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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
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 1715-5320Article in journal (Refereed) Accepted
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
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)38241662 (PubMedID)
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-01-30Bibliographically 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
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 1432-2323Article in journal (Refereed) Epub ahead of print
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)
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: 2024-02-26Bibliographically 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
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 1552-6259Article in journal (Refereed) Epub ahead of print
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)38284956 (PubMedID)
Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2024-02-01Bibliographically 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
McGinigle, K. L., Spangler, E. L., Ayyash, K., Arya, S., Settembrini, A. M., Thomas, M. M., . . . de Boer, H. D. (2023). A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery. Journal of Vascular Surgery, 77(5), 1295-1315
Open this publication in new window or tab >>A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery
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2023 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 77, no 5, p. 1295-1315Article in journal (Refereed) Published
Abstract [en]

The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS®) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated peri-operative care for patients undergoing infrainguinal bypass surgery for peripheral artery disease. Structured around the ERAS® core elements, 26 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Peripheral artery disease, analgesia and anesthesia, enhanced recovery after surgery, evidence-based recommendations, guidelines, infrainguinal bypass surgery, perioperative care
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-105109 (URN)10.1016/j.jvs.2023.01.018 (DOI)000985172600001 ()36931611 (PubMedID)2-s2.0-85151242833 (Scopus ID)
Available from: 2023-03-22 Created: 2023-03-22 Last updated: 2023-07-03Bibliographically approved
Baban, B., Eklund, D., Tuerxun, K., Alshamari, M., Laviano, A., Ljungqvist, O. & Särndahl, E. (2023). Altered insulin sensitivity and immune function in patients with colorectal cancer. Clinical Nutrition ESPEN, 58, 193-200
Open this publication in new window or tab >>Altered insulin sensitivity and immune function in patients with colorectal cancer
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2023 (English)In: Clinical Nutrition ESPEN, E-ISSN 2405-4577, Vol. 58, p. 193-200Article in journal (Refereed) Published
Abstract [en]

Background & aims: Insulin resistance and chronic inflammation have been reported in patients with cancer. However, many of the underlying mechanisms and associations are yet to be unveiled. We examined both the level of insulin sensitivity and markers of inflammation in patients with colorectal cancer for comparison to controls.

Methods: Clinical exploratory study of patients with colorectal cancer (n = 20) and matched controls (n = 10). Insulin sensitivity was quantified using the hyperinsulinemic normoglycemic clamp and blood samples were taken for quantification of several key, both intra- and extracellular, inflammatory markers. We analysed the differences in these parameters between the two groups.

Results: Patients exhibited both insulin resistance (M-value, patients median (Mdn) 4.57 interquartile range (IQR) 3.49-5.75; controls Mdn 5.79 (IQR 5.20-6.81), p = 0.049), as well as increased plasma levels of the pro-inflammatory cytokines IL-1b(patients Mdn 0.48 (IQR 0.33-0.58); controls Mdn 0.36 (IQR 0.29-0.42), p = 0.02) and IL-6 (patients Mdn 3.21 (IQR 2.31-4.93); controls Mdn 2.16 (IQR 1.50-2.65), p = 0.02). The latter is present despite an almost two to three fold decrease (p < 0.01) in caspase-1 activity, a facilitating enzyme of IL-1b production, within circulating immune cells.

Conclusion: Patients with colorectal cancer displayed insulin resistance and higher levels of plasma IL-1b and IL-6, in comparison to matched healthy controls. The finding of a seemingly disconnect between inflammasome (caspase-1) activity and plasma levels of key pro-inflammatory cytokines in cancer patients may suggest that, in parallel to dysregulated immune cells, tumour-driven inflammatory pathways also are in effect.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Insulin resistance, Inflammation, Inflammasome, Cytokines, Cancer, Gastrointestinal adenocarcinoma
National Category
Cancer and Oncology Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-109845 (URN)10.1016/j.clnesp.2023.09.917 (DOI)001096215500001 ()38057005 (PubMedID)2-s2.0-85173178914 (Scopus ID)
Funder
Knowledge Foundation, 202100-2924Nyckelfonden
Available from: 2023-11-23 Created: 2023-11-23 Last updated: 2024-02-19Bibliographically approved
Scott, M. J., Aggarwal, G., Aitken, R. J., Anderson, I. D., Balfour, A., Foss, N. B., . . . Peden, C. J. (2023). Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care. World Journal of Surgery, 47(8), 1850-1880
Open this publication in new window or tab >>Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care
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2023 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 8, p. 1850-1880Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care.

METHODS: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL.

RESULTS: Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process.

CONCLUSIONS: These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-106373 (URN)10.1007/s00268-023-07020-6 (DOI)001003943800002 ()37277507 (PubMedID)2-s2.0-85160731029 (Scopus ID)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-08-02Bibliographically approved
Pilkington, M., Nelson, G., Cauley, C., Holder, K., Ljungqvist, O., Molina, G., . . . Brindle, M. E. (2023). Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process. JAMA Network Open, 6(2), Article ID e2248460.
Open this publication in new window or tab >>Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process
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2023 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 2, article id e2248460Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: Enhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively.

OBJECTIVE: To integrate the 2 tools to facilitate key perioperative decision-making.

EVIDENCE REVIEW: Snowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65%-69% agreement) or consensus (≥70% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022.

FINDINGS: Round 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs.

CONCLUSIONS AND RELEVANCE: The SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.

Place, publisher, year, edition, pages
American Medical Association, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-104111 (URN)10.1001/jamanetworkopen.2022.48460 (DOI)001059475600002 ()36753283 (PubMedID)2-s2.0-85147783502 (Scopus ID)
Available from: 2023-02-09 Created: 2023-02-09 Last updated: 2023-12-08Bibliographically approved
Ljungqvist, O. & de Boer, H. D. (2023). Enhanced Recovery After Surgery and Elderly Patients: Advances. Anesthesiology clinics, 41(3), 647-655
Open this publication in new window or tab >>Enhanced Recovery After Surgery and Elderly Patients: Advances
2023 (English)In: Anesthesiology clinics, ISSN 1932-2275, Vol. 41, no 3, p. 647-655Article, review/survey (Refereed) Published
Abstract [en]

Enhanced recovery after surgery (ERAS) is a new way of working where evidence-based care elements are assembled to form a care pathway involving the patient's entire journey through surgery. Many elements included in ERAS have stress-reducing effects on the body or helps avoid side effects associated with alternative treatment options. This leads to less overall stress from the injury caused by the operation and helps facilitate recovery. In old, frail patients with concomitant diseases and less physical reserves, this may help explain why the ERAS care is reported to be beneficial for this specific patient group.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Anesthesia, Complications, ERAS, Frailty, Older patients, Recovery, Surgery
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-107450 (URN)10.1016/j.anclin.2023.02.010 (DOI)37516500 (PubMedID)2-s2.0-85150346327 (Scopus ID)
Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2023-08-09Bibliographically approved
Peden, C. J., Aggarwal, G., Aitken, R. J., Anderson, I. D., Balfour, A., Foss, N. B., . . . Scott, M. J. (2023). Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient. World Journal of Surgery, 47(8), 1881-1898
Open this publication in new window or tab >>Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient
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2023 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 8, p. 1881-1898Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: This is Part 3 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy using an enhanced recovery after surgery (ERAS) approach. This paper addresses organizational aspects of care.

METHODS: Experts in management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and MEDLINE database searches were performed for ERAS elements and relevant specific topics. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations.

RESULTS: Components of organizational aspects of care were considered. Consensus was reached after three rounds of a modified Delphi process.

CONCLUSIONS: These guidelines are based on best current available evidence for organizational aspects of an ERAS® approach to patients undergoing emergency laparotomy and include discussion of less common aspects of care for the surgical patient, including end-of-life issues. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-106372 (URN)10.1007/s00268-023-07039-9 (DOI)001003943800003 ()37277506 (PubMedID)2-s2.0-85160747892 (Scopus ID)
Note

Funding agency:

SCELC, Statewide California Electronic Library Consortium

Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-08-02Bibliographically approved
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