Perioperative catabolism

Schricker, Thomas; Lattermann, Ralph

doi:10.1007/s12630-014-0274-y

Cited by 69 publications

(45 citation statements)

References 158 publications

(155 reference statements)

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“…As noted in Part 1 (McEvoy MD et al 2016), pain after major abdominal surgery is severe and is a major component of the stress response if not adequately treated, and a structured, multicomponent plan is needed throughout all phases of care (Schricker & Lattermann 2015). This Part 2 consensus document focuses on all phases of postoperative care ranging from the post-anesthesia care unit (PACU) to the surgical ward to the transition to home and post-discharge period.…”

Section: Introductionmentioning

confidence: 99%

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

et al. 2017

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BackgroundWithin an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia”, which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects.MethodsWith input from a multidisciplinary, international group of experts and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients.DiscussionAs a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery within an ERP. The goal was twofold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus on care in the post-anesthesia care unit, general care ward, and transition to home after discharge. The preoperative and operative consensus statement for analgesia was covered in Part 1 of this paper. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of “optimal analgesia” as set forth in this document.

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Section: Introductionmentioning

confidence: 99%

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

et al. 2017

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“…Reasons for postoperative weight loss are multifold: besides cancer-related cachexia, upper GI surgery induces malabsorption, postprandial symptoms and taste changes, leading to reduced oral intake [16,21,25] . The catabolic state in the early post-surgical period, induced by increased carbohydrate, protein and insulin metabolism, induces the so-called perioperative stress, resulting in worsening nutritional status [26] . On the other hand, impaired postoperative nutritional status may partially explain postoperative fatigue and prolonged recovery time, as shown after gastric cancer surgery [27] .…”

Section: Discussionmentioning

confidence: 99%

Nutritional Status Deteriorates Postoperatively Despite Preoperative Nutritional Support

Grass¹,

Benoit²,

Bertrand

et al. 2016

Ann Nutr Metab

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Background/Aims: The aim of the current study was to assess the postoperative evolution of nutritional status and to relate it with postoperative outcomes. Methods: Demographic, surgical and nutritional parameters were assessed 10 days preoperatively (d-10) and 30 days postoperatively (d30) in 146 patients. Risk factors responsible for perioperative (>5% between d-10 and d30) weight loss were identified. Overall, severe (Clavien 3-5) and infectious complications were compared in patients with and without perioperative weight loss (>5%). Results: Nutritional status worsened beyond the postoperative period as reflected by decreasing weight (67 ± 13 kg at d-10 vs. 63 ± 13 kg at d30, p < 0.001), body mass index (23.4 ± 4 vs. 22.2 ± 4 kg/m², p < 0.001) and mid upper-arm muscle circumference (MAMC, 241 ± 32 vs. 232 ± 30 mm, p < 0.001). Fifty-two patients (46%) lost >5% of their body weight between d-10 and d30. Patients who presented overall (63 vs. 36%, p = 0.004) and major (27 vs. 10%, p = 0.016) postoperative complications were at significantly higher risk to deteriorate postoperative nutritional status. Multivariate analysis identified low preoperative lean body mass (OR 3.2; 95% CI 1.2-8.9, p = 0.023) and low preoperative MAMC (OR 2.5; 95% CI 0.9-6.8, p = 0.066) as independent risk factors for perioperative weight loss. Conclusions: These data suggest continuing nutritional follow-up after the index hospitalization.

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“…For every 20% reduction in insulin sensitivity, the risks of mortality, heart failure, stroke, dialysis need and infection among the cardiac surgical patients more than doubled, irrespective of their diabetes status [16,17]. Surgical techniques with less tissue injury like laparoscopic procedures have less impact on glucose metabolism compared to laparotomy [18].…”

Section: Glucose Metabolism and Insulin Resistancementioning

confidence: 99%

Nutrition and the Elderly Surgical Patients

Lim¹

2017

MOJS

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Malnutrition is common among the elderly surgical patients. The surgical injuries to tissues cause a cascade of endocrine and metabolic changes which can impede full recovery after surgery. Active screening for malnutrition, proactive preoperative intervention and nutritional support postoperatively have all been shown to reduce breakdown of muscle mass, reduce catabolism and insulin resistance due to surgical injuries and reduce postoperative complications. Keywords:

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Perioperative catabolism

Cited by 69 publications

References 158 publications

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2—From PACU to the Transition Home

Nutritional Status Deteriorates Postoperatively Despite Preoperative Nutritional Support

Nutrition and the Elderly Surgical Patients

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