SP9.1.2 Sarcopenia and myosteatosis predict thirty-day emergency laparotomy mortality [The FrOGS study]

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Samantha Body ◽  
Marjolein Ligthart ◽  
James Ward ◽  
Philip H Pucher ◽  
Nathan Curtis ◽  
...  
Keyword(s):  
Decision Making ◽  
Body Composition ◽  
Emergency Surgery ◽  
Risk Assessments ◽  
Muscle Quality ◽  
Emergency Laparotomy ◽  
Decision Making Process ◽  
Shared Decision ◽  
Charlson Score ◽  
Poor Outcomes

Abstract Aims Sarcopenia (low muscle mass - SM) and myosteatosis (low muscle quality - SM-RA) are associated with poor outcomes after elective cancer surgery. Body composition parameters have not been explored in emergency surgery and may offer additive value to risk prediction scores. This multicentre study assessed the association of body composition and survival after emergency laparotomy. Methods A retrospective longitudinal cohort of 674 patients, across 10 hospitals in southern England were recruited (NCT03534765). All patients underwent emergency laparotomy, fulfilling NELA criteria, between August 2016 and November 2017. Pre-operative CTs were blindly analysed using L3 slices, assessing SM and SM-RA. Regression analysis was used to assess associations of body composition and 30-day mortality. Results Six hundred and ten patients were included [283(46%) men, median(IQR) age 71 years (57-79)]. P-POSSUM and NELA predicted mortality was 7% and 4.5% respectively, with a length of stay of 15 days (9-24), 30-day mortality of 7.8% and 1-year mortality of 18.9%. Significant univariate associations between 30-day mortality and age (OR1.04 (1.02-1.07);p=0.001), Charlson score (OR 6.84 (1.64-28.55);p=0.008), P-POSSUM (OR 1.03 (1.02-1.05);p<0.001, NELA mortality (OR 1.06 (1.04-1.08);p<0.001), SM (OR 0.98 (0.97-0.99);p=0.003 and SM-RA (OR 0.93 (0.9-0.96);p<0.001. Significant multivariate associations between 30-day mortality and NELA (OR 1.05 (1.03-1.07); p < 0.001, P-POSSUM (OR 1.03 (1.01-1.04); p < 0.001, SM-RA (OR 0.94 (0.9-0.97); p < 0.001. Conclusions Sarcopenia and myosteatosis are associated with increased mortality in patients undergoing emergency surgery. Body composition should be considered as an objective adjunct to traditional risk assessments, further informing the shared-decision making process around emergency surgery.

The role of a shared decision-making process in paediatric epilepsy surgery

2021 ◽  
Vol 429 ◽  
pp. 119162
Author(s):  
Michelle Gratton ◽  
Bonnie Wooten ◽  
Sandrine Deribaupierre ◽  
Andrea Andrade
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Epilepsy Surgery ◽  
Decision Making Process ◽  
Shared Decision ◽  
Paediatric Epilepsy

scholarly journals Shared decision making for the initiation and continuation of dialysis: a proposal from the Japanese Society for Dialysis Therapy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kazuyoshi Okada ◽  
Ken Tsuchiya ◽  
Ken Sakai ◽  
Takahiro Kuragano ◽  
Akiko Uchida ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Japanese Society ◽  
Healthcare Management ◽  
Maintenance Hemodialysis ◽  
Decision Making Process ◽  
Healthcare Team ◽  
Shared Decision ◽  
Dialysis Therapy ◽  
Terminal Stage

Abstract Background In Japan, forgoing life-sustaining treatment to respect the will of patients at the terminal stage is not stipulated by law. According to the Guidelines for the Decision-Making Process in Terminal-Stage Healthcare published by the Ministry of Health, Labor and Welfare in 2007, the Japanese Society for Dialysis Therapy (JSDT) developed a proposal that was limited to patients at the terminal stage and did not explicitly cover patients with dementia. This proposal for the shared decision-making process regarding the initiation and continuation of maintenance hemodialysis was published in 2014. Methods and results In response to changes in social conditions, the JSDT revised the proposal in 2020 to provide guidance for the process by which the healthcare team can provide the best healthcare management and care with respect to the patient's will through advance care planning and shared decision making. For all patients with end-stage kidney disease, including those at the nonterminal stage and those with dementia, the decision-making process includes conservative kidney management. Conclusions The proposal is based on consensus rather than evidence-based clinical practice guidelines. The healthcare team is therefore not guaranteed to be legally exempt if the patient dies after the policies in the proposal are implemented and must respond appropriately at the discretion of each institution.

scholarly journals Documentation of Individualized Preoperative Risk Assessment: A Multi-Center Study

2019 ◽  
Author(s):  
Joshua Aaron Bloomstone ◽  
Benjamin T Houseman ◽  
Evora Vicents Sande ◽  
Ann Brantley ◽  
Jessica Curran ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Patients ◽  
Individual Risk ◽  
Shared Decision ◽  
Surgical Risk ◽  
Poor Outcomes ◽  
Multi Center Study ◽  
Cardiac Surgeons

Abstract Background Individual surgical risk prediction tools that inform shared-decision making, strengthen the consent process and support clinical management are considered important tools to enhance patient experience and outcomes. Neither the use of individual pre-surgical risk assessment (ISRA) tools nor the rate of documented individual risk is known. The primary endpoint of this study was the rate of physician documented ISRAs within the records of patients with poor outcomes. Secondary endpoints included the effects of age, sex, race, ASA class, and time and type of surgery on the rate of documented presurgical risk.Methods The records of non-obstetric surgical patients within 22 hospitals in Arizona, Colorado, Nebraska, Nevada, and Wyoming, between January 1 and December 31, 2017 were evaluated. Logistic regression was used to analyze both individual and group effects associated with ISRA documentation.Results 756 of 140,756 inpatient charts met inclusion criteria [0.54%, 95% CI 0.50% to 0.58%]. ISRAs were documented by 16.08% of surgeons [p<0.0001; R-squared=68.23%] and 4.50% of anesthesiologists [p< 0.0001, R-squared 15.38%]. Cardiac surgeons documented ISRAs more frequently than non-cardiac surgeons (25.87% vs 16.15%) [p=0.0086, R-squared=0.970%]. Elective surgical patients were more likely than emergency surgical patients (19.57 vs 12.03%) to have risk documented [p=0.0226, R-squared=0.730%]. Patients over the age of 65 were more likely than patients under the age of 65 to have ISRA documentation (20.31 vs 14.61%) [p=0.0429, R-squared=0.580%].Conclusions The observed rate of documented individual surgical risk assessment in our sample was low. Surgeons were more likely than anesthesiologists to document individual presurgical risk. In-line with the Salzburg Statement on Shared-Decision Making, information regarding surgical risk represents the bedrock of presurgical decision making and informed consent. The rate and quality of risk documentation must be improved.

scholarly journals 023 PP: INVOLVING PATIENTS AND CARERS IN RESEARCH: THE EXPERIENCE OF OLDER PEOPLE IN THE SHARED DECISION-MAKING PROCESS IN ADVANCED KIDNEY CARE a

BMJ Open ◽  
2017 ◽  
Vol 7 (Suppl 2) ◽  
pp. bmjopen-2017-016492.41
Author(s):  
N Thomas ◽  
K Jenkins ◽  
S Datta ◽  
R Endacott ◽  
J Kent ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision

Depressed Latinx Older Adults’ Shared Decision-Making Preferences

2021 ◽  
Author(s):  
Sara Romero ◽  
Patrick Raue ◽  
Andrew Rasmussen
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Puerto Rican ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Medical Conditions ◽  
Depression Severity ◽  
Related Information ◽  
Health Related

The shared decision-making (SDM) model is the optimal patient-centered approach to reduce racial and ethnic health disparities in primary care settings. This study examined decision-making preferences and the desire to be knowledgeable of health-related information of a multiheritage group of depressed older Latinx primary care patients. The primary aim was to determine differences in treatment preferences for both general medical conditions and depression and desire to be knowledgeable of health-related information between older Puerto Rican adults compared to older non-Puerto Rican Latinx adults. We also examined whether depression severity moderated those relationships. A sample of 178 older Latinx patients were assessed on measures of decision-making preferences, information-seeking desires, and depression severity. Regression models indicated depression severity moderated the relationship between Latinx heritage and decision-making preferences that relate to general medical decisions, but not depression treatment. Specifically, Puerto Ricans with high levels of depression preferred to be more active in making decisions related to general medical conditions compared to non-Puerto Rican patients who preferred less active involvement. There was no difference between groups at low levels of depression as both groups preferred to be similarly active in the decision-making process. This investigation adds to the literature by indicating between-group differences within a Latinx older adult sample regarding decision-making preferences and the desire to be informed of health-related information. Future research is needed to identify other sociocultural characteristics that contribute to this disparity between Latinx heritage groups in their desires to participate in the decision-making process with their primary care provider.

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