scholarly journals NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1781
Author(s):  
Emanuele Rinninella ◽  
Alberto Biondi ◽  
Marco Cintoni ◽  
Pauline Raoul ◽  
Francesca Scialanga ◽  
...  
Keyword(s):  
Body Composition ◽  
Colorectal Surgery ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Cell Mass ◽  
Length Of Hospital Stay ◽  
Bioelectrical Impedance ◽  
High Volume ◽  
Analysis Data ◽  
Perioperative Outcomes

Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. Methods: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into “NutriCatt + ERAS” (n = 166) or “standard ERAS” patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01–0.56; p = 0.009). Conclusions: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.

Bioelectrical impedance assessment of body composition in thyroid disease

1997 ◽  
Vol 136 (5) ◽  
pp. 493-498 ◽  
Author(s):  
Thomas Seppel ◽  
Andrea Kosel ◽  
Reiner Schlaghecke
Keyword(s):  
Body Composition ◽  
Thyroid Disease ◽  
Cell Mass ◽  
Bioelectrical Impedance ◽  
Metabolic Effects ◽  
Whole Body ◽  
Body Resistance ◽  
Biochemical Assessment ◽  
Qualitative Changes

Abstract To assess the metabolic effects of thyroid disease, body composition was determined by bioimpedance analysis (BIA) in 72 patients with untreated hyperthyroidism (mean age 48·7±1·9 years) and 26 patients with untreated hypothyroidism (63·8±3·4 years). Bioelectrical whole body resistance (R) and reactance (Xc) were used for computerized calculation of lean body mass (LBM), body cell mass (BCM), extracellular mass (ECM) and body fat (BF). Compared with age- and sex-matched healthy controls the most sensitive parameter indicating excess thyroid hormone was the ECM/BCM ratio which was markedly elevated in all hyperthyroid subjects. ECM/BCM alteration resulted from marked depletion of BCM with concomitant expansion of ECM. BCM change is thought to be predominantly due to a loss of muscle mass while ECM rise may reflect an increase in extracellular fluids. In contrast, hypothyroidism was characterized by an increase in BF besides a relatively unaffected LBM component. Serum parameters of thyroid function (tri-iodothyronine (T3), free thyroxine, TSH) did not correlate with the determinants of body composition except for a slight inverse relationship between the phase angle (Xc/R×180°/π) and T3 concentration in Graves' disease patients. We conclude that hyperthyroidism is primarily accompanied by quantitative as well as qualitative changes in the lean body while considerable fat increase is the most important feature of hypothyroidism. Severity of body composition derangement cannot be predicted from the degree of thyroid dysfunction. BIA could become a useful tool which allows objective determination of even subtle metabolic manifestations of thyroid disease and should, therefore, complement conventional clinical and biochemical assessment. European Journal of Endocrinology 136 493–498

scholarly journals Efficacy of Tolvaptan in Elderly Patients with Heart Failure and Preserved Ejection Fraction

2019 ◽  
Vol 5 (2) ◽  
pp. 59-65
Author(s):  
Yoriyasu Suzuki ◽  
Akira Murata ◽  
Satoshi Tsujimoto ◽  
Yusuke Ochiumi ◽  
Tatsuya Ito
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Rest Period ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Abstract Background: There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. Methods: This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. Results: Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. Conclusions: TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.

Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

2019 ◽  
Vol 32 (10) ◽  
pp. 1-8
Author(s):  
P Prasad ◽  
M Navidi ◽  
A Immanuel ◽  
S M Griffin OBE ◽  
A W Phillips
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Cochrane Library ◽  
Published Data ◽  
Meta Analyses ◽  
The Impact

SUMMARY Changes in the structure of surgical training have affected trainees’ operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)—this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11–15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

scholarly journals Effect of 12-Week Swimming Training on Body Composition in Young Women

2019 ◽  
Vol 16 (3) ◽  
pp. 346 ◽  
Author(s):  
Malgorzata Charmas ◽  
Wilhelm Gromisz
Keyword(s):  
Body Composition ◽  
Young Women ◽  
Cell Mass ◽  
Bioelectrical Impedance ◽  
The Body ◽  
Body Cell Mass ◽  
Swimming Training ◽  
Hip Circumference ◽  
Good Shape ◽  
Total Body

Background: Systematic physical activity can permanently prevent disadvantageous developments in the human body. This is very important especially for women, for whom the maintenance of a lean body in good shape is sometimes a primary consideration. However, in most cases, this activity is taken randomly and does not produce the desired effects such as reducing body fat. The purpose of the study was to evaluate changes in female body composition induced by 12 weeks of swimming training compared to sedentary controls. Methods: Training sessions occurred three times per week (60 min/session). Height, body mass, and waist/hip circumference and waist/hips ratio (WHR) were measured. Body cell mass (BCM), total body water (TBW), extracellular (ECW) and intracellular water (ICW), fat mass (FM), lean mass (FFM), and muscle mass (MM) were measured using bioelectrical impedance (pre/post). Results: Training elicited decreases in hip circumference and increase in WHR. No changes were recorded in BCM, TBW, ECW, ICW, FM, FFM, and MM. Controls experienced decreases in values of BCM, ICW, and MM and increases in ECW. Conclusion: The applied swimming training did not significantly affect the body composition parameters. Inactivity also triggered a tendency toward unhealthy movement of water from the intracellular to extracellular space.

scholarly journals Body Composition and Leptin/Ghrelin Levels during Lenvatinib for Thyroid Cancer

2019 ◽  
Vol 9 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Simone De Leo ◽  
Carla Colombo ◽  
Marta Di Stefano ◽  
Antonella Dubini ◽  
Silvia Cozzi ◽  
...  
Keyword(s):  
Body Composition ◽  
Thyroid Cancer ◽  
Kinase Inhibitor ◽  
Cell Mass ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
The Body ◽  
Fat Free Mass ◽  
Oral Nutritional Supplements ◽  
Total Body

Weight loss is one of the most frequent adverse events during treatment with multikinase inhibitors, but scanty data are available on its extent and characteristics. This is the first assessment of the body composition by bioelectrical impedance analysis and of circulating leptin and ghrelin levels, in patients with advanced thyroid cancer before and at regular intervals during treatment with the tyrosine kinase inhibitor lenvatinib. Body mass index (BMI) decreased in all patients, with an average ∆ reduction of –6.4, –9.8, and –15.3% at 3, 6, and 12 months of treatment, respectively. Interestingly, in most patients, after the first year of treatment, BMI remained stable. In all patients, fat mass (FM) reduced more than fat-free mass, the highest decrement being of –60 and –16%, respectively. A decrease in the body cell mass, a parameter mainly due to muscle tissue, was observed only in patients with a vast baseline muscular mass. Total body water decreased in parallel to BMI. During treatment, leptin tightly paralleled the decrease of BMI values, consistent with the decrease in FM, whereas ghrelin levels increased upon BMI decrease. The loss of the FM accounts for the largest portion of BMI reduction during lenvatinib treatment. The increase in ghrelin could account for the BMI stabilization observed after 1 year of treatment. Nevertheless, oral nutritional supplements should be given as early as possible and athletic patients should be encouraged to maintain physical activity. In some circumstances, parenteral nutrition is required for the rehabilitation of these patients.

Impact of Surgical Mentorship on Retroperitoneoscopic Adrenalectomy with Comparison to Transperitoneal Laparoscopic Adrenalectomy

2013 ◽  
Vol 79 (2) ◽  
pp. 162-166
Author(s):  
James T. Broome ◽  
Carmen C. Solorzano
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Retroperitoneoscopic Adrenalectomy ◽  
The Mean ◽  
The Impact

Retroperitoneoscopic adrenalectomy (RA) provides a direct approach to the adrenal gland. RA represents a complex approach with unique orientation that is less intuitive. The authors objectively evaluated the impact of mentorship on the performance of RA and also compared it with laparoscopic adrenalectomy (LA). After implementing the use of RA, a retrospective review of the operative experience of two high-volume endocrine surgeons was performed. Both surgeons participated in a hands-on RA mentorship. Clinical presentation and perioperative outcomes were compared. Subgroup analysis was used to compare RA pre- and postmentorship and with LA. Sixty-one LAs and 31 RAs were included in the analysis. The mean operative time was 115 for LA versus 90 minutes for RA ( P = 0.002). Blood loss was greater for LA versus RA (56 vs 22 mL; P = 0.001). Length of stay (LOS) for LA was 2.2 versus 1.5 days for RA ( P = 0.029). Ten patients were treated by RA in the prementorship era versus 21 in the postmentorship era. The mean operative time for the prementorship group was 118 minutes, which decreased to 77 minutes postmentorship ( P < 0.0001). LOS also decreased from 2.0 to 1.2 days ( P = 0.04) in the postmentorship era. RA demonstrates a shorter operative time, less blood loss, and decrease length of hospital stay as compared with standard LA. After proper mentorship and patient selection, RA may represent a superior option for removal of small, benign adrenal tumors.

scholarly journals Applications of Bioelectrical Impedance Vector Analysis (BIVA) in the Study of Body Composition in Athletes

2021 ◽  
Vol 11 (21) ◽  
pp. 9781
Author(s):  
Sandra de la Cruz Marcos ◽  
Mª Paz Redondo del Río ◽  
Beatriz de Mateo Silleras
Keyword(s):  
Body Composition ◽  
Cell Mass ◽  
Bioelectrical Impedance ◽  
Compartment Model ◽  
Vector Analysis ◽  
Qualitative Assessment ◽  
Hydration Status ◽  
Bioelectrical Impedance Vector Analysis ◽  
Measurement Protocol ◽  
Impedance Vector

The study of body composition (BC) allows evaluating nutritional status, optimizing competitive performance, and monitoring the success of training regimens in athletes. Since BC reference techniques are expensive and/or invasive, in practice simpler, less expensive, and safer methods such as anthropometry are often used. The problem is that anthropometry requires a qualified anthropometrist, a rigorous measurement protocol using validated equipment, and a lengthy procedure because of its limited accuracy. Bioimpedance analysis (BIA) is an indirect method for estimating BC in a simple, fast, inexpensive, noninvasive, accurate, and reproducible manner. Despite the limitations of conventional BIA, it is still the most commonly used method for assessing BC in athletes. However, bioelectrical impedance vector analysis (BIVA) allows qualitative assessment of body cell mass (BCM) and hydration status without the need for biological assumptions and without being subject to conventional BIA errors. The purpose of this article was to demonstrate the uses and applications of BIA in the study of the BC and physical characteristics of athletes. For example, several practical cases of athletes from different sports were compared. The results obtained from somatotype studies, conventional BIA, and BIVA were included. BIVA interpretation and somatotype were consistent for all cases analyzed, but BIVA also provided information about hydration and BCM. The application of BIVA in the assessment of athletes can improve BC studies in sports because it is fast, simple, and reliable and neither imposes two-compartment-model limitations on BC estimation nor requires any biological assumptions.

scholarly journals Body Composition and Bioelectrical-Impedance-Analysis-Derived Raw Variables in Pole Dancers

2021 ◽  
Vol 18 (23) ◽  
pp. 12638
Author(s):  
Giada Ballarin ◽  
Luca Scalfi ◽  
Fabiana Monfrecola ◽  
Paola Alicante ◽  
Alessandro Bianco ◽  
...  
Keyword(s):  
Body Composition ◽  
Bioelectrical Impedance Analysis ◽  
Cell Mass ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
The Body ◽  
Fat Free Mass ◽  
Lower Limbs ◽  
Whole Body ◽  
Fat Percentage

Few data are available on the body composition of pole dancers. Bioelectrical impedance analysis (BIA) is a method that is used to estimate fat-free mass (FFM) and fat mass (FM), while raw BIA variables, such as the impedance ratio (IR) and phase angle (PhA), are markers of body cell mass and the ratio between extracellular and total body water. The aim of this study was to evaluate the body composition of pole dancers compared to controls, in particular, those raw BIA variables that are considered as markers of muscle composition. Forty female pole dancers and 59 controls participated in the study. BIA was performed on the whole body and upper and lower limbs, separately, at 5, 50, 100 and 250 kHz. The FFM, FFM index, FM and body fat percentage (BF%) were predicted. The bioelectrical impedance indexes IR and PhA were also considered. Pole dancers exhibited higher FFMI and BI indexes and lower BF%. PhA was greater and IRs were smaller in pole dancers than in controls for the whole body and upper limbs. Considering the training level, FFM, whole-body IR and PhA were higher in the professionals than non-professionals. Raw BIA variables significantly differed between the pole dancers and controls, suggesting a higher BCM; furthermore, practicing pole dancing was associated with a greater FFM and lower FM.

scholarly journals Robotic-assisted pancreatic surgery in the elderly patient: experiences from a high-volume centre

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karl H. Hillebrandt ◽  
Sebastian Knitter ◽  
Lea Timmermann ◽  
Matthäus Felsenstein ◽  
Christian Benzing ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Surgery ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
The Elderly ◽  
Robotic Assisted ◽  
Conversion To Open Surgery ◽  
Number Of Patients ◽  
Group 2

Abstract Background Robotic-assisted pancreatic surgery (RPS) has fundamentally developed over the past few years. For subgroups, e.g. elderly patients, applicability and safety of RPS still needs to be defined. Given prognosticated demographic developments, we aim to assess the role of RPS based on preoperative, operative and postoperative parameters. Methods We included 129 patients undergoing RPS at our institution between 2017 and 2020. Eleven patients required conversion to open surgery and were excluded from further analysis. We divided patients into two groups; ≥ 70 years old (Group 1; n = 32) and < 70 years old (Group 2; n = 86) at time of resection. Results Most preoperative characteristics were similar in both groups. However, number of patients with previous abdominal surgery was significantly higher in patients ≥ 70 years old (78% vs 37%, p < 0.0001). Operative characteristics did not significantly differ between both groups. Although patients ≥ 70 years old stayed significantly longer at ICU (1.8 vs 0.9 days; p = 0.037), length of hospital stay and postoperative morbidity were equivalent between the groups. Conclusion RPS is safe and feasible in elderly patients and shows non-inferiority when compared with younger patients. However, prospectively collected data is needed to define the role of RPS in elderly patients accurately. Trial registration Clinical Trial Register: Deutschen Register Klinischer Studien (DRKS; German Clinical Trials Register). Clinical Registration Number: DRKS00017229 (retrospectively registered, Date of Registration: 2019/07/19, Date of First Enrollment: 2017/10/18).

scholarly journals Postoperative Delirium is Associated with Negative Outcomes and Long-Term Mortality in Elderly Koreans: A Retrospective Observational Study

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 618 ◽  
Author(s):  
Park ◽  
Kim
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Postoperative Delirium ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Korean Patients ◽  
Clinical Complications ◽  
Elderly Koreans ◽  
Long Term Mortality

Background and objectives: Delirium is an acute state that causes confusion and occurs frequently after surgery in elderly patients. Delirium is also related to various clinical complications. With increasing numbers of surgeries performed on elderly Koreans, the number of cases of delirium and associated complications will likely rise. The purpose of the present study was to determine whether postoperative delirium in elderly Korean patients negatively influenced other clinical outcomes and their long-term mortality. Materials and Methods: The medical records of 1016 elderly patients (65 years or older) who underwent major abdominal surgery from January 2014 to December 2016 were retrospectively investigated. To determine long-term mortality, patients were followed for up to 12 months post-operation. Results: Delirium occurred in 194 patients (18.3%). Postoperative delirium was significantly associated with the length of hospital stay (B = 2.72), length of ICU stay (B = 18.78), adverse medical events (OR = 2.26, CI = 1.45–3.52), reoperation (OR = 5.50, CI = 1.66–18.22), ICU readmission (OR = 14.10, CI = 2.97–66.90), medical costs (B = 2473.85), discharge to somewhere other than the patient’s home (OR = 6.01, CI = 3.35–10.76), hospital readmission (OR = 2.73, CI = 1.45–5.14), in-hospital mortality (OR = 3.34, CI = 1.21–9.19), three-month mortality (HR = 3.22, CI = 1.27–8.14), six-month mortality (HR = 2.85, CI = 1.28–6.36), and 12-month mortality (HR = 2.19, CI = 1.10–4.32). Conclusions: Postoperative delirium in elderly Korean patients was associated with negative clinical outcomes and mortality. For rapid recovery and increased survival rates in surgical patients, effective delirium-prevention care and active delirium treatments are necessary.

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