scholarly journals Multimodal prehabilitation before major abdominal surgery: A retrospective study

2021 ◽  
Vol 50 (12) ◽  
pp. 892-902
Author(s):  
Ning Qi Pang ◽  
Stephanie Shengjie He ◽  
Joel Qi Xuan Foo ◽  
Natalie Hui Ying Koh ◽  
Tin Wei Yuen ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Retrospective Review ◽  
Older Patients ◽  
Psychosocial Support ◽  
Enhanced Recovery ◽  
Major Abdominal Surgery ◽  
University Hospital ◽  
Control Group ◽  
National University ◽  
Postoperative Length

Introduction: Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme. Methods: Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation. Results: There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (P=0.150) or major complications (P=0.690) were noted. Patients in the prehabilitation group were observed to ambulate a longer distance and participate more actively with their physiotherapists from postoperative day 1 until 4. In the subgroup of patients with cancer, more patients underwent neoadjuvant therapy in the prehabilitation group compared to the control group (21.7% versus 12.6%, P=0.009). Prehabilitation patients were more likely to proceed to adjuvant chemotherapy (prehabilitation 87.2% vs control 65.6%, P<0.001) if it had been recommended. Conclusion: The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review. Keywords: Frailty, general surgery, geriatric surgery, perioperative care, prehabilitation

The safety of restrictive fluid therapy for major abdominal surgery: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Ping Li ◽  
Sheng-Wen Wu ◽  
Dong-Fang Ge ◽  
Zai-Rong Tang ◽  
Cong-Chao Ma ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Fluid Therapy ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register ◽  
Clinical Trials Registry

Abstract Background: Restrictive fluid therapy is essential to enhanced recovery after surgery. A meta-analysis was conducted to explore the safety of restrictive fluid therapy for major abdominal surgery and compare it with liberal fluid therapy. Methodology : We searched MEDLINE, the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs), the WHO International Clinical Trials Registry Platform, and EMBASE in which restrictive and liberal fluid therapies were compared. Data on complications, anastomotic leaks, and wound infections were extracted. Results: Eleven RCTs comparing the two therapies were included. Compared with liberal fluid therapy, restrictive fluid therapy lowered the risk of complications and cardiopulmonary dysfunction and had similar rates of mortality, anastomotic leak, pneumonia and would infection. But increased kidney injury was also observed in restrictive fluid therapy. Conclusion: Restrictive fluid therapy is safe but may have potential dangers, so caution is warranted in its application.

Long-term outcomes of major abdominal surgery and postoperative delirium after multimodal prehabilitation of older patients

Surgery Today ◽  
2020 ◽  
Vol 50 (11) ◽  
pp. 1461-1470
Author(s):  
Ties L. Janssen ◽  
Ewout W. Steyerberg ◽  
Chantal C. H. A. van Hoof-de Lepper ◽  
Tom C. J. Seerden ◽  
Dominique C. de Lange ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Major Abdominal Surgery ◽  
Long Term Outcomes

scholarly journals The Effect of Scheduled Intravenous Acetaminophen in an Enhanced Recovery Protocol Pathway in Patients Undergoing Major Abdominal Procedures: A Prospective, Randomized, and Placebo-Controlled Clinical Trial

Pain Medicine ◽  
2021 ◽  
Author(s):  
Kathirvel Subramaniam ◽  
Stephen A Esper ◽  
Kushanth Mallikarjun ◽  
Alec Dickson ◽  
Kristin Ruppert ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pain Relief ◽  
Abdominal Surgery ◽  
Rating Scale ◽  
Enhanced Recovery ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Major Abdominal Surgery ◽  
Number Of Patients ◽  
Group A

Abstract Objective Enhanced recovery protocols (ERPs) utilize multi-modal analgesia regimens. Individual regimen components should be evaluated for their analgesic efficacy. We evaluated the effect of scheduled intravenous (IV) acetaminophen within an ERP on analgesia and recovery after a major abdominal surgery. Design This study is a prospective, randomized, double-blinded clinical trial. Setting The study setting was a tertiary care, academic medical center. Subjects Adult patients scheduled for elective major abdominal surgical procedures Methods Patients in group A received 1g IV acetaminophen, while patients in group P received IV placebo every six hours for 48 hours postoperatively within an ERP. Pain scores, opioid requirements, nausea and vomiting, time to oral intake and mobilization, length of stay, and patient satisfaction scores were measured and compared. Results From 412 patients screened, 154 patients completed the study (Group A: 76, Group P: 78). Primary outcome was the number of patients with unsatisfactory pain relief, defined as a composite of average Numeric Rating Scale (NRS) scores above 5 and requirement of IV patient-controlled analgesia for pain relief during the first 48 hours postoperatively, and was not significantly different between the two groups (33 (43.4%) in group A versus 42 (53.8%) patients in group P, p=0.20). Opioid consumption was comparable between two groups. Group A utilized significantly less postoperative rescue antiemetics compared to group P (41% vs. 58%, p= 0.02). Conclusions Scheduled administration of IV acetaminophen did not improve postoperative analgesia or characteristics of postoperative recovery in patients undergoing major abdominal surgery within an ERP pathway.

scholarly journals Anosmia in SARS-CoV-2 Patients: a Retrospective Study

2021 ◽  
Author(s):  
ChenHui Yee ◽  
Matthew Koh ◽  
Paul Anantharajah Tambyah ◽  
David Allen ◽  
Jyoti Somani ◽  
...  
Keyword(s):  
Objective Assessment ◽  
University Hospital ◽  
University Of Pennsylvania ◽  
Control Group ◽  
Inpatient Setting ◽  
Item Questionnaire ◽  
Olfactory Testing ◽  
National University ◽  
Smell Identification ◽  
Question Survey

Abstract BackgroundPost viral anosmia has been reported in human coronavirus infections. In this current pandemic, olfactory dysfunction (OD) has emerged as a common key presenting symptom of COVID-19 infection. In this study, we describe OD assessment in the inpatient setting of patients both suspected of and with confirmed COVID-19 infection via University of Pennsylvania Smell Identification Test (UPSIT) objective assessment and a simple self-reported 3-item questionnaire.MethodsThirty patients admitted to the isolation wards of the National University Hospital, Singapore for either suspected or confirmed COVID-19 infection from April to May 2020 were recruited to this study. 10 patients who tested negative for SARS-CoV-2 were recruited as control subjects. The 20 patients with COVID-19 infection were divided into two groups (10 had olfactory testing performed during the first week of illness, 10 in the second week of illness). A simple 3-question survey was administered to each participant - to rank the severity, state the onset and duration of their hyposmia. Olfactory testing was performed using an English version of the UPSIT.ResultsLoss of smell was reported in 2 participants from the control group, 6 participants from the in the first week of illness and 5 participants from the second week of illness. Two COVID-19 patients have anosmia on the UPSIT. COVID-19 patients were more likely to have severe hyposmia or anosmia by objective assessment, a difference that was statistically significant (P = 0.0485). The differences in degree of OD among COVID-19 patients in their first and second week of illness were not statistically significant (P= 0.6563).ConclusionSelf-reported anosmia was higher among COVID-19 patients compared to controls who were admitted to isolation wards for respiratory symptoms but were tested negative for SARS-CoV-2 infection. On objective assessment by the UPSIT, COVID-19 patients were found to have higher rates of severe hyposmia or anosmia, a difference that was statistically significant (P = 0.0485). A limitation of this study is the odorants used in UPSIT which may be less familiar to the primarily Asian participants in this study, owing to cultural differences.

scholarly journals The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial

2019 ◽  
Vol 7 (8) ◽  
pp. 1276-1281
Author(s):  
Ahmed Hasanin ◽  
Karim Hussein Mourad ◽  
Inas Farouk ◽  
Sherin Refaat ◽  
Ahmed Nabih ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Fluid Therapy ◽  
Extravascular Lung Water ◽  
Stroke Volume Variation ◽  
Major Abdominal Surgery ◽  
Control Group ◽  
Lung Water ◽  
Goal Directed Fluid Therapy ◽  
Ultrasound Score ◽  
The Impact

BACKGROUND: A growing interest had been paid to goal-directed fluid therapy (GDT) in abdominal surgery; however, its impact on the respiratory profile was not well investigated. AIM: We evaluated the impact of GDT on postoperative extravascular lung water and oxygenation after prolonged major abdominal surgery. METHODS: A randomised, controlled study was conducted in Kasr Alainy hospital from April 2016 till December 2017 including 120 adult patients scheduled for prolonged major abdominal surgery. Patients were randomised into either GDT group (n = 60) who received baseline restricted fluid therapy (2 mL/Kg/hour) which is guided by stroke volume variation, or control group (n = 60) who received standard care. Both study groups were compared according to hemodynamic data, fluid requirements, lung ultrasound score, and PaO2/fraction of inspired oxygen ratio (P/F ratio), RESULTS: Intraoperatively, GDT group received less volume of fluids and showed higher intraoperative mean arterial pressure compared to the control group. Postoperatively, lung ultrasound score was lower, and P/F ratio was higher in the GDT group compared to the control group. The number of patients who showed a significant postoperative increase in LUS was higher in the control group 44 (73%) patients versus 14 (23%) patients, P < 0.001). CONCLUSIONS: Using stroke volume variation for guiding fluid therapy in prolonged, major abdominal operations were associated with better hemodynamic profile, less intraoperative fluid administration, lower extravascular lung water and better oxygenation compared to standard care.

Pharmacogenetics-guided analgesics in major abdominal surgery: Further benefits within an enhanced recovery protocol

2017 ◽  
Vol 213 (3) ◽  
pp. 467-472 ◽  
Author(s):  
Anthony J. Senagore ◽  
Bradley J. Champagne ◽  
Eslam Dosokey ◽  
Justin Brady ◽  
Scott R. Steele ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Enhanced Recovery ◽  
Major Abdominal Surgery ◽  
Enhanced Recovery Protocol

scholarly journals Effect of Enhanced Recovery Pathway on Hysterectomy Complications in Suez Canal University Hospital and General Hospital at Ismailia City

2020 ◽  
pp. 77-86
Author(s):  
Heba Ahmed Galal Atia ◽  
Eman Ahmed Keshk ◽  
Inas Mohamed Abd-Allah
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Enhanced Recovery ◽  
Suez Canal ◽  
University Hospital ◽  
Control Group ◽  
Study Group ◽  
Enhanced Recovery Pathway ◽  
Quasi Experimental ◽  
Surgical History

Background: The enhanced recovery pathway concept emerged as a multimodal approach directed at optimizing the patient experience, standardizing perioperative care, and improving surgical outcomes. Aim: to evaluate the effect of enhanced recovery pathway on hysterectomy complications for women in Suez Canal University Hospital and General Hospital in Ismailia City. Design: - A quasi-experimental study design was used in this study. Sample: - convenient sample consist of 132 women undergoing hysterectomy operation. Tool: - Structured interviewing questionnaire included questions personal and socio-demographic characteristics and -Obstetric, gynecological, surgical history and follow up assessment checklist. Results: - the majority of women in two groups were complained from bleeding (65.2% in control group and 60.6% in study group). 54.5 % of control group and 42.4% of study group had fibroid as a medical diagnosis. The highest frequency women (60.6% in control group and 43.9% in study group) had 1-6 month as time of current complained. The women in the study group were less likely to suffer from complications as fever, vaginal prolapse and pneumothorax compared to those in control group. Differences observed are statistically significant P= (0.023, 0.049, 0.004). Conclusion: The result of the study concluded that women undergoing hysterectomy operation who received enhanced recovery pathway protocol were more likely to decrease the incidence of post-operative complications than women who didn’t. Recommendation: - Health care settings should emphasize the importance of coordination between health care members relating to the application of the evidenced key elements of enhanced recovery pathway management regarding hysterectomy.

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