Quality of recovery after major emergency abdominal surgery: a prospective observational cohort study

Oreskov, Jakob Ohm; Burcharth, Jakob; Nielsen, Andreas F; Ekeloef, Sarah; Kleif, Jakob; Gögenür, Ismail

doi:10.23736/s0026-4733.20.08226-7

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…Patient-reported recovery was substantially affected in a similar population even on postoperative day 30. 23 Interestingly, we did not find a significant difference in %CV between admission and discharge periods despite an overall decline over time. This finding may be explained by the fact that patients with a high glucose variability tend to require longer hospital stays.…”

Section: Discussioncontrasting

confidence: 57%

Glycemic profile and quality of recovery after emergency abdominal surgery–A prospective explorative cohort study

Andersen

Priergaard

Banke

et al. 2023

Acta Anaesthesiol Scand

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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.

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Section: Discussioncontrasting

confidence: 57%

Glycemic profile and quality of recovery after emergency abdominal surgery–A prospective explorative cohort study

Andersen

Priergaard

Banke

et al. 2023

Acta Anaesthesiol Scand

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“…This study reports a secondary outcome from a prospective protocol (ClinicalTrials no. NCT03010969), and the primary outcome has earlier been reported 18,19 . Data were collected from the Department of Surgery at Zealand University Hospital, Denmark.…”

Section: Methodsmentioning

confidence: 99%

“…NCT03010969), and the primary outcome has earlier been reported. 18,19 Data were collected from the Department of Surgery at Zealand University Hospital, Denmark. The protocol was approved by the Danish Local Ethics Committee (no.…”

Section: Population and Study Designmentioning

confidence: 99%

Patient perceptive focus on recovery: An exploratory study on follow‐up after major emergency abdominal surgery

Kristiansen

Oreskov

Ekeloef

et al. 2021

Acta Anaesthesiol Scand

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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.

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“…Several organs are affected by the underlying pathology and the surgical stress response leading to an increased risk of perioperative single and multiorgan dysfunction [ 14 ]. Therefore, national and regional initiatives have in recent years been implemented in order to improve the clinical outcomes for this specific surgical population [ 15 – 17 ]. The risk and consequences of AKI are well known after major elective surgery and in critically ill surgical patients in the intensive care unit, however, no specific focus has been on AKI after major emergency abdominal surgery where the majority of the patients are treated in the general surgical ward postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury following major emergency abdominal surgery – a retrospective cohort study based on medical records data

et al. 2022

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Background Acute Kidney Injury (AKI) is a frequent and serious postoperative complication in trauma or critically ill patients in the intensive care unit. We aimed to estimate the risk of AKI following major emergency abdominal surgery and the association between AKI and 90-day postoperative mortality. Methods In this retrospective cohort study, we included patients undergoing major emergency abdominal surgery at the Department of Surgery, Zealand University Hospital, Denmark, from 2010 to 2016. The primary outcome was the occurrence of AKI within postoperative day seven (POD7). AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO)-criteria. The risk of AKI was analysed with a multivariable logistic regression. The association between AKI and 90-day mortality was analysed with a multivariable survival analysis. Results In the cohort, 122 out of 703 (17.4%) surgical patients had AKI within POD7. Of these, 82 (67.2%) had AKI stage 1, 26 (21.3%) had AKI stage 2, and 14 (11.5%) had AKI stage 3. Fifty-eight percent of the patients who developed postoperative AKI did so within the first 24 h of surgery. Ninety-day mortality was significantly higher in patients with AKI compared with patients without AKI (41/122 (33.6%) versus 40/581 (6.9%), adjusted hazard ratio 4.45 (95% confidence interval 2.69–7.39, P < 0.0001)), and rose with increasing KDIGO stage. Pre-existing hypertension and intraoperative peritoneal contamination were independently associated with the risk of AKI. Conclusions The risk of AKI is high after major emergency abdominal surgery and is independently associated with the risk of death within 90 days of surgery.

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Quality of recovery after major emergency abdominal surgery: a prospective observational cohort study

Cited by 8 publications

References 26 publications

Glycemic profile and quality of recovery after emergency abdominal surgery–A prospective explorative cohort study

Glycemic profile and quality of recovery after emergency abdominal surgery–A prospective explorative cohort study

Patient perceptive focus on recovery: An exploratory study on follow‐up after major emergency abdominal surgery

Acute kidney injury following major emergency abdominal surgery – a retrospective cohort study based on medical records data

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