A significant proportion of patients undergoing non-cardiac surgery suffer from adverse cardiovascular events in the post-operative period. 1,2 The most common is myocardial injury, which is defined as an isolated troponin elevation due to myocardial ischaemia. 3,4 Even though the majority of patients with myocardial injury are asymptomatic, the event has been associated with an increased risk of post-operative mortality primarily shown in large observational studies investigating a heterogenic non-cardiac surgical population. 1,5 Post-operative complications are frequent after major emergency abdominal surgery. 6-8 While 30-day mortality is estimated between 10% and 20%, the risk of medical and

Background Optimal recovery can be defined as the adequate in‐hospital length of stay with minimal postoperative complications and readmissions. The quality of recovery beyond the immediate postoperative period after major emergency abdominal surgery is yet to be fully described. We hypothesized that long‐term measures of overall recovery were affected after surgery. The study aimed to investigate patient‐focused recovery‐related parameters 1 year after major emergency abdominal surgery. Method This is a prospective study including patients undergoing major emergency abdominal surgery at a Danish secondary referral center. Three questionnaires were answered regarding the recovery following the procedure; Activities Assessment Scale (AAS); Quality of Recovery‐15 (QoR‐15), and Self‐complete Leeds Assessment of Neuropathic Symptoms and Signs (S‐LANSS). All questionnaires were answered at postoperative days (PODs) 14, 30, 90, and 365. Results Eighty‐two patients were included, and 68 were available for follow‐up until 1 year after surgery. The response rates differed between the follow‐up time points, with a response rate of 85% (n = 59) at POD30 and 50% (n = 36) at POD365. A decrease in the level of physical function following surgery was observed in 60% of the patients at POD14, which improved to 36% at POD365. Twenty‐four patients (48%) reported postoperative pain at POD14, which declined to 9 (26%) at POD365. The maximum overall recovery was reached at POD30, which remained stable throughout the study period. Conclusion One in three patients reported physical functional impairment, and one in four patients reported pain 1 year after their surgical procedure.

Associations between degrees of postoperative hyperglycemia and morbidity has previously been established. There may be an association between the glycemic profile and patient‐reported recovery, and this may be a target for perioperative quality improvements. We aimed to investigate the association between metrics of the 30‐day glycemic profile and patient‐reported recovery in nondiabetic patients after major abdominal surgery. In a prospective, explorative cohort study, nondiabetic adult patients undergoing acute, major abdominal surgery were included within 24 h after surgery. Interstitial fluid glucose concentration was measured for 30 consecutive days with a continuous glucose measurement device. The validated questionnaire ‘Quality of Recovery‐15’ was used to assess patient‐reported quality of recovery on postoperative days 10, 20, and 30. Follow‐up time was divided into five‐day postoperative intervals using days 26–30 as a reference. Linear mixed models were applied to investigate temporal changes in mean p‐glucose, coefficient of variation, time within 70–140 mg/dl, and time above 200 mg/dl in relation to patient‐reported recovery. Twenty‐seven patients completed the study per protocol. A hyperglycemic event (>200 mg/dl) occurred in 18 of 27 patients (67%) within the first three postoperative days. Compared to the reference period, the coefficient of variation was significantly increased during all time intervals, indicating prolonged postoperative insulin resistance. During 30 days of follow‐up, patient‐reported recovery was associated with the coefficient of variation measured for 3 and 5 days before the corresponding recovery score assessment (recovery score estimate −1.52 [p < .001] and −0.92 [p = .006], respectively). We did not find an association between the remaining metrics and patient‐reported recovery. Alterations in the glycemic profile are frequent and prolonged during the first postoperative month after major surgery probably due to peripheral insulin resistance. Our findings indicate that high‐glycemic variation is associated with poorer patient‐reported recovery and might represent a proxy for care improvements in the postoperative period.

Results Methodologically simple research papers identified targets for disease prevention early on in both industries: from 1918 for silicon carbide, and from 1936 for primary aluminium. Later and more complicated studies of disease mechanisms, and studies involving detailed exposure characterisations, do not seem to have served preventive practice to any great extent. The scientific community tends to support stakeholders request for more research before lowering of TLVs or reducing exposure. Disagreement about what constitutes evidence has delayed prevention and stimulated research, but the research questions were not always relevant for prevention. The Norwegian regulatory model, with environmental standards based on tripartite consensus, may have discouraged technological innovation. Conclusions Regulatory authorities must accept documentation of harmful exposure as sufficient evidence, long before the scientific community is ready to reject the null hypothesis of no risk. Quasi-experimental prevention can eradicate disease earlier than prevention based on too much evidence. But we may never know exactly why our efforts seemed to work.