261
DOI: 10.3748/wjg.v28.i22.2403 -
JAMA Network Open Feb 2022This cross-sectional study examines the prevalence of preoperative opioid prescribing and the specialties of clinicians who prescribe these medications.
This cross-sectional study examines the prevalence of preoperative opioid prescribing and the specialties of clinicians who prescribe these medications.
Topics: Adult; Aged; Analgesics, Opioid; Cross-Sectional Studies; Drug Prescriptions; Female; Forecasting; Humans; Male; Middle Aged; Pain; Practice Patterns, Physicians'; Preoperative Care; Prevalence; United States
PubMed: 35142837
DOI: 10.1001/jamanetworkopen.2021.47897 -
International Urogynecology Journal Jan 2022Methods to increase surgical preparedness in urogynecology are lacking. Our objective was to evaluate the impact of a preoperative provider-initiated telehealth call on... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION AND HYPOTHESIS
Methods to increase surgical preparedness in urogynecology are lacking. Our objective was to evaluate the impact of a preoperative provider-initiated telehealth call on surgical preparedness.
METHODS
This was a multicenter randomized controlled trial. Women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence were randomized to either a telehealth call 3 (± 2) days before surgery plus usual preoperative counseling versus usual preoperative counseling alone. Our primary outcome was surgical preparedness, as measured by the Preoperative Prepardeness Questionnaire. The Modified Surgical Pain Scale, Pelvic Floor Distress Inventory-20, Patient Global Impressions of Improvement, Patient Global Impressions of Severity, Satisfaction with Decision Scale, Decision Regret Scale, and Clavien-Dindo scores were obtained at 4-8 weeks postoperatively and comparisons were made between groups.
RESULTS
Mean telehealth call time was 11.1 ± 4.11 min. Women who received a preoperative telehealth call (n = 63) were significantly more prepared for surgery than those who received usual preoperative counseling alone (n = 69); 82.5 vs 59.4%, p < 0.01). A preoperative telehealth call was associated with greater understanding of surgical alternatives (77.8 vs 59.4%, p = 0.03), complications (69.8 vs 47.8%, p = 0.01), hospital-based catheter care (54 vs 34.8%, p = 0.04) and patient perception that nurses and doctors had spent enough time preparing them for their upcoming surgery (84.1 vs 60.9%, p < 0.01). At 4-8 weeks, no differences in postoperative and patient reported outcomes were observed between groups (all p > 0.05).
CONCLUSIONS
A short preoperative telehealth call improves patient preparedness for urogynecological surgery.
Topics: Female; Humans; Pelvic Floor; Pelvic Organ Prolapse; Preoperative Care; Telemedicine; Urinary Incontinence, Stress
PubMed: 34028575
DOI: 10.1007/s00192-021-04831-w -
Revista Paulista de Pediatria : Orgao... 2019To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy. (Review)
Review
OBJECTIVE
To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy.
DATA SOURCE
Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected.
DATA COLLECTION AND ANALYSIS
Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time.
CONCLUSIONS
There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.
Topics: Adolescent; Anti-Bacterial Agents; Antibiotic Prophylaxis; Appendectomy; Appendicitis; Child; Drug Administration Schedule; Humans; Preoperative Care; Surgical Wound Infection; Treatment Outcome
PubMed: 31291445
DOI: 10.1590/1984-0462/;2019;37;4;00013 -
BMC Health Services Research Nov 2019Requesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by... (Review)
Review
BACKGROUND
Requesting blood prior to a surgical procedure for perioperative transfusion is a common practice in surgical patients. More unit of blood is requested than used by anticipating the patient will be transfused to provide a safety margin in an event of unexpected haemorrhage. Over requesting with minimal utilization results in significant wastage of blood, reagents and human resource. This study was conducted to assess blood utilization practice of the largest tertiary hospital in Ethiopia.
METHODS
A cross-sectional prospective study method was used. Data was collected using a Proforma questionnaire by perusal of each individual patient's records from December 1, 2017 to February 28, 2018.patient age, sex, department requesting the blood, level of operating surgeon, hemodynamic status, number of unit requested, number of unit crossed matched and number of unit transfused were collected. Efficiency of blood utilization was calculated with three indices: Crossmatch to transfusion ratio, transfusion probability, and transfusion index indices.
RESULTS
Blood was requested for 406 patients and a total of 898 units were crossmatched for this patients. Overall Crossmatch to transfusion ration, transfusion probability and transfusion index were 7.6, 15.3% and 0.29 respectively. Results showed insignificant blood usage. Among different departments and units, better blood utilization was seen in neurosurgical unit with C/T ratio, TP and TI of 4.9, 24.4 and 0.6% respectively, while worst indices were from obstetrics unit with C/T ratio, TP and TI of 31.0, 6.5% and 0.06.
CONCLUSION
Using all the three parameters for evaluation of efficiency of blood utilization, the practice in our hospital shows ineffective blood utilization in elective surgical procedure. Blood requesting physician should order the minimum blood anticipated to be used as much as possible.
Topics: Blood Grouping and Crossmatching; Blood Transfusion; Cost-Benefit Analysis; Cross-Sectional Studies; Elective Surgical Procedures; Humans; Practice Guidelines as Topic; Preoperative Care; Prospective Studies
PubMed: 31694644
DOI: 10.1186/s12913-019-4584-1 -
Ciencia & Saude Coletiva Sep 2019The presence of clowns in hospitals is relatively recent and more than 700 organizations now perform clown therapy in hospitals in Brazil and around the world.... (Review)
Review
The presence of clowns in hospitals is relatively recent and more than 700 organizations now perform clown therapy in hospitals in Brazil and around the world. Considering the emphasis on comprehensive care and the humanization of health, it is timely to understand and analyze the national and international scientific literature on clown therapy. This practice challenges the hegemonic biomedical model and potentially helps in the recuperation of health. A review of the literature was conducted and 18 publications were analyzed using thematic content analysis. The following categories arose from the analysis: physiological, behavioral, and emotional responses; presurgical anxiety and attribution of new meanings to practices and the hospital environment. Results have shown that clown therapy leads to a significant decrease in preoperative anxiety in children, even compared with the results obtained with the use of anesthesia-inducing drugs. Most studies investigated the use of clown therapy during patients' adaptation to hospitalization, helping them to attribute new meanings to this situation. Despite its low representation in the scientific field and the fact that it has not been widely accepted as a health practice, several studies have shown the benefits of using clown therapy in the hospital setting.
Topics: Adaptation, Psychological; Anxiety; Brazil; Child; Hospitalization; Hospitals; Humans; Laughter Therapy; Preoperative Care
PubMed: 31508760
DOI: 10.1590/1413-81232018249.22832017 -
European Review For Medical and... Jul 2022
Topics: Exercise Therapy; Heart Failure; Humans; Postoperative Complications; Preoperative Care; Preoperative Exercise
PubMed: 35916788
DOI: 10.26355/eurrev_202207_29278 -
JAMA Network Open May 2021Real-world surgical practice often lags behind the best scientific evidence. For example, although optimizing comorbidities such as smoking and morbid obesity before...
IMPORTANCE
Real-world surgical practice often lags behind the best scientific evidence. For example, although optimizing comorbidities such as smoking and morbid obesity before ventral and incisional hernia repair improves outcomes, as many as 25% of these patients have a high-risk characteristic at the time of surgery. Implementation strategies may effectively increase use of evidence-based practice.
OBJECTIVE
To describe current trends in preoperative optimization among patients undergoing ventral hernia repair, identify barriers to optimization, develop interventions to address these barriers, and then pilot these interventions.
DESIGN, SETTING, AND PARTICIPANTS
This quality improvement study used a retrospective medical record review to identify hospital-level trends in preoperative optimization among patients undergoing ventral and incisional hernia repair. Semistructured interviews with 21 practicing surgeons were conducted to elicit barriers to optimizing high-risk patients before surgery. Next, a task force of experts was convened to develop pragmatic interventions to increase surgeon use of preoperative optimization. Finally, these interventions were piloted at 2 sites to assess acceptability and feasibility. This study was performed from January 1, 2014, to December 31, 2019.
MAIN OUTCOMES AND MEASURES
The main outcome was rate of referrals for preoperative patient optimization at the 2 pilot sites.
RESULTS
Among 23 000 patients undergoing ventral hernia repair, the mean (SD) age was 53.9 (14.3) years, and 12 315 (53.5%) were men. Of these, 8786 patients (38.2%) had at least 1 high-risk characteristic at the time of surgery, including 7683 with 1, 1079 with 2, and 24 with 3. At the hospital level, the mean proportion of patients with at least 1 of 3 high-risk characteristics at the time of surgery was 38.2% (95% CI, 38.1%-38.3%). This proportion varied widely from 21.5% (95% CI, 17.6%-25.5%) to 52.8% (95% CI, 43.9%-61.8%) across hospitals. Interviews with surgeons identified 3 major barriers to improving this practice: lost financial opportunity by not offering a patient an operation, lack of surgeon awareness of available resources for optimization, and organizational barriers. A task force therefore developed 3 interventions: a financial incentive to optimize high-risk patients, an educational intervention to make surgeons aware of available optimization resources, and on-site facilitation. These strategies were piloted at 2 sites where preoperative risk optimization referrals increased 860%.
CONCLUSIONS AND RELEVANCE
This study demonstrates a stepwise process of identifying a practice gap, eliciting barriers that contribute to this gap, using expert consensus and local resources to develop strategies to address these barriers, and piloting these strategies. This implementation strategy can be adopted to diverse settings given that it relies on developing and implementing strategies based on local practice patterns.
Topics: Adult; Aged; Clinical Competence; Feasibility Studies; Female; Guideline Adherence; Hernia, Ventral; Herniorrhaphy; Humans; Male; Middle Aged; Motivation; Obesity, Morbid; Patient Education as Topic; Pilot Projects; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care; Quality Improvement; Referral and Consultation; Retrospective Studies; Risk Factors; Surgeons; Tobacco Smoking
PubMed: 33978723
DOI: 10.1001/jamanetworkopen.2021.6836 -
The Journal of Frailty & Aging 2023Frailty is a multidimensional state of increased vulnerability. Frail patients are at increased risk for poor surgical outcomes. Prior research demonstrates that... (Clinical Trial)
Clinical Trial
BACKGROUND
Frailty is a multidimensional state of increased vulnerability. Frail patients are at increased risk for poor surgical outcomes. Prior research demonstrates that rehabilitation strategies deployed after surgery improve outcomes by building strength.
OBJECTIVES
Examine the feasibility and impact of a novel, multi-faceted prehabilitation intervention for frail patients before surgery.
DESIGN
Single arm clinical trial.
SETTING
Veterans Affairs hospital.
PARTICIPANTS
Patients preparing for major abdominal, urological, thoracic, or cardiac surgery with frailty identified as a Risk Analysis Index≥30.
INTERVENTION
Prehabilitation started in a supervised setting to establish safety and then transitioned to home-based exercise with weekly telephone coaching by exercise physiologists. Prehabilitation included (a)strength and coordination training; (b)respiratory muscle training (IMT); (c)aerobic conditioning; and (d)nutritional coaching and supplementation. Prehabilitation length was tailored to the 4-6 week time lag typically preceding each participant's normally scheduled surgery.
MEASUREMENTS
Functional performance and patient surveys were assessed at baseline, every other week during prehabilitation, and then 30 and 90 days after surgery. Within-person changes were estimated using linear mixed models.
RESULTS
43 patients completed baseline assessments; 36(84%) completed a median 5(range 3-10) weeks of prehabilitation before surgery; 32(74%) were retained through 90-day follow-up. Baseline function was relatively low. Exercise logs show participants completed 94% of supervised exercise, 78% of prescribed IMT and 74% of home-based exercise. Between baseline and day of surgery, timed-up-and-go decreased 2.3 seconds, gait speed increased 0.1 meters/second, six-minute walk test increased 41.7 meters, and the time to complete 5 chair rises decreased 1.6 seconds(all P≤0.007). Maximum and mean inspiratory and expiratory pressures increased 4.5, 7.3, 14.1 and 13.5 centimeters of water, respectively(all P≤0.041).
CONCLUSIONS
Prehabilitation is feasible before major surgery and achieves clinically meaningful improvements in functional performance that may impact postoperative outcomes and recovery. These data support rationale for a larger trial powered to detect differences in postoperative outcomes.
Topics: Humans; Exercise Therapy; Frailty; Physical Functional Performance; Postoperative Complications; Preoperative Care; Preoperative Exercise
PubMed: 38008976
DOI: 10.14283/jfa.2022.42