Preoperative optimization

Snowden, Christopher; Anderson, Helén

doi:10.1097/aco.0b013e32834ef903

Cited by 17 publications

(4 citation statements)

References 53 publications

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“…Our study found that emergency surgery was linked to a higher risk of mortality compared to elective surgery. Previous research has shown that preoperative optimization and adequate preparation are crucial for surgical outcomes [12]. Therefore, it is possible that disruptions in the antisepsis chain may have contributed to SSIs caused by aggressive and drug-resistant hospital-acquired pathogens, rather than harmless skin colonizers.…”

Section: Resultsmentioning

confidence: 99%

Mortality in Surgical Site Infections Post-cardiac Surgery - a Prospective, International Id-iri Study

Erdem,

Ankarali,

Al-Tawfiq

et al. 2024

Preprint

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OBJECTIVES Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality. This multi-center study aimed to identify mortality risk factors associated with SSIs following heart surgery. METHODS Conducted from January to March 2023, this prospective study included 167 patients aged > 16 with post-heart surgery SSIs. The primary focus was on 30-day mortality. Univariate analysis and a multivariate logistic regression model, utilizing the Backward elimination method, were employed to establish the final model. RESULTS A number of factors had substantial correlations to death. These included urinary catheterization [OR 14.197 (90% CI 12.198–91.721)], emergent surgery [OR 8.470 (90% CI 2.028–35.379)], valvular replacement [OR 4.487 (90% CI 1.001–20.627)], higher qSOFA scores [OR 3.147 (90% CI 1.450–6.827)], advancing age [OR 1.075 (90% CI 1.020–1.132)] and postoperative re-interventions within 30 days following SSI [OR 14.832 (90% CI 2.684–81.972)]. No pathogen was isolated from wound cultures in 53 (31.7%) patients. 43.1% of SSIs (n = 72) were due to Gram-positive microorganisms, while 27.5% of cases (n = 46) involved Gram-negatives. Among Gram-positives, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, while Klebsiellae (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), Pseudomonas aeruginosa (n = 7, 4.2%), and were the most prevalent among Gram-negatives. Colonization with VRE, MRSA, carbapenem resistant enteric bacteria on admission was detected in 9 (6.1%) cases. CONCLUSION To mitigate mortality following heart surgery, stringent infection control measures, preoperative screening, and effective surgical antisepsis are crucial. Timely detection of bloodstream infections and the clinical progression of the disease reflected by qSOFA score, and effective treatment are other essential components of SSI management.

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Section: Resultsmentioning

confidence: 99%

Mortality in Surgical Site Infections Post-cardiac Surgery - a Prospective, International Id-iri Study

Erdem,

Ankarali,

Al-Tawfiq

et al. 2024

Preprint

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“…Indirectly, these clinics have been shown to reduce surgical cancellations and improve day-of-surgery arrival rates. 28 Importantly, they also provide an early opportunity to identify and address modifiable risk factors associated with postoperative complications, an approach often referred to as 'prehabilitation'. This approach has included interventions to improve nutritional status, correct diet-induced iron deficiency anaemia, 29 promote smoking cessation, 30 reduce anxiety, 31,32 provide patients with information regarding the perioperative pathway 33,34 and increase physical activity.…”

Section: Orthopaedic Surgery and Postoperative Complicationsmentioning

confidence: 99%

Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT

Snowden

Lynch

Avery

et al. 2020

Health Technol Assess

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Background Heavy alcohol consumption is associated with an increased risk of postoperative complications and extended hospital stay. Alcohol consumption therefore represents a modifiable risk factor for surgical outcomes. Brief behavioural interventions have been shown to be effective in reducing alcohol consumption among increased risk and risky drinkers in other health-care settings and may offer a method of addressing preoperative alcohol consumption. Objectives To investigate the feasibility of introducing a screening process to assess adult preoperative drinking levels and to deliver a brief behavioural intervention adapted for the target population group. To conduct a two-arm (brief behavioural intervention plus standard preoperative care vs. standard preoperative care alone), multicentre, pilot randomised controlled trial to assess the feasibility of proceeding to a definitive trial. To conduct focus groups and a national web-based survey to establish current treatment as usual for alcohol screening and intervention in preoperative assessment. Design A single-centre, qualitative, feasibility study was followed by a multicentre, two-arm (brief behavioural intervention vs. treatment as usual), individually randomised controlled pilot trial with an embedded qualitative process evaluation. Focus groups and a quantitative survey were employed to characterise treatment as usual in preoperative assessment. Setting The feasibility study took place at a secondary care hospital in the north-east of England. The pilot trial was conducted at three large secondary care centres in the north-east of England. Participants Nine health-care professionals and 15 patients (mean age 70.5 years, 86.7% male) participated in the feasibility study. Eleven health-care professionals and 68 patients (mean age 66.2 years, 80.9% male) participated in the pilot randomised trial. An additional 19 health-care professionals were recruited to one of three focus groups, while 62 completed an electronic survey to characterise treatment as usual. Interventions The brief behavioural intervention comprised two sessions. The first session, delivered face to face in the preoperative assessment clinic, involved 5 minutes of structured brief advice followed by 15–20 minutes of behaviour change counselling, including goal-setting, problem-solving and identifying sources of social support. The second session, an optional booster, took place approximately 1 week before surgery and offered the opportunity to assess progress and boost self-efficacy. Main outcome measures Feasibility was assessed using rates of eligibility, recruitment and retention. The progression criteria for a definitive trial were recruitment of ≥ 40% of eligible patients and retention of ≥ 70% at 6-month follow-up. Acceptability was assessed using themes identified in qualitative data. Results The initial recruitment of eligible patients was low but improved with the optimisation of recruitment processes. The recruitment of eligible participants to the pilot trial (34%) fell short of the progression criteria but was mitigated by very high retention (96%) at the 6-month follow-up. Multimethod analyses identified the methods as acceptable to the patients and professionals involved and offers recommendations of ways to further improve recruitment. Conclusions The evidence supports the feasibility of a definitive trial to assess the effectiveness of brief behavioural intervention in reducing preoperative alcohol consumption and for secondary outcomes of surgical complications if recommendations for further improvements are adopted. Trial registration Current Controlled Trials ISRCTN36257982. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 12. See the National Institute for Health Research Journals Library website for further project information.

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“…In British Columbia, the average preoperative waiting times for 90% of cases were completed within 21 weeks for colostomy/ileostomy, 21 weeks for laparoscopy and 30 weeks for rectal surgery between June 2023 and August 2023 [11]. There is a growing body of research focused on earlier intervention in this preoperative phase, called prehabilitation, that may serve as a complementary strategy to mitigate the risk of postsurgical complications and reduce the healthcare costs of colorectal surgery by optimizing patients' preoperative physiological reserves [12][13][14][15][16][17]. Most studies on prehabilitation interventions have typically focused on exercise as the main component, sometimes with nutritional and/or psychological support [18,19].…”

Section: Introductionmentioning

confidence: 99%

Preparing for colorectal surgery: a feasibility study of a novel web‐based multimodal prehabilitation programme in Western Canada

Ip,

Zhang,

Karimuddin

et al. 2024

Colorectal Disease

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AimPrehabilitation for colorectal cancer has focused on exercise‐based interventions that are typically designed by clinicians; however, no research has yet been patient‐oriented. The aim of this feasibility study was to test a web‐based multimodal prehabilitation intervention (known as PREP prehab) consisting of four components (physical activity, diet, smoking cessation, psychological support) co‐designed with five patient partners.MethodA longitudinal, two‐armed (website without or with coaching support) feasibility study of 33 patients scheduled for colorectal surgery 2 weeks or more from consent (January–September 2021) in the province of British Columbia, Canada. Descriptive statistics analysed a health‐related quality of life questionnaire (EQ5D‐5L) at baseline (n = 25) and 3 months postsurgery (n = 21), and a follow‐up patient satisfaction survey to determine the acceptability, practicality, demand for and potential efficacy in improving overall health.ResultsPatients had a mean age of 52 years (SD 14 years), 52% were female and they had a mean body mass index of 25 kg m−2 (SD 3.8 kg m−2). Only six patients received a Subjective Global Assessment for being at risk for malnutrition, with three classified as ‘severely/moderately’ malnourished. The majority (86%) of patients intended to use the prehabilitation website, and nearly three‐quarters (71%) visited the website while waiting for surgery. The majority (76%) reported that information, tools and resources provided appropriate support, and 76% indicated they would recommend the PREP prehab programme. About three‐quarters (76%) reported setting goals for lifestyle modification: 86% set healthy eating goals, 81% aimed to stay active and 57% sought to reduce stress once a week or more. No patients contacted the team to obtain health coaching, despite broad interest (71%) in receiving active support and 14% reporting they received ‘active support’.ConclusionThis web‐based multimodal prehabilitation programme was acceptable, practical and well‐received by all colorectal surgery patients who viewed the patient‐oriented multimodal website. The feasibility of providing active health coaching support requires further investigation.

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Preoperative optimization

Cited by 17 publications

References 53 publications

Mortality in Surgical Site Infections Post-cardiac Surgery - a Prospective, International Id-iri Study

Mortality in Surgical Site Infections Post-cardiac Surgery - a Prospective, International Id-iri Study

Preoperative behavioural intervention to reduce drinking before elective orthopaedic surgery: the PRE-OP BIRDS feasibility RCT

Preparing for colorectal surgery: a feasibility study of a novel web‐based multimodal prehabilitation programme in Western Canada

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