Influence of Depression on Recovery After Major Noncardiac Surgery

Orri, Massimiliano; Boleslawski, Emmanuel; Régimbeau, Jean Marc; Barry, Caroline; Hassler, Christine; Grégoire, Émilie; Bachellier, Philippe; Scatton, Olivier; Mabrut, Jean Yves; Adham, Mustapha; Vibert, Éric; Révah-Lévy, Anne; Farges, Olivier

doi:10.1097/sla.0000000000001448

Cited by 28 publications

(21 citation statements)

References 47 publications

(38 reference statements)

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“…In order to test the hypothesis that improved FC is associated with a reduction of the severity of complications after surgery, the CCI is presented both as a continuous and a dichotomous variable, using upper quartile as the cutoff for defining major/severe complication, as described in the literature [26]. Association between gain in the 6MWD and 30 d post-surgical severe complications were tested using logistic regression, and univariable and multivariable logistic regression are presented.…”

Section: Discussionmentioning

confidence: 99%

The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer

et al. 2019

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Background: Poor functional capacity (FC) is an independent predictor of postoperative morbidity. However, there is still a lack of evidence as to whether enhancing FC before surgery has a protective effect on postoperative complications. The purpose of this study was to determine whether an improvement in preoperative FC impacted positively on surgical morbidity. Methods: This was a secondary analysis of a cohort of patients who underwent colorectal resection for cancer under Enhanced Recovery After Surgery care. FC was assessed with the 6-min walk test, which measures the distance walked in 6 min (6MWD), at 4 weeks before surgery and again the day before. The study population was classified into two groups depending on whether participants achieved a significant improvement in FC preoperatively (defined as a preoperative 6MWD change 19 meters) or not (6MWD change <19 meters). The primary outcome measure was 30-d postoperative complications, assessed with the Comprehensive Complication Index (CCI). The association between improved preoperative FC and severe postoperative complication was evaluated using multivariable logistic regression. Results: A total of 179 eligible adults were studied: 80 (44.7%) improved in 6MWD by 19 m preoperatively, and 99 (55.3%) did not. Subjects whose FC increased had lower CCI (0 [0-8.7] versus 8.7 [0-22.6], p ¼ .022). Furthermore, they were less likely to have a severe complication (adjusted OR 0.28 (95% CI 0.11-0.74), p ¼ .010), and to have an ED visit. Conclusion: Improved preoperative FC was independently associated with a lower risk of severe postoperative complications. Further investigation is required to establish a causative relationship conclusively.Abbreviation: 6MWD: 6-min walk distance; 6MWT: 6-min walk test; CCI: Comprehensive Complication

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Section: Discussionmentioning

confidence: 99%

The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer

et al. 2019

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“…68 These trials showed a greater ability to detect differences between treatment effects than classic endpoints such as 'any complication' or 'major complication' defined according to the Clavien-Dindo classification. The index has been used in large multi-centric studies, [69][70][71][72][73][74][75][76][77] notably as a benchmark endpoint for major surgery. 70 Exploring the potential added value of the comprehensive comprehensive index to standard assessment of postoperative morbidity, and to clarify potential controversies for its application, Clavien et al 78 reported that it yielded substantial additional value to the Clavien-Dindo classification in patients with more than one complication.…”

Section: Descriptionmentioning

confidence: 99%

European Society of Gynaecological Oncology quality indicators for surgical treatment of cervical cancer

Cibula

Planchamp

Fischerová

et al. 2020

Int J Gynecol Cancer

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BackgroundOptimizing and ensuring the quality of surgical care is essential to improve the management and outcome of patients with cervical cancer.To develop a list of quality indicators for surgical treatment of cervical cancer that can be used to audit and improve clinical practice.MethodsQuality indicators were developed using a four-step evaluation process that included a systematic literature search to identify potential quality indicators, in-person meetings of an ad hoc group of international experts, an internal validation process, and external review by a large panel of European clinicians and patient representatives.ResultsFifteen structural, process, and outcome indicators were selected. Using a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are also detailed to define how the indicator will be measured in practice. Each indicator has a target which gives practitioners and health administrators a quantitative basis for improving care and organizational processes.DiscussionImplementation of institutional quality assurance programs can improve quality of care, even in high-volume centers. This set of quality indicators from the European Society of Gynaecological Cancer may be a major instrument to improve the quality of surgical treatment of cervical cancer.

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“…This implies that the use of the CCI 1 may significantly decrease the sample sizes in future studies. 7 The CCI 1 has been used in large multicentric studies, [9][10][11][12][13][14][15][16][17] as a benchmark endpoint for major surgery, 10 or in individual centers to assess quality and individual surgeon's performance (Han-Kwang Yang, ASA 2016, personal communication).…”

Section: Learning Objectivesmentioning

confidence: 99%

The Comprehensive Complication Index (CCI®)

Clavien¹,

et al. 2017

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Influence of Depression on Recovery After Major Noncardiac Surgery

Abstract: Nearly 1 quarter of patients undergoing major abdominal surgery are depressed preoperatively. This depression is a strong independent predictor of prolonged LOS and partly explains surgeons' failure to predict outcome accurately.

Cited by 28 publications

References 47 publications

The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer

The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer

European Society of Gynaecological Oncology quality indicators for surgical treatment of cervical cancer

The Comprehensive Complication Index (CCI®)

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