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Nutrients Jun 2024Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors... (Review)
Review
Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.
Topics: Humans; Crohn Disease; Preoperative Care; Postoperative Complications; Nutritional Status; Preoperative Exercise; Malnutrition
PubMed: 38892714
DOI: 10.3390/nu16111783 -
Nutrients May 2024Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation... (Review)
Review
BACKGROUND/AIM
Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy.
METHODS
A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence.
RESULTS
Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73-0.93; = 0.0029) and decrease postoperative complications (-36.7%; = 0.008) and readmission rates (-15.38%; = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (-1 day; < 0.01), a reduction in the length of hospital stay (-1.75 days; = 0.01), an improvement in handgrip strength (+6.8%, < 0.001), an increase in bone mass (+0.3 kg, = 0.04), and a better BMI value (+2.3%, = 0.001).
CONCLUSIONS
Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results.
Topics: Humans; Cystectomy; Postoperative Complications; Preoperative Care; Length of Stay; Preoperative Exercise; Nutritional Status; Dietary Supplements; Randomized Controlled Trials as Topic; Recovery of Function
PubMed: 38892615
DOI: 10.3390/nu16111682 -
International Journal of Molecular... May 2024Appendicitis is primarily diagnosed based on intraoperative or histopathological findings, and few studies have explored pre-operative markers of a perforated appendix....
Appendicitis is primarily diagnosed based on intraoperative or histopathological findings, and few studies have explored pre-operative markers of a perforated appendix. This study aimed to identify systemic biomarkers to predict pediatric appendicitis at various time points. The study group comprised pediatric patients with clinically suspected appendicitis between 2016 and 2019. Pre-surgical serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), intercellular cell-adhesion molecule-1 (ICAM-1), and endothelial selectin (E-selectin) levels were tested from day 1 to day 3 of the disease course. The biomarker values were analyzed and compared between children with normal appendices and appendicitis and those with perforated appendicitis (PA) and non-perforated appendicitis. Among 226 pediatric patients, 106 had non-perforated appendicitis, 102 had PA, and 18 had normal appendices. The levels of all serum proinflammatory biomarkers were elevated in children with acute appendicitis compared with those in children with normal appendices. In addition, the serum IL-6 and TNF-α levels in children with PA were significantly higher, with an elevation in TNF-α levels from days 1 and 2. In addition, serum IL-6 levels increased significantly from days 2 and 3 (both < 0.05). Serum ICAM-1 and E-selectin levels were elevated in the PA group, with consistently elevated levels within the first three days of admission (all < 0.05). These results indicate that increased serum levels of proinflammatory biomarkers including IL-6, TNF-α, ICAM-1, and E-selectin could be used as parameters in the prediction and early diagnosis of acute appendicitis, especially in children with PA.
Topics: Humans; Appendicitis; Child; Female; Male; Biomarkers; Cytokines; Intercellular Adhesion Molecule-1; Chemokines; Child, Preschool; Interleukin-6; Tumor Necrosis Factor-alpha; E-Selectin; Adolescent; Appendectomy
PubMed: 38892260
DOI: 10.3390/ijms25116076 -
Nursing Open Jun 2024To identify factors related to preoperative frailty in patients with cancer and map the tools that measure frailty. (Review)
Review
AIM
To identify factors related to preoperative frailty in patients with cancer and map the tools that measure frailty.
DESIGN
A Scoping review.
METHODS
This scoping review based on Arksey and O'Malley's framework. Articles from CINAHL, PubMed, EMBASE, and PsycINFO databases published between January 2011 and April 2021. The searched keywords were concepts related to 'cancer', 'frailty' and 'measurement'.
RESULTS
While 728 records were initially identified, 24 studies were eventually selected. Research on frailty was actively conducted between 2020 and 2021. Factors related to preoperative frailty were age (22.9%), sex (11.4%), body mass index (11.4%) and physical status indicators (54.3%). The most common result of preoperative frailty was postoperative complications (35.0%). 24 instruments were used to measure frailty.
IMPLICATIONS FOR PATIENT CARE
Selecting an appropriate preoperative frailty screening tool can help improve patient postoperative treatment outcomes.
IMPACT
There are many instruments for assessing preoperative frailty, each evaluating a multi-dimensional feature. We identified the frailty screening tools used today, organized the factors that affect frailty, and explored the impact of frailty. Identifying and organizing frailty measurement tools will enable appropriate evaluation.
REPORTING METHOD
PRISMA-ScR.
PATIENT CONTRIBUTION
No patient or public contribution.
Topics: Humans; Neoplasms; Frailty; Geriatric Assessment; Frail Elderly; Preoperative Period; Postoperative Complications; Aged
PubMed: 38890786
DOI: 10.1002/nop2.2216 -
Scientific Reports Jun 2024Gallstones are common in Western countries and increasing in developing countries through adoption of western lifestyle. Gallstones may cause life-threatening... (Observational Study)
Observational Study
Gallstones are common in Western countries and increasing in developing countries through adoption of western lifestyle. Gallstones may cause life-threatening complications, including acute cholecystitis, acute cholangitis, and acute pancreatitis. Cholecystectomy is the treatment of choice for symptomatic gallstones. Presentation of symptomatic gallstones may be indistinguishable from that of other upper gastro-intestinal tract (UGI) pathologies. Some surgeons routinely perform preoperative UGI endoscopy to diagnose and treat concomitant UGI pathology. A prospective cross-sectional observational study was undertaken at University of Pretoria teaching hospitals to evaluate this practice. Patients aged 18 years and older, with symptomatic gallstones but did not satisfy Tokyo guidelines for acute cholecystitis were recruited. UGI endoscopy was performed before cholecystectomy. There were 124 patients, 110 (88.7%) females and 14 (11.3%) males, mean age 44.0 (13.2) (range: 22-78) years. Most common symptoms were right upper quadrant (RUQ) pain (87%), epigastric pain (59.7%), nausea (58.1%) and vomiting (47.9%). Clinically, 80% had RUQ tenderness and 52.4% epigastric tenderness. UGI endoscopy found 35.4% pathology, 28.2% were active, and comprised acute gastritis (27.4%), peptic ulcers (4.8%), duodenitis (3.2%) and oesophagitis (2.4%). Twelve patients had more than one pathology. This warranted treatment before elective cholecystectomy and justifies the practice of routine preoperative UGI endoscopy.
Topics: Humans; Female; Male; Adult; Middle Aged; Aged; Gallstones; Cholecystectomy; Cross-Sectional Studies; Prospective Studies; Young Adult; Elective Surgical Procedures; Endoscopy, Gastrointestinal; Preoperative Care
PubMed: 38890422
DOI: 10.1038/s41598-024-64019-2 -
Scientific Reports Jun 2024Isoflurane anesthesia (IA) partially compensates NREM sleep (NREMS) and not REM sleep (REMS) requirement, eliciting post-anesthetic REMS rebound. Sleep deprivation...
Isoflurane anesthesia (IA) partially compensates NREM sleep (NREMS) and not REM sleep (REMS) requirement, eliciting post-anesthetic REMS rebound. Sleep deprivation triggers compensatory NREMS rebounds and REMS rebounds during recovery sleep as a result of the body's homeostatic mechanisms. A combination of sleep deprivation and isoflurane anesthesia is common in clinical settings, especially prior to surgeries. This study investigates the effects of pre-anesthetic sleep deprivation on post-anesthetic sleep-wake architecture. The effects of isoflurane exposure (90 min) alone were compared with the effects of isoflurane exposure preceded by experimental sleep deprivation (6 h, gentle handling) on recovery sleep in adult mice by studying the architecture of post-anesthetic sleep for 3 consecutive post-anesthetic days. Effects of isoflurane anesthesia on recovery sleep developed only during the first dark period after anesthesia, the active phase in mice. During this time, mice irrespective of preceding sleep pressure, showed NREMS and REMS rebound and decreased wakefulness during recovery sleep. Additionally, sleep deprivation prior to isoflurane treatment caused a persistent reduction of theta power during post-anesthetic REMS at least for 3 post-anesthetic days. We showed that isoflurane causes NREMS rebound during recovery sleep which suggests that isoflurane may not fully compensate for natural NREMS. The study also reveals that isoflurane exposure preceded by sleep deprivation caused a persistent disruption of REMS quality. We suggest that preoperative sleep deprivation may impair postoperative recovery through lasting disruption in sleep quality.
Topics: Isoflurane; Animals; Sleep Deprivation; Mice; Male; Anesthetics, Inhalation; Sleep, REM; Wakefulness; Mice, Inbred C57BL; Electroencephalography; Sleep; Anesthesia
PubMed: 38890405
DOI: 10.1038/s41598-024-64975-9 -
International Journal of Surgery Case... Jul 2024Thyroidectomy is a surgical procedure commonly employed in the management of thyroid disorders. Complications include, but not limited to, postoperative hypocalcemia. In...
INTRODUCTION
Thyroidectomy is a surgical procedure commonly employed in the management of thyroid disorders. Complications include, but not limited to, postoperative hypocalcemia. In order to effectively manage hypocalcemia following thyroidectomy, a comprehensive approach is essential.
CASE PRESENTATION
We present an intriguing case of a patient who developed severe transient hypocalcemia that was resistant to conventional therapeutic interventions following a total thyroidectomy.
DISCUSSION
Hypocalcemia post total thyroidectomy is a well-established complication which can lead to devastating consequences. Some of the contributing factors include failure of pre-operative optimization, autoimmune disease, malignancy, and prolonged surgical time. A comprehensive approach to identify the contributors is essential in managing the risk factors associated with hypocalcemia.
CONCLUSION
This case highlights the importance of pre-operative elevation and management as well as the close monitoring and individualized treatment plans for patients at risk for post-thyroidectomy hypocalcemia. The successful management of severe hypocalcemia in this patient involved a multidisciplinary team approach and consideration of alternative treatment options.
PubMed: 38889515
DOI: 10.1016/j.ijscr.2024.109899 -
The British Journal of Surgery Jun 2024
Defining standards and core outcomes for clinical trials in prehabilitation for colorectal surgery (DiSCO): modified Delphi methodology to achieve patient and healthcare professional consensus.
Topics: Humans; Delphi Technique; Consensus; Preoperative Exercise; Clinical Trials as Topic; Colorectal Surgery
PubMed: 38888991
DOI: 10.1093/bjs/znae056 -
Cureus Jun 2024CT-guided surgery has demonstrated superior accuracy over traditional methods in the dental literature. However, inherent errors such as discrepancies between jaw...
CT-guided surgery has demonstrated superior accuracy over traditional methods in the dental literature. However, inherent errors such as discrepancies between jaw dimensions in scans and reality can challenge the fabrication of screw-retained provisional restorations. These discrepancies can impede final restoration fabrication. Traditional immediate loading of edentulous jaws using temporary cylinders in existing dentures often requires time-consuming abutment positioning and drilling. Many articles addressed these issues through minimally invasive implant placement with immediate loading, achieved through careful preoperative planning and exact prosthetic techniques. CT-guided surgery facilitates minimally invasive procedures and immediate restoration of edentulous jaws, resulting in reduced morbidity and quicker, more precise outcomes. This case report illustrates how digital dentistry enhances implant placement precision and reliability. It involves using a lock object system between the surgical guide and provisional restoration, streamlining the process. A 59-year-old male with significant periodontal issues and non-restorable teeth was treated with implant-supported fixed prostheses using digital planning and computer-fabricated surgical guides. The plan included immediate loading with mechanical and magnetic locks for optimal outcomes. The patient received complete fixed provisional restorations on both arches through minimally invasive procedures. Digital dentistry facilitated precise implant placement and restoration, improving function, esthetics, and patient satisfaction. Digital technologies streamlined the process, reducing time and enhancing predictability and reproducibility. In conclusion, integrating digital dentistry into implant treatment planning and execution offers enhanced accuracy, efficiency, and patient outcomes. By utilizing digital technologies and innovative methods, clinicians can attain consistent and reliable outcomes, thereby enhancing the quality of care for patients undergoing implant therapy.
PubMed: 38887748
DOI: 10.7759/cureus.62469 -
Cureus Jun 2024Ankle arthrodesis is a crucial surgical intervention for advanced hindfoot conditions, aiming to restore plantigrade walking and alleviate pain. This study evaluates the...
INTRODUCTION
Ankle arthrodesis is a crucial surgical intervention for advanced hindfoot conditions, aiming to restore plantigrade walking and alleviate pain. This study evaluates the effectiveness of a specific surgical approach for tibiotalocalcaneal arthrodesis (TTCA), focusing on rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, and assesses the outcomes of this approach in terms of bone fusion and reduction of postoperative complications.
MATERIALS AND METHODS
This retrospective analysis includes 17 patients who underwent TTCA in a trauma-orthopedic department over seven years. Data were collected from medical records, the HOSIX software, and patient consultations. Preoperative assessments, surgical techniques, postoperative care, and follow-up evaluations were documented.
RESULTS
The mean age of patients was 42.4 years, with a male predominance. Surgical indications included post-traumatic arthropathy (53%), inflammatory arthropathy, ankle infectious pathologies, and Charcot foot and ankle prosthesis failures. All patients underwent standard preoperative evaluations and received corticocancellous grafts. An angled retrograde femoral nail in the sagittal plane was used for internal fixation. Postoperative immobilization lasted 6 to 8 weeks, with subsequent rehabilitation. The bone fusion rate was 100%, with a low complication rate (23.5%).
DISCUSSION
Our study showed a younger patient population with a male predominance, different from some previous studies. Surgical techniques, including the anterior approach combined with a lateral subtalar approach, were consistent with some studies but differed from others. Corticocancellous grafts and the angled retrograde femoral nail in the sagittal plane demonstrated favorable outcomes in terms of fusion. Complication rates were lower compared to some previous reports, highlighting potential improvements in postoperative management.
CONCLUSION
The surgical approach described for TTCA, emphasizing rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, led to satisfactory bone fusion and reduced postoperative complications. These results underscore the importance of this approach in achieving optimal functional outcomes in ankle arthrodesis.
PubMed: 38887747
DOI: 10.7759/cureus.62014