Pre‐operative optimisation of the surgical patient with diagnosed and undiagnosed diabetes: a practical review

Levy, N.; Dhatariya, Ketan

doi:10.1111/anae.14510

Cited by 52 publications

(46 citation statements)

References 52 publications

(66 reference statements)

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“…Patients are rarely informed in a timely manner about the benefits of lifestyle changes [6] and most patients participating in this study believed it was too late to change lifestyle weeks before surgery. If patients optimise their own health before surgery by exercising, improving nutritional status, or discontinuing smoking, alcohol and other substances they can reduce complications [6,7,30,31]. A major study on orthopaedic patients found that ceasing smoking six to eight weeks before surgery could reduce overall complications from 56 to 18% [32].…”

Section: Discussionmentioning

confidence: 99%

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

Harris

Søfteland

Moi

et al. 2020

BMC Health Serv Res

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Background: Patients' involvement in patient safety has increased in healthcare. Use of checklists may improve patient outcome in surgery, though few have attempted to engage patients' use of surgical checklist. To identify risk elements of complications based on patients' and healthcare workers' experiences is warranted. This study aims to identify what the patients and healthcare workers find to be the risk elements that should be included in a patient-driven surgical patient safety checklist. Method: A qualitative study design where post-operative patients, surgeons, ward physicians, ward nurses, and secretaries from five surgical specialties took part in focus group interviews. Eleven focus groups were conducted including 25 post-operative patients and 27 healthcare workers at one tertiary teaching hospital and one community hospital in Norway. Based on their experiences, participants were asked to identify perceived risks before and after surgery. The interviews were analysed using content analysis.Results: Safety risk factors were categorised as pre-operative information: pre-operative preparations, post-operative information, post-operative plans and follow-up. The subcategories under pre-operative information and preparations were: contact information, medication safety, health status, optimising health, dental status, read information, preparation two weeks before surgery, inform your surgical ward, planning your own discharge, preparation on admission and just before surgery. The subcategories under post-operative information, further plans and follow-up were: prevention and complications, restriction and activity, medication safety, pain relief, stomach functions, further care and appointments. Both healthcare workers and patients express the need for a surgical patient safety checklist. Conclusion:A broad spectre of risk elements for a patient safety checklist were identified. Developing a surgical safety checklist based on these risk elements might reduce complications and unwanted errors. Trail registration: The study is registered as part of a clinical trial in ClinicalTrials.gov: NCT03105713.

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Section: Discussionmentioning

confidence: 99%

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

Harris

Søfteland

Moi

et al. 2020

BMC Health Serv Res

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“…26 Only a few well-designed controlled studies are available in the orthopedic setting, 27 and the implementation of effective procedures in frail hyperglycemic patients by dedicated teams requires special attention. 28…”

Section: Discussionmentioning

confidence: 99%

<p>Stress Hyperglycemia and Complications Following Traumatic Injuries in Individuals With/Without Diabetes: The Case of Orthopedic Surgery</p>

Luzio¹,

Dusi²,

Mazzotti³

et al. 2020

DMSO

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Purpose: Hyperglycemia in trauma patients may stem from metabolic response to stress, both in the presence and the absence of underlying diabetes. We aimed to test the association of stress hyperglycemia with risks of adverse events subjects undergoing orthopedic surgery. Patients and Methods: In a prospective observational study, we enrolled 202 consecutive patients with hyperglycemia at hospital admission for trauma injuries requiring orthopedic surgery. Based on history, diabetes was present in 183, and 13 more were defined as unknown diabetes on the basis of HbA1c ≥48mmol/mol. Stress hyperglycemia was defined in subjects with/without diabetes by a stress hyperglycemia ratio (SHR) >1.14, calculated as admission glucose/average glucose, estimated from glycosylated hemoglobin. Logistic regression analysis was used to calculate the risk of post-surgery adverse events associated with different states of hyperglycemia, after correction for demographic and clinical confounders. Results: Stress hyperglycemia was diagnosed, either as superimposed to diabetes (54/196 cases, 27.6%) as well as in the 6 cases without diabetes. At least one complication was recorded in 68 cases (33.7%), the most common being systemic infection (22.8% of cases). In the total cohort, stress hyperglycemia, irrespective of the presence of diabetes, increased the risk of adverse events (any events, odds ratio [OR], 4.43; 95% confidence interval [CI], 2.11-9.30), cardiovascular events (OR, 7.09; 95% CI, 2.47-19.91), systemic infections (OR, 4.21; 95% CI, 1.97-9.03) and other adverse events (OR, 6.30; 95% CI, 1.41-28.03), after adjustment for confounders; hospital stay was much longer. The same was true when the analysis was limited to the diabetes cohort or by comparing pure stress hyperglycemia vs diabetes without stress hyperglycemia. Conclusion: The study highlights the importance of stress hyperglycemia for adverse events in the setting of orthopedic surgery following trauma injuries. This condition requires stricter management, considering the much longer length of hospital stay and higher costs.

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“…Risk factors for neuropsychological complications including obesity, diabetes, and dyslipidemia have been reported [2]. The number of people with diabetes mellitus (DM) worldwide has increased to about 425 million [3] and over 90% of those people have type 2 diabetes mellitus (T2DM) caused by diet and lifestyle [4]. In the early postoperative period, cognitive outcome is worse in DM patients than in non-diabetic patients [5], and transient advanced mental impairment occurs more frequently in DM patients after aortic surgery [6].…”

Section: Introductionmentioning

confidence: 99%

Suppression of behavioral activity and hippocampal noradrenaline caused by surgical stress in type 2 diabetes model mice

Nishimura

Nomura

Egi

et al. 2020

Preprint

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Background: There has been much discussion recently about the occurrence of neuropsychological complications during the perioperative period. Diabetes is known to be one of the metabolic risk factors. Although the number of patients with diabetes mellitus (DM) has been increasing, the pathophysiology of postoperative neuropsychological dysfunction in DM patients is still unclear. Recently, a deficiency of neurotransmitters, such as monoamines, was reported to be associated with mental disorders. Therefore, we investigated the effects of surgical stress on behavioral activity and hippocampal noradrenaline (NA) level in type 2 diabetes mellitus model (T2DM) mice.Methods: Eighty-four 6-week-old male C57BL/6J mice were divided into four groups (non-diabetes, non-diabetes with surgery, T2DM, and T2DM with surgery groups). T2DM mice were established by feeding a high-fat diet (HFD) for 8 weeks. At 14 weeks of age, fifteen mice in each group underwent a series of behavioral tests including an open field (OF) test, a novel object recognition (NOR) test and a light-dark (LD) test. In the surgery groups, open abdominal surgery with manipulation of the intestine was performed 24 hours before the behavioral tests as a surgical stress. Hippocampal noradrenaline (NA) concentration was examined in six mice in each group by high-performance liquid chromatography. The data were analyzed by the Mann-Whitney U test, and p values less than 0.05 were considered significant.Results: The T2DM group showed significantly increased explorative activity in the NOR test (P = 0.0016) and significantly increased frequency of transition in the LD test (P = 0.043) compared with those in the non-diabetic group before surgery. In T2DM mice, surgical stress resulted in decreased total distance in the OF test, decreased explorative activity in the NOR test, and decreased frequency of transition in the LD test (OF: P = 0.015, NOR: P = 0.009, LD: P = 0.007) and decreased hippocampal NA (P = 0.015), but such differences were not observed in the non-diabetic mice.Conclusions: Mice with T2DM induced by feeding an HFD showed increased behavioral activities, and surgical stress in T2DM mice caused postoperative hypoactivity and reduction of the hippocampal NA level.

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Pre‐operative optimisation of the surgical patient with diagnosed and undiagnosed diabetes: a practical review

Cited by 52 publications

References 52 publications

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

<p>Stress Hyperglycemia and Complications Following Traumatic Injuries in Individuals With/Without Diabetes: The Case of Orthopedic Surgery</p>

Suppression of behavioral activity and hippocampal noradrenaline caused by surgical stress in type 2 diabetes model mice

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