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Publications (10 of 324) Show all publications
Bergemalm, D., Baban, B., Ljungqvist, O. & Halfvarson, J. (2025). Insulin sensitivity in moderately severe to acute severe ulcerative colitis. Scandinavian Journal of Gastroenterology
Open this publication in new window or tab >>Insulin sensitivity in moderately severe to acute severe ulcerative colitis
2025 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Patients hospitalized with moderately severe or acute severe ulcerative colitis (UC) may experience metabolic disturbances, including alterations in insulin resistance due to inflammation and the administration of glucocorticoids (GCs). This pilot study aimed to evaluate insulin sensitivity in patients hospitalized for moderately severe to severe UC.

METHOD: Patients hospitalized for moderately-severely active UC at Örebro University Hospital, Sweden, were eligible for inclusion. Quantification of insulin sensitivity was performed using the hyperinsulinemic euglycemic clamp (HEC) methodology. Assessment of insulin sensitivity was performed during both the index flare and while patients were in steroid-free clinical, biochemical and endoscopic remission during follow-up. Additionally, healthy controls were evaluated using HEC for comparison.

RESULTS: Five patients with moderately-severely active UC, treated with intravenous GCs for ≥2 days, were included and underwent HEC assessment. During the index flare, four patients received second-line treatment with infliximab due to non-response to GC, and one patient was subsequently referred for acute subtotal colectomy. At inclusion, all five patients exhibited significantly reduced insulin sensitivity, and levels appeared similar regardless of the outcome of the index flare. At remission during follow-up, the insulin sensitivity was restored to levels comparable to healthy controls (n = 5).

CONCLUSION: The study demonstrates that patients with moderately severe to severe UC experience significant insulin resistance, irrespective of the outcome of the flare. The reduced insulin sensitivity is likely driven by a combination of active inflammation and GC treatment, as insulin sensitivity returned to normal levels when patients achieved remission during follow-up.

Place, publisher, year, edition, pages
Taylor & Francis, 2025
Keywords
Ulcerative colitis, hyperinsulinemic euglycemic clamp, insulin resistance
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-118995 (URN)10.1080/00365521.2025.2459870 (DOI)39882844 (PubMedID)
Funder
Bengt Ihres FoundationRegion Örebro County, OLL-709831
Note

Funding Agencies:

The Bengt Ihre research foundation to DB, the Örebro University Hospital Research Foundation, grant number OLL-709831 to DB; Mag-Tarmfonden for DB, Lisa and Johan Grönbergs Stiftelse for DB.

Available from: 2025-01-31 Created: 2025-01-31 Last updated: 2025-01-31Bibliographically approved
Li, Y., Hajar, R., Gramlich, L., Nelson, G., Ljungqvist, O. & Gillis, C. (2025). Surgical Recovery Through the Lens of Patients with Colorectal Disease: A Qualitative Study in an Enhanced Recovery after Surgery Setting. Journal of the American College of Surgeons, 240(1), 11-23
Open this publication in new window or tab >>Surgical Recovery Through the Lens of Patients with Colorectal Disease: A Qualitative Study in an Enhanced Recovery after Surgery Setting
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2025 (English)In: Journal of the American College of Surgeons, ISSN 1072-7515, E-ISSN 1879-1190, Vol. 240, no 1, p. 11-23Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: As perioperative care shifts to a more patient-centered model, understanding needs and experiences of patients is vital. Gaining such insight can enhance the alignment of care with patient priorities, encouraging adherence to recovery-oriented interventions. We aimed to explore patient-defined recovery and the elements that modify the recovery process for patients with colorectal disease under Enhanced Recovery After Surgery (ERAS) care.

STUDY DESIGN: A qualitative study was conducted at an ERAS-participating hospital in Alberta, Canada, between April 2018 to June 2019. A co-design focus group set the research direction and semi-structured interviews were conducted postoperatively in hospital or within 3 months post-discharge. Diverse patient ages and colorectal conditions were targeted through purposive sampling. Interviews were transcribed verbatim and analyzed through manifest and latent content analysis.

RESULTS: Twenty patients with mean age 62 (SD:13) years and 45% with cancer (n=17 interview, n=2 focus group and interview, n=1 focus group only) were enrolled. Recovery was defined by patients as the return to normal routines and four themes were identified. First, Phases of recovery: recovery was described as multidimensional phases distinctively as early, late/long-term, and the endpoint. Second, Recovery facilitators: recovery was supported through positive mindsets, conscious recovery, and taking an active role. Third, Recovery barriers: recovery was hindered by negative mindsets and treatment side-effects. Finally, Recovery catalysts: communication, autonomy, and expectations facilitated active or passive recovery.

CONCLUSION: Our patient-oriented recovery model may contribute a new dimension to the ERAS framework by capturing patients' recovery experiences. Further research is encouraged to explore its value in enhancing patient-centered care within ERAS.

Place, publisher, year, edition, pages
Wolters Kluwer, 2025
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-117023 (URN)10.1097/XCS.0000000000001218 (DOI)001378875700007 ()39431618 (PubMedID)2-s2.0-85212991103 (Scopus ID)
Available from: 2024-12-18 Created: 2024-12-18 Last updated: 2025-01-15Bibliographically approved
Bellafronte, N. T., Nasser, R., Gramlich, L., Carli, F., Liberman, A. S., Santa Mina, D., . . . Gillis, C. (2024). A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada. Applied Physiology, Nutrition and Metabolism, 49(5), 687-699
Open this publication in new window or tab >>A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada
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2024 (English)In: Applied Physiology, Nutrition and Metabolism, ISSN 1715-5312, E-ISSN 1715-5320, Vol. 49, no 5, p. 687-699Article in journal (Refereed) Published
Abstract [en]

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCP) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n=111 dietitians, n=72 physicians, n=42 allied healthcare professionals), 96%-100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n=142/220; dietitians: 88% vs. physicians: 40%) reported screening for malnutrition, mostly in the postoperative period (n=117) by dietitians (n=94), and just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n=121/212), time (40%, n=84/212) and support from others (38%, n=80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier.

Place, publisher, year, edition, pages
National Research Council Canada, 2024
Keywords
enhanced recovery after surgery, prehabilitation, preoperative, surgical nutrition, nutritional status, nutrition, screening
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-111029 (URN)10.1139/apnm-2023-0195 (DOI)001205661500001 ()38241662 (PubMedID)2-s2.0-85192027280 (Scopus ID)
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2025-01-20Bibliographically approved
Ljungqvist, O., Weimann, A., Sandini, M., Baldini, G. & Gianotti, L. (2024). Contemporary Perioperative Nutritional Care. Annual review of nutrition (Print), 44(1), 231-255
Open this publication in new window or tab >>Contemporary Perioperative Nutritional Care
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2024 (English)In: Annual review of nutrition (Print), ISSN 0199-9885, E-ISSN 1545-4312, Vol. 44, no 1, p. 231-255Article, review/survey (Refereed) Published
Abstract [en]

Over the last decades, surgical complication rates have fallen drastically. With the introduction of new surgical techniques coupled with specific evidence-based perioperative care protocols, patients today run half the risk of complications compared with traditional care. Many patients who in previous years needed weeks of hospital care now recover and can leave in days. These remarkable improvements are achieved by using nutritional stress-reducing care elements for the surgical patient that reduce metabolic stress and allow for the return of gut function. This new approach to nutritional care and how it is delivered as an integral part of enhancing recovery after surgery are outlined in this review. We also summarize the new and increased understanding of the effects of the routes of delivering nutrition and the role of the gut, as well as the current recommendations for artificial nutritional support.

Place, publisher, year, edition, pages
Annual Reviews, 2024
Keywords
Enhanced recovery after surgery, nutrition, prehabilitation, surgery
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-115700 (URN)10.1146/annurev-nutr-062222-021228 (DOI)001308404500010 ()39207877 (PubMedID)2-s2.0-85203114864 (Scopus ID)
Available from: 2024-09-02 Created: 2024-09-02 Last updated: 2024-09-25Bibliographically approved
Wilnerzon Thörn, R.-M., Forsberg, A., Stepniewski, J., Hjelmqvist, H., Magnuson, A., Ahlstrand, R. & Ljungqvist, O. (2024). Immediate mobilization in post-anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double-blinded controlled trial within an enhanced recovery protocol. World Journal of Surgery, 48(4), 956-966
Open this publication in new window or tab >>Immediate mobilization in post-anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double-blinded controlled trial within an enhanced recovery protocol
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2024 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 48, no 4, p. 956-966Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The level of post-operative mobilization according to Enhanced Recovery After Surgery (ERAS) guidelines is not always achieved. We investigated whether immediate mobilization increases postoperative physical activity. The objective was to evaluate the effects of immediate postoperative mobilization in the post-anesthesia care unit (PACU) compared to standard care.

METHODS: This randomized controlled trial, involved 144 patients, age ≥18 years, undergoing elective colorectal surgery. Patients were randomized to mobilization starting 30 min after arrival in the PACU, or to standard care. Standard care consisted of mobilization a few hours later at the ward according to ERAS guidelines. The primary outcome was physical activity, in terms of number of steps, measured with an accelerometer during postoperative days (PODs) 1-3. Secondary outcomes were physical capacity, functional mobility, time to readiness for discharge, complications, compliance with the ERAS protocol, and physical activity 1 month after surgery.

RESULTS: With the intention-to-treat analysis of 144 participants (median age 71, 58% female) 47% underwent laparoscopic-or robotic-assisted surgery. No differences in physical activity during hospital stay were found between the participants in the intervention group compared to the standard care group (adjusted mean ratio 0.97 on POD 1 [95% CI, 0.75-1.27], p = 0.84; 0.89 on POD 2 [95% CI, 0.68-1.16], p = 0.39, and 0.90 on POD 3 [95% CI, 0.69-1.17], p = 0.44); no differences were found in any of the other outcome measures.

CONCLUSIONS: Addition of the intervention of immediate mobilization to standard care did not make the patients more physically active during their hospital stay.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NTC 03357497.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
colorectal surgery, early mobilization, enhanced recovery after surgery, randomized clinical trial
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-111664 (URN)10.1002/wjs.12102 (DOI)001160584400001 ()38348901 (PubMedID)2-s2.0-85190162709 (Scopus ID)
Funder
Region Örebro County
Note

This study was supported by grants from the Research Committee of Örebro County Council and Örebro University Hospital Research Foundation, Sweden.

Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2025-01-20Bibliographically approved
Grant, M. C., Crisafi, C., Alvarez, A., Arora, R. C., Brindle, M. E., Chatterjee, S., . . . Engelman, D. T. (2024). Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS). Annals of Thoracic Surgery, 117(4), 669-689
Open this publication in new window or tab >>Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS)
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2024 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 117, no 4, p. 669-689Article in journal (Refereed) Published
Abstract [en]

Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-111234 (URN)10.1016/j.athoracsur.2023.12.006 (DOI)001217811100001 ()38284956 (PubMedID)2-s2.0-85186215541 (Scopus ID)
Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2024-05-29Bibliographically approved
Ljungqvist, O. (2024). Researching implementation of ERAS. Il Giornale di chirurgia, 44(3), Article ID e30.
Open this publication in new window or tab >>Researching implementation of ERAS
2024 (English)In: Il Giornale di chirurgia, ISSN 0391-9005, Vol. 44, no 3, article id e30Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2024
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-117365 (URN)10.1097/IA9.0000000000000030 (DOI)001347712600001 ()2-s2.0-85206505475 (Scopus ID)
Available from: 2024-11-15 Created: 2024-11-15 Last updated: 2024-11-15Bibliographically approved
Bjerregaard, F., Asklid, D., Ljungqvist, O., Elliot, A. H., Pekkari, K. & Gustafsson, U. O. (2024). Risk factors for anastomotic leakage in colonic procedures within an ERAS-protocol: A retrospective cohort study from the Swedish part of the international ERAS-database. World Journal of Surgery
Open this publication in new window or tab >>Risk factors for anastomotic leakage in colonic procedures within an ERAS-protocol: A retrospective cohort study from the Swedish part of the international ERAS-database
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2024 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed) Published
Abstract [en]

Background: Research on anastomotic leakage (AL) in colonic procedures within an Enhanced Recovery After Surgery (ERAS) protocol has not yet been conducted. The aim of this study was to identify risk factors for AL after colonic surgery.

Methods: The study included all consecutively recorded patients operated with colonic resection surgery in the Swedish part of the international ERAS (R) Interactive Audit System (EIAS) between September 2009 and June 2022. The cohort was analyzed and evaluated regarding risk factors for AL.

Results: Altogether 10,632 patients were included, 10,219 were without AL and 413 (3.9%) were with AL. After adjusted analysis, male sex (4.6% AL), OR: 1.49; 95% CI (1.16-1.90), obesity (4.8% AL), OR: 1.62; 95% CI (1.18-2.24), previous surgery (4.4% AL), OR: 1.45; 95% CI (1.14-1.86), open surgery (4.4% AL), OR: 1.36; 95% CI (1.02-1.83), anastomosis between small bowel and rectum (13.1% AL), OR: 3.97; 95% CI (2.23-7.10), stapled anastomosis (5.3% AL), OR: 2.46; 95% CI (1.79-3.38), inhalation anesthesia (4.2% AL), OR: 1.80; 95% CI (1.26-2.57), and conversion to open surgery (5.5% AL), OR 1.49; 95% CI (1.02-2.19) were significant risk factors for AL. Although pre and intraoperative compliance to the ERAS-protocol was similar, excess of fluids day 0 was an independent predictor for AL.

Conclusion: Male sex, obesity, previous surgery, open surgery, stapled anastomotic technique, anastomosis between small bowel and rectum, inhalation anesthesia, conversion to open surgery, and among ERAS interventions, excess of fluids day 0, were significant risk factors for AL.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
anastomotic leakage, colonic surgery, ERAS
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-113654 (URN)10.1002/wjs.12205 (DOI)001215784400001 ()38719788 (PubMedID)2-s2.0-85192469849 (Scopus ID)
Funder
Stockholm County Council, FoUI-963819
Available from: 2024-05-17 Created: 2024-05-17 Last updated: 2025-01-20Bibliographically approved
Bjerregaard, F., Baloch, N., Asklid, D., Ljungqvist, O., Pekkari, K., Elliot, A. H. & Gustafsson, U. O. (2024). Risk factors for severe complications and mortality in elderly undergoing colon surgery - a retrospective cohort study from the ERAS-registry. Paper presented at 19th Congress of European Crohns and Colitis Organisation (ECCO), Stockholm, Sweden, February 21-24, 2024. British Journal of Surgery, 111(Suppl. 7), Article ID 71223.
Open this publication in new window or tab >>Risk factors for severe complications and mortality in elderly undergoing colon surgery - a retrospective cohort study from the ERAS-registry
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2024 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 111, no Suppl. 7, article id 71223Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: The rising global population of older adults is expected to lead to more elderly individuals needing surgery for colon cancer. It’s crucial to study risk factors for mortality and complications following colon surgery in this demographic.

Method: The Swedish part of the ERAS-database (EIAS) from 2009 and 2022 was used. Patients aged ≥ 75 years undergoing colon surgery were compared with younger patients regarding basic characteristics and type of surgery. Possible risk factors for mortality and complications in the elderly group were analyzed using multivariate regression.

Result: 11 767 patients were included. After adjusting for available confounders, male gender, OR: 1.62; 95% CI: (1.23-2.14), ASA ≥ 3, OR: 1.59; 95% CI: (1.19-2.12), severe pulmonary disease, OR: 1.74; 95% CI: (1.03-2.95), recent immunosuppressive treatment, OR: 3.23; 95% CI: (1.61-6.47), diverticular disease as indication for surgery, OR: 2.78; 95% CI: (1.53-5.07) and open surgery, OR: 1.40; 95% CI (1.05-1.85) were significantly associated with severe complications in patients ≥ 75 years. Likewise, smoking, OR: 2.59; 95% CI (1.04-6.50), ASA ≥ 3, OR: 2.38; 95% CI (1.15-4.92), severe pulmonary disease, OR: 2.98; 95% CI (1.21-7.33), and open surgery, OR: 2.07; 95% CI (1.09-3.91) weresignificantly associated with mortality within 30 days in the elderly group.

Discussion: Several risk factors for severe complications and mortality within 30 days of colon surgery in the elderly population were identified. Among these, severe pulmonary disease, an ASA score of ≥ 3, and undergoing open surgery were all significantly associated with both severe complications and mortality.

Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-116306 (URN)10.1093/bjs/znae175.052 (DOI)001303797200040 ()
Conference
19th Congress of European Crohns and Colitis Organisation (ECCO), Stockholm, Sweden, February 21-24, 2024
Available from: 2024-10-03 Created: 2024-10-03 Last updated: 2024-10-03Bibliographically approved
Ljungqvist, O., Gustafsson, U. & de Boer, H. D. (2023). 20 + Years of Enhanced Recovery After Surgery: What's Next. World Journal of Surgery, 47(5), 1087-1089
Open this publication in new window or tab >>20 + Years of Enhanced Recovery After Surgery: What's Next
2023 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 5, p. 1087-1089Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Springer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-104505 (URN)10.1007/s00268-023-06955-0 (DOI)000938096500001 ()36820869 (PubMedID)2-s2.0-85148625022 (Scopus ID)
Available from: 2023-02-24 Created: 2023-02-24 Last updated: 2023-05-19Bibliographically approved
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