Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Tengberg, Line Toft; Bay‐Nielsen, Morten; Bisgaard, Thue; Cihoric, Mirjana; Lauritsen, Morten Laksáfoss; Foss, Nicolai Bang; Orbæk, Janne; Veyhe, Lena; Nielsen, Hans Jørgen; Lindgaard, L

doi:10.1002/bjs.10427

Cited by 120 publications

(176 citation statements)

References 47 publications

Supporting

Mentioning

162

Contrasting

Unclassified

Order By: Relevance

“…19,46,[51][52][53] In the present study 34% of patients experienced postoperative pulmonary complications, which corresponds to the 36% reported for the total cohort of 600 patients who received AHA surgery following a multidisciplinary perioperative protocol. 7 Results of the present study showed that a higher proportion of patients who were nonindependently mobile on POD-7 experienced a pulmonary complication. Nonindependent patients were also more sedentary (lay or sat more) than patients who were independently mobile on POD-7.…”

Section: Physical Performancementioning

confidence: 46%

“…This study is an embedded part of a larger cohort study, initiated in 2013, investigating the effect of an enhanced recovery program after AHA surgery in 600 patients (Clinicaltrials.gov: NCT01899885). 7 The larger study does not include the aim and outcomes reported in the present study.…”

Section: Study Populationmentioning

confidence: 92%

“…7 In addition to early mobilization, every patient received daily physiotherapy until POD-7 and was evaluated by an occupational therapist. The physiotherapy sessions (10-30 min per session based on the capability of the patient) progressed on an individual level and consisted of exercises in bed and practising basic mobility activities, including transfer in and out of bed, sitting to standing from a chair, walking and stair climbing.…”

Section: Study Populationmentioning

confidence: 99%

“…7 Patient characteristics and information about comorbidities; day of admission; type and duration of operation; presence of epidural, preoperative sepsis and postoperative pulmonary complications; Eastern Cooperative Oncology Group (ECOG) scores; American Society of Anesthesiologists (ASA) classification; and 30-day mortality were all extracted from a central database from the larger cohort study. Postoperative pulmonary complications were defined as Clavien-Dindo classification higher than grade I, and preoperative sepsis was evaluated using the predisposition, insult, response, organ dysfunction (PIRO) classification.…”

Section: Study Populationmentioning

confidence: 99%

“…[1][2][3][4][5][6] It is defined as immediate emergency laparoscopy or laparotomy primarily to treat intestinal obstruction, perforated viscus or bowel ischemia. 7 A focus on enhanced recovery programs specifically for patients following AHA surgery is needed to improve the postoperative outcome. [8][9][10][11][12][13][14][15] Possible interventions include reducing time before surgery, the early use of antibiotics, optimized fluid management, pain treatment, early nutrition and early mobilization.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

cjs

View full text Add to dashboard Cite

Background: Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Methods:Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization.Results: Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Conclusion:Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.Contexte : La chirurgie abdominale d'urgence à risque élevé est associée à un fort taux de mortalité, à des complications postopératoires multiples et à des hospitalisations prolongées. Il est donc nécessaire d'élaborer de nouvelles stratégies pour amélio-rer le rétablissement après ce type de chirurgie. La présente étude visait à décrire le fonctionnement physique et les obstacles aux déplacements autonomes chez les patients ayant subi une chirurgie de ce type (jours postopératoires 1 à 7).Méthodes : Nous avons recruté successivement les patients subissant une chirurgie abdominale d'urgence à risque élevé dans un hôpital universitaire du Danemark. Durant la première semaine postopératoire, tous les patients ont subi quotidiennement une évaluation visant à vérifier leur fonctionnement physique. Nous nous sommes servis du Cumulated Ambulation Score (CAS; de 0 à 6 points) pour évaluer la mobilité de base et du moniteur activPAL pour évaluer le niveau d'activé physique 24 heures par jour. Nous avons noté les obstacles aux déplacements autonomes.Résultats : Cinquante patients (âge moyen : 61,4 ans ± 17,2) ont été retenus. Sept sont décédés durant la première semaine postopératoire, et 15 des 43 patients restants (35 %) ne se déplaçaient pas encore de façon autonome (CAS < 6) le septième jour, une situation associée à l'apparition de c...

show abstract

Section: Physical Performancementioning

confidence: 46%

Section: Study Populationmentioning

confidence: 92%

Section: Study Populationmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

cjs

View full text Add to dashboard Cite

show abstract

Evaluation of the Collaborative Use of an Evidence-Based Care Bundle in Emergency Laparotomy

et al. 2019

View full text Add to dashboard Cite

Key Points Question Is a quality improvement collaborative approach to implementation of a care bundle associated with reductions in mortality from emergency laparotomy? Findings In this study of a collaborative project involving 28 hospitals and a total of 14 809 patients, reductions in mortality and length of stay were seen after implementation of a care bundle. Improvement took time to occur and was not seen until the second year of the collaborative project. Meaning The findings suggest that hospitals should consider adopting a care bundle approach and participating in a collaborative group to see improvement in outcomes for patients undergoing emergency laparotomy.

show abstract

Initial emergency laparotomy outcomes following a transdisciplinary perioperative care pathway in Singapore

Ong

Goh

Tung

et al. 2021

Acute Medicine & Surgery

View full text Add to dashboard Cite

Aim: Emergency laparotomy (EL) is a common surgery associated with high morbidity and mortality. An enhanced care pathway incorporates evidence-based care bundles with the aim of providing standardized perioperative care. Prior to 2019, EL management in our institution was not standardized. This study aims to assess whether implementation of a transdisciplinary perioperative Emergency Laparotomy (ELAP) pathway improves clinical and efficiency outcomes of EL.Methods: A prospective single-center audit was undertaken between 1 January and 31 December, 2019 following the implementation of the ELAP pathway. Comparisons were made with retrospective data from the preimplementation period between 1 January and 31 December, 2017. Demographics and clinical and efficiency outcomes were compared for patients (age > 16 years old) requiring EL for acute abdominal conditions.Results: There were 152 and 162 patients from preimplementation and postimplementation periods, respectively. There was a nonsignificant reduction of 30-day mortality in the intervention group receiving perioperative pathway care compared with the preintervention group (3.1% versus 5.3%, respectively; P = 0.40). There was a decrease in postoperative complications in the intervention group, in particular for Clavien-Dindo IV complications (11.2% versus 3.1%, p < 0.01). Efficiency outcomes improved postimplementation with increased consultant surgeon and anesthetist presence in operating theater and postoperative geriatric assessment for elderly patients.

show abstract

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Abstract: The introduction of a multidisciplinary perioperative protocol was associated with a significant reduction in postoperative mortality in patients undergoing AHA surgery. NCT01899885 (http://www.clinicaltrials.gov).

Cited by 120 publications

References 47 publications

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Evaluation of the Collaborative Use of an Evidence-Based Care Bundle in Emergency Laparotomy

Initial emergency laparotomy outcomes following a transdisciplinary perioperative care pathway in Singapore

Contact Info

Product

Resources

About