Enhanced Recovery after Vascular Surgery

Stojanović, Milena; Marković, Danica; Vuković, Anita; Dinić, Vesna; Nikolic, Aleksandar N.; Maričić, T.G.; Janković, Radmilo

doi:10.3389/fmed.2018.00002

Cited by 16 publications

(11 citation statements)

References 52 publications

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“…Specifically, for sarcopenia, preoperative progressive strength training is considered a key exercise in frail patients [ 34 ]. For malnutrition, it can be alleviated by nutritional conditioning with targeted protein or carbohydrate loads [ 36 ]. For cognitive impairment, patients receiving TJA have been reported to be at high risk for postoperative delirium (POD).…”

Section: Discussionmentioning

confidence: 99%

Influence of frailty and its interaction with comorbidity on outcomes among total joint replacement

Lia

Yang

et al. 2022

BMC Musculoskelet Disord

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Background Patients with frailty get more and more attention in clinical practice. Yet, no large-scale studies have explored the impact of frailty on the perioperative acute medical and surgical complications following TJA. what is more, comorbid diseases may lead, at least additively, to the development of frailty. There also no studies to find the possible interaction between comorbidity and frailty on the postoperative complications after TJA. Methods Discharge data of 2,029,843 patients who underwent TJA from 2005 to 2014 from the National Inpatient Sample (NIS) database, which was analyzed using cross-tabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from frailty-defining diagnosis indicator of Johns Hopkins Adjusted Clinical Groups. Results Among patients who underwent total joint replacement surgeries, 50,385 (2.5%) were identified as frail. Frailty is highly associated with old age, especially for those over the age of 80, meanwhile females and black races have a high Charlson comorbidity index (CCI) of ≥ 3, together with emergency/urgent admission and teaching hospital. While comorbidity is associated with greater odds of acute medical complications, and frailty has a better predictive effect on in-hospital deaths, acute surgical complications. Furthermore, frailty did not show an enhancement in the predictive power of the Charlson comorbidity score for postoperative complications or in-hospital deaths but postoperative LOS and hospitalization costs. Conclusion Frailty can be used to independently predicted postoperative surgical and medical complications, which also has a synergistic interaction with comorbidity for patients who are preparing to undergo TJA.

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Section: Discussionmentioning

confidence: 99%

Influence of frailty and its interaction with comorbidity on outcomes among total joint replacement

Lia

Yang

et al. 2022

BMC Musculoskelet Disord

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“…Patients awaiting vascular surgery are frequently in poor nutritional condition, consisting as part of the frailty-syndrome. Malnutrition is associated with a longer hospital stay, muscle weakness, fatigue, depression, immunological dysfunction, slower wound healing and longer need for rehabilitation 70,71. In vascular patients, serious wound infection could lead to the contamination of the vascular graft, causing severe bleeding, loss of the limb or even death 72.…”

Section: Discussionmentioning

confidence: 99%

“…Mortality rate is doubled when glucose levels are above 140–150 mg/dl in the perioperative period. The goal of insulin therapy is to avoid surgical wound complications,92 gastrointestinal function and inflammatory responses 70. Every 40 mg/dl increase in glucose levels increases the risk for graft failure and infection by 30%, followed by a longer intensive care unit (ICU) stay 93.…”

Section: Discussionmentioning

confidence: 99%

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

Czobor¹,

Lehot²,

Holndonner–Kirst³

et al. 2019

TCRM

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Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.

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“…However, postoperative activity protocols, including bedrest, are not evidencebased. 5,6,10 In cardiac surgery and intensive care patients, earlier postoperative ambulation reportedly reduces the risk of thromboembolism, improves pulmonary toilet, decreases hospital length of stay (LOS), and reduces deconditioning and the need for rehabilitation. [12][13][14][15][16] Whether earlier postoperative ambulation is associated with improved postoperative outcomes for groin muscle flaps following infrainguinal vascular surgery is unknown.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Randomized Clinical Trial of Early Ambulation after Groin Reconstruction with Sartorius Muscle Flaps

Nguyen

Kohn

Lentz

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: The use of muscle flaps, such as the sartorius muscle, for groin coverage in high-risk vascular patients has been shown to reduce complication rates. However, it remains unknown whether earlier postoperative ambulation is associated with improved postoperative outcomes for groin muscle flaps following infrainguinal vascular surgery. Methods: We performed a pilot randomized trial to analyze the effect of early ambulation on postoperative outcomes in patients who had groin reconstruction with sartorius muscle flaps following infrainguinal vascular surgery at our academic institution. Results: Fourteen patients were randomized to standard ambulation (on postoperative day 6), and 14 patients were randomized to early ambulation (on postoperative day 2). The treatment arms were similar with respect to age, body mass index, risk category, smoking status, and comorbidities. Median length of stay was 6 days in the early group versus 7 days in the standard group. Immediate and long-term physical function and general health were better in the early group There were slightly more wound complications in the standard (57.1%) versus the early group (42.9%), and the early group had more lymphatic complications (35.7% versus 14.3%). Conclusions: The decision to ambulate a patient after this surgery continues to be a decision between the vascular and plastic surgeons. However, this pilot trial has shown the safety profile of early ambulation and that it should be considered for specific patients. Additionally, this trial has provided valuable information for performing a larger scale randomized controlled trial to determine the optimal postoperative protocol for patients with these reconstructions.

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Enhanced Recovery after Vascular Surgery

Cited by 16 publications

References 52 publications

Influence of frailty and its interaction with comorbidity on outcomes among total joint replacement

Influence of frailty and its interaction with comorbidity on outcomes among total joint replacement

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

A Pilot Randomized Clinical Trial of Early Ambulation after Groin Reconstruction with Sartorius Muscle Flaps

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