The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study.

BACKGROUND: Postoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications. METHODS: We included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications. RESULTS: Of the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48-71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications. CONCLUSIONS: Preoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.

Airway Management in Patients With a History of Esophagectomy: A Case Series.

OBJECTIVE: Esophagectomy is a highly invasive surgery, and it often is accompanied by various postoperative complications. With increases in the rate and length of patient survival in postoperative esophagectomy patients, the number of said patients receiving subsequent surgeries is increasing. However, airway management in post-esophagectomy patients is yet to be researched widely. This study used anesthesia records from the Kitakyushu Municipal Medical Center to examine airway conditions and complications in patients who had undergone 1 or more additional surgeries following an esophagectomy. DESIGN: Case series. SETTING: Single center in Japan. PARTICIPANTS: Forty-one post-esophagectomy patients from August 2010 to July 2019. INTERVENTIONS: None. MAIN RESULTS: Forty-one post-esophagectomy patients underwent 58 surgeries. Two of the cases (3%) involved retrosternal reconstruction, and in each, reflux from the gastric conduit was observed during tracheal intubation. The author determined that, in both cases, the gastric conduit was located laterally to the trachea, was sandwiched between both lungs, and was located ventrally to the oral cavity. There were no cases of aspiration. CONCLUSIONS: The possibility of aspiration-especially in cases of retrosternal reconstruction-should be considered in post-esophagectomy patients. Based on computed tomography findings, rapid- sequence induction with head-up position is recommended. Conversely, lung ventilation (inflation) and routine cricoid pressure may be less effective or, in some patients, even harmful.

Changes in smoking behavior among victims after the great East Japan earthquake and tsunami.

BACKGROUND: In areas affected by the tsunami of the great East Japan Earthquake, smoking behavior may have deteriorated due to high stress and drastic changes in living environment. Surveys were conducted to reveal changes in smoking behaviors among victims. METHODS: A population-based random-sample home-visit interview survey of victims in Iwate and Miyagi Prefectures affected by the tsunami disaster was conducted in 2012 (n = 1978), while a population-based nationwide survey was conducted in 2013 (n = 1082). A panel survey in 2014 was conducted with respondents of the 2012 survey (n = 930). Multiple logistic regression analysis was performed to reveal factors related to smoking status after the disaster. RESULTS: There was high smoking prevalence of both sexes in the tsunami disaster area (current smoking rate in coastal area, 50.0% for male, 21.4% for female; inland area, 34.7% for male, 7.6% for female). Low prevalence of male quitters was observed (quitter rate in coastal area, 20.8% for male, 8.0% for female; inland area, 23.4% for male, 5.5% for female). The prevalence of nicotine-dependent people assessed by FTND (Fagerström Test for Nicotine Dependence) in the coastal area was also higher than in the inland area or other areas of Japan. Smoking behavior among victims worsened after the disaster and did not improve 3 years from the disaster. Post-disaster factors related to smoking were living in coastal area, complete destruction of house, and living in temporary housing. CONCLUSIONS: Smoking prevalence and the level of nicotine dependence of tsunami victims were still high even 3 years after the disaster. It is important to emphasize measures for smoking control in the disaster areas for an extended time period.

Relationship between Health-Seeking Behavior by Basic Health Examination and Subsequent Health Expenditure among Remote Island Inhabitants of Japan.

BACKGROUND: Convincing evidence has not been obtained as to whether having a basic health examination in the prime of life inhibits the surge of health expenditure in old age. DATA SOURCES: Data on participants in the basic health examination from 1996 to 2000 among residents of a remote island in Japan, and individual health care expenditure data from March 2005 to February 2008. STUDY DESIGN: A community-based retrospective study. DATA COLLECTION: Japanese residents who were subscribers to the National Health Insurance Scheme of Chibu Town from March 1996 to March 2007 and were aged 40 to 64 years in March 1996 (n = 179) were divided into 3 groups depending on the frequency of participating in the basic health examination over 5 years: 0 times (nontakers), 1 to 3 times (occasional takers), or 4 to 5 times (regular takers). The distribution of total health expenditure according to the frequency of having a basic health examination was determined, and the Cochrane-Armitage test was used for comparison. RESULTS: Nontakers formed the highest proportion of subjects with low expenditure (0-200,000 yen) (nontaker, occasional, regular: 38.5%, 24.1%, 23.5%; P = 0.002), and also accounted for the highest proportion of subjects with high expenditure (> 1,400,000 yen) (33.3%, 16.1%, 9.4%; P = 0.004). CONCLUSION: Persons not participating in health examinations during middle age include a group with high future health care expenditure.