Preventive Effects of Sustainable and Developmental Perioperative Oral Management Using the “Oral Triage” System on Postoperative Pneumonia after Cancer Surgery

Perioperative oral management is widely recognized in the healthcare system of Japan. Conventionally, the surgeon refers patients with oral problems to a dental or oral surgery clinic in the hospital. However, frequent in-house referrals were found to increase the number of incoming patients resulting in unsustainable situations due to an insufficient workforce. In 2011, the Center for Perioperative Medicine was established at our hospital to function as a management gateway for patients scheduled to undergo surgery under general anesthesia. The “oral triage” system, wherein a dental hygienist conducts an oral screening to select patients who need preoperative oral hygiene and functional management, was established in 2012. A total of 37,557 patients who underwent surgery at our hospital from April 2010 to March 2019 (two years before and seven years after introducing the system) were evaluated in this study. The sustainability and effectiveness of introducing the system were examined in 7715 cancer surgery patients. An oral management intervention rate of 20% and a significant decrease in the incidence of postoperative pneumonia (aOR = 0.50, p = 0.03) indicated that this system could be useful as a sustainable and developmental oral management strategy to manage surgical patients with minimal human resources.

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Faculty Opinions recommendation of Review article: the role of the perioperative period in recurrence after cancer surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.3606959.3319059 ◽

2010 ◽

Author(s):

André Boezaart ◽

Andrea Toufexis Esch

Keyword(s):

Perioperative Period ◽

Review Article ◽

Cancer Surgery ◽

After Cancer

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Differences in Patients, Surgical Complexity, and Outcomes After Cancer Surgery at National Cancer Institute-designated Cancer Centers Compared to Other Hospitals

Medical Care ◽

10.1097/mlr.0b013e3182928f44 ◽

2013 ◽

Vol 51 (7) ◽

pp. 606-613 ◽

Cited By ~ 15

Author(s):

Ryan P. Merkow ◽

David J. Bentrem ◽

Jeanette W. Chung ◽

Jennifer L. Paruch ◽

Clifford Y. Ko ◽

...

Keyword(s):

National Cancer Institute ◽

Cancer Surgery ◽

Cancer Centers ◽

Surgical Complexity ◽

After Cancer

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The effects of centralizing cancer surgery on postoperative mortality: A systematic review and meta-analysis

Journal of Health Services Research & Policy ◽

10.1177/13558196211008942 ◽

2021 ◽

pp. 135581962110089

Author(s):

Roberto Grilli ◽

Federica Violi ◽

Maria Chiara Bassi ◽

Massimiliano Marino

Keyword(s):

Evaluation Studies ◽

Meta Analysis ◽

Postoperative Mortality ◽

Interrupted Time Series ◽

High Volume ◽

Cancer Surgery ◽

Interrupted Time Series Analysis ◽

Meta Regression ◽

Meta Regression Analysis ◽

After Cancer

Objectives To review the evidence of the effects of centralization of cancer surgery on postoperative mortality. Methods We searched Medline, Embase, Cinahl, Cochrane and Scopus (up to November 2019) for studies that (i) assessed the effects of centralization of cancer surgery policies on in-hospital or 30-day mortality, or (ii) described changes in both postoperative mortality for a surgical intervention and degree of centralization using reduction in the number of hospitals or increases in the proportion of patients undergoing cancer surgery at high volume hospitals as proxy. PRISMA guidelines were followed. We estimated pooled odds ratios (OR) and conducted meta-regression to assess the relationship between degree of centralization and mortality. Results A total of 41 studies met our inclusion criteria of which 15 evaluated the effect of centralization policies on postoperative mortality after cancer surgery and 26 described concurrent changes in the degree of centralization and postoperative mortality. Policy evaluation studies mainly used before-after designs (n = 13) or interrupted time series analysis (n = 2), mainly focusing on pancreatic, oesophageal and gastric cancer. All but one showed some degree of reduction in postoperative mortality, with statistically significant effects demonstrated by six studies. The pooled odds ratio for centralization policy effect was 0.68 (95% Confidence interval: 0.54–0.85; I2 = 80%). Meta-regression analysis of the 26 descriptive studies found that an increase of the proportion of patients treated at high volume hospitals was associated with greater reduction in postoperative mortality. Conclusions Centralization of cancer surgery is associated with reduced postoperative mortality. However, existing evidence tends to be of low quality and estimates of the effect size are likely inflated. There is a need for prospective studies using more robust approaches, and for centralization efforts to be accompanied by well-designed evaluations of their effectiveness.

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427 The Effect of Malnutrition on Early Outcomes after Cancer Surgery: An International Prospective Cohort Study in 82 Countries

British Journal of Surgery ◽

10.1093/bjs/znab135.044 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Riad ◽

S Knight ◽

E Harrison

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Elective Surgery ◽

Final Analysis ◽

Cancer Surgery ◽

Postoperative Outcomes ◽

Disease Stage ◽

Severe Malnutrition ◽

Colorectal Cancer Surgery ◽

After Cancer

Abstract Background Malnutrition is a state linked to worse postoperative outcomes, and cancer patients are particularly vulnerable due to cachexia. We aimed to explore the effect of malnutrition on 30-day mortality following gastric and colorectal cancer surgery. Method GlobalSurg3 was multicentre international cohort study which collected data from consecutive patients undergoing emergency or elective surgery for gastric and colorectal cancer. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Multilevel variable regression approaches determined the relationship between malnutrition and early postoperative outcomes. Results 6438 patients were included in the final analysis (1184 gastric cancer; 5254 colorectal cancer). Severe malnutrition was common across all income-strata, affecting 1 in 4 patients overall, with a higher burden in low and lower-middle income countries (64%). In patients undergoing elective surgery (n = 5709), severe malnutrition was independently associated with increased mortality (aOR = 1.62 (1.07-2.48, P = 0.024) after accounting for patient factors, disease stage and country effects. Conclusions Severe malnutrition represents a high global burden in cancer surgery, particularly within lower income settings. Malnutrition is an independent risk-factor for 30-day mortality following elective surgery for gastric and colorectal cancer, suggesting perioperative nutritional interventions may improve outcomes after cancer surgery.

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Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

The Lancet ◽

10.1016/s0140-6736(21)00001-5 ◽

2021 ◽

Vol 397 (10272) ◽

pp. 387-397 ◽

Cited By ~ 1

Author(s):

Stephen R Knight ◽

Catherine A Shaw ◽

Riinu Pius ◽

Thomas M Drake ◽

Lisa Norman ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postoperative Mortality ◽

Cancer Surgery ◽

Global Variation ◽

After Cancer

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Plasmapheresis and Heparin Reexposure as a Management Strategy for Cardiac Surgical Patients with Heparin-Induced Thrombocytopenia

Anesthesia & Analgesia ◽

10.1213/ane.0b013e3181c3c1cd ◽

2010 ◽

Vol 110 (1) ◽

pp. 30-35 ◽

Cited By ~ 68

Author(s):

Ian J. Welsby ◽

John Um ◽

Carmelo A. Milano ◽

Thomas L. Ortel ◽

Gowthami Arepally

Keyword(s):

Management Strategy ◽

Surgical Patients ◽

Heparin Induced Thrombocytopenia

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Efficacy of a password-protected pill-dispensing device to enhance disposal of unused opioids after cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.264 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 264-264

Author(s):

Jacob Cogan ◽

Melissa Kate Accordino ◽

Melissa Parsons Beauchemin ◽

Sophie Ulene ◽

Elena B. Elkin ◽

...

Keyword(s):

Pain Control ◽

Cancer Surgery ◽

High Rate ◽

Smartphone App ◽

Opioid Use ◽

Structured Interviews ◽

Health Crisis ◽

Patient Reported ◽

After Cancer ◽

The Impact

264 Background: Opioid misuse is a public health crisis. Initial opioid exposures often occur post-operatively, and 10% of opioid-naïve patients who undergo cancer surgery subsequently become long-term opioid users. It has been shown that 70% of opioids prescribed post-operatively go unused, but only 9% of unused pills are disposed appropriately, which increases the risk of unintended use. We evaluated the impact of an inexpensive, password-protected dispensing device with mail return capacity on retrieval of unused pills after cancer surgery. Methods: Adult patients scheduled for major cancer-related surgery were eligible. Enrolled patients received opioid prescriptions in a password-protected, pill-dispensing device (Addinex) from a specialty pharmacy. The mechanical device links to a smartphone app, which provides passwords on a prescriber-defined schedule. Patients request a password when they are in pain, enter the password into the device and receive a pill if the prescribed time has elapsed. The smartphone app provides clinical guidance based on patient-reported pain levels, and suggests tapering strategies. Patients are instructed to return the device in a DEA-approved mailer when opioid use is no longer required for pain control. Unused pills are destroyed upon receipt. The primary objective was to determine the feasibility of device return, defined as > 50% of patients with device return. We also explored patterns of device use, patient reported outcomes, and device satisfaction via surveys and semi-structured interviews. Results: Between October, 2020 and April, 2021, 13 patients completed the study; 4 patients are currently enrolled. Among the initial 13 patients, 7 underwent abdominal hysterectomy, 4 underwent mastectomy and 2 underwent cutaneous tumor resections. The majority of these patients (n = 10, 77%) returned the device, and more than half (n = 7, 54%) returned the device within 6 weeks of surgery. Only a minority of patients (n = 5, 38%) used the device to obtain opioids; most (n = 8, 62%) used no opioids at home, and all of these patients returned the device and the unused pills. Of 11 patients who participated in semi-structured interviews, most (n = 7, 64%) said they felt safer having opioids in the device instead of a regular pill bottle. Among device users, the majority (n = 4, 80%) reported an overall positive experience. All non-users reported having no opioid requirement for pain control. Conclusions: Our early findings suggest that use of an inexpensive, password-protected, pill-dispensing device to assist with opioid dispensing and return is feasible, with a high rate of device and unused opioid return to the pharmacy. This strategy may be effective for reducing opioid diversion. Analyses and recruitment are ongoing to evaluate the benefits of reducing post-operative opioid consumption.

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