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Operative Nutritional Status (Preoperative and Postoperative)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Preoperative and postoperative health status has many subparts, including nutritional status. The nutritional and immune status of surgical patients are important for preoperative management and postoperative recovery. A preoperative patient's nutritional condition reflects not only his or her health status, but also, indirectly, the patient's immune status. Thus, preoperative nutrition status influences a patient's tolerance to surgical stress, postoperative physical recovery, local wound healing, and surgical infection rates.1
Management of osteoporotic acetabular fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Peter V. Giannoudis, Panagiotis Douras
ORIF remains the most common treatment modality of acetabular fracture management in the young and middle-aged patient. However, in the elderly population, two important issues must be considered prior to contemplating ORIF: Is the patient fit enough to tolerate the surgical stress induced by the procedure and mentally able to follow the postoperative instructions?Can the surgeon reduce the fracture pattern and retain the fixation and the congruity of the hip joint and completion of fracture union?
Perioperative and anaesthetic care
Published in Tom Cecil, John Bunni, Akash Mehta, A Practical Guide to Peritoneal Malignancy, 2019
Nina Ashraf-Kashani, John Bell
There is a significant surgical stress response to major abdominal surgery, and as such this type of surgery carries a high risk of morbidity and mortality. CRS and HIPEC presents an additional physiological challenge due to the propensity for extensive surgical resection and the thermal stress induced by HIPEC. The intensity of the stress response is directly related to the degree of tissue trauma and the increased metabolic and physiologic demands. This begins intra-operatively and may persist for several weeks afterwards.
Enhanced Recovery after arthroplasty surgery
Published in Acta Orthopaedica, 2020
The surgical stress response originates at the surgical site with an inflammatory response (IL-6, PGE), katabolic/anabolic hormonal release/body heat loss which cause more stress hormone release within the feedback loop, which causes more stress etc. The basic idea is to reduce these effects of surgical stimuli by optimizing the individual patient before, during and after surgery. Perioperative blood management is only one important factor, which was evaluated in the largest RCT on blood management in over 2,500 patients (So-Osman et al. 2014). The integral approach on this and other perioperative factors on the patient recovery are addressed in the multimodal approach on pathophysiological responses after surgery in patients. A such enhanced recovery after surgery (ERAS), as terminology perfectly explains this complex process, is then the repair of one part of the musculoskeletal organ (e.g. hip, knee, spine etc.) of a patient. It needs a multidisciplinary collaboration between surgeon, anaesthesiologists, nursing staff, rehabilitation and the patient.
Enhanced Recovery After Surgery program with dexamethasone administration for major head and neck surgery with free tissue transfer reconstruction: initial institutional experience
Published in Acta Oto-Laryngologica, 2018
Takayuki Imai, Koreyuki Kurosawa, Kayo Yamaguchi, Naoko Satake, Yukinori Asada, Ko Matsumoto, Sinkichi Morita, Satoshi Saijo, Jiro Aoi, Keitaro Fujii, Kazuhiro Kishimoto, Takahiro Goto, Kazuto Matsuura
Minimizing surgical stress and the negative effects of invasive procedures is required to enhance recovery after surgery. There are two methods for enhancing recovery: improving surgical techniques and improving perioperative care. The ERAS program is a perioperative management protocol to reduce the negative effects of invasive procedures and enhance recovery after surgery. The ERAS program was first introduced in colorectal cancer surgery, where it significantly reduced postoperative hospital stays. However, clear evidence that the ERAS program reduces the surgical stress response is surprisingly limited [17]. The proinflammatory cytokines IL-1 and IL-6 and the acute-phase circulating protein CRP, which is altered by these proinflammatory cytokines, are reported to independently indicate the magnitude of the surgical stress response [18]. Perioperative strategies to reduce surgical stress are needed.
Self-efficacy is an independent predictor for postoperative six-minute walk distance after elective open repair of abdominal aortic aneurysm
Published in Disability and Rehabilitation, 2018
Kazuhiro Hayashi, Kiyonori Kobayashi, Miho Shimizu, Yohei Tsuchikawa, Akio Kodama, Kimihiro Komori, Yoshihiro Nishida
The present study showed for the first time that the postoperative recovery of physical status after open AAA surgery measured by the 6MWD was 84 m less (−17.2%) 1 week post-operation than the corresponding preoperative figure. The postoperative 6MWD compared to the preoperative 6MWD was reported to be as follows: 34 m less (−7.2%) 10 days after laparoscopic or laparotomy gastrointestinal cancer surgery [9], 150 m less (−27.7%) 2 weeks after liver donation [10], 48 m less (−10.2%) 3 weeks after elective colon resection surgery [6], 25 m less (−5.8%) 4 weeks after colorectal resection surgery [7], and 30 m less (−5.5%) 4 weeks after liver or kidney donation [8,9]. Surgical stress encompasses many elements, such as fasting, tissue damage, hemorrhage, hypothermia, fluid shifts, pain, hypoxia, bed rest, ileus, anxiety, and cognitive imbalance [35]. Metabolically healthy patients lose between 40 and 80 g of nitrogen after elective open abdominal operations, which is equivalent to 1.2–2.4 kg of wet skeletal muscle [36]. In addition, bed rest reduces skeletal muscle strength, cardiac output, and VO2 max at a rate of approximately 1% every two days. [35]. Completing rehabilitation for postoperative recovery of functional exercise capacity and muscle strength is required for patients.