Patient characteristics and preferences for a surgical prehabilitation program design: results from a pilot survey.

PURPOSE: Surgical prehabilitation aims to reduce a decline in the functional capacity thereby optimising health and fitness before surgery. One of the major barriers in successfully implementing a prehabilitation program in hospitals has been poor patient adherence. In our pilot survey on surgical patients, we sought to explore patient preferences regarding the program design, the barriers and enablers to patient participation in a multimodal prehabilitation program. METHODS: The survey was administered to patients undergoing major abdominal surgery in the preoperative period. The first two parts of the instrument mainly included questions on demographics, social history, activity levels, interest towards prehabilitation program and their involvement in co-design, preferences towards the components of the program, the barriers and enablers. The last part of survey included symptom and physical assessments. RESULTS: The survey was completed by 24 patients undergoing major abdominal surgery. The median age of our cohort was 71 (range 35-91) years and 75% were retired. 75% of our participants were extremely interested in improving health and fitness and 63% were very keen to co-design their program when explained. Home-based programs were preferred by most participants and among exercises, walking was preferred by 71% of the participants. One third of the participants were interested in professional dietary counselling. There were only two participants who preferred group psychological therapy while 25% preferred individual psychological counselling sessions. CONCLUSION: Our survey highlighted a need to design a personalised program with tailored interventions due to the wide variation in the interest and preferences among surgical patients.

Perioperative hypothermia during hip fracture surgery: An observational study.

RATIONALE: Elderly patients are at high risk of accidental perioperative hypothermia. The primary objective of this study was to measure the changes in body temperature and the incidence of hypothermia in elderly patients undergoing hip fracture surgery. METHODS: We conducted a prospective observational study on all adult patients undergoing surgery for fractured neck of femur between December 2013 and July 2014. We monitored their temperatures in different perioperative areas at multiple time points and also noted the warming methods used. RESULTS: Eighty-seven patients were included in this study. A significant drop in body temperature (0.7°C, 95% CI: 0.6-0.9, P < 0.001) occurred from their arrival at the operating theatre until their arrival at the recovery room. A significant drop of 0.2°C (95% CI: 0.1-0.4, P < 0.001) was observed at the holding bay area. One third of the patients were noted to be hypothermic when they arrived at the recovery room. CONCLUSION: These results indicate that despite the use of active warming methods for most patients, significant hypothermia is still an issue amongst elderly patients undergoing hip fracture surgery. Further improvement is necessary to prevent hypothermia in this high-risk group of patients.

Reduced risk of medical morbidity and mortality in patients selected for laparoscopic colorectal resection in England: a population-based study.

OBJECTIVES: To quantify the occurrence of significant medical complications following elective colorectal resection and investigate potential differences in medical morbidity following open and minimal access colorectal surgery. DESIGN: Retrospective analysis of Hospital Episode Statistics, which is a prospectively maintained national database. SETTING: All patients undergoing colorectal resection in National Health Service trusts in England. PATIENTS: Adult patients undergoing elective or planned surgery between April 2001 and March 2008. INTERVENTION: Colorectal resection for benign and malignant diagnoses. MAIN OUTCOME MEASURES: Mortality and morbidity at 30 days and 1 year following elective colorectal resection. RESULTS: One hundred thirty-eight thousand seven hundred thirty-five elective colorectal resections were identified between the study dates. Thirty-day in-hospital mortality was 3.4% and 1.7% following conventional and laparoscopic surgery, respectively (P < .001). Overall, the 30-day postoperative medical morbidity rate was 14.6%. Use of the minimal access approach demonstrated a significant reduction in total morbidity risk at 30 days (odds ratio, 0.79; P < .001) and 365 days (odds ratio, 0.81; P < .001) following case-mix adjustment. Multiple regression analyses demonstrated that cardiorespiratory complications and venous thromboembolism occurred less frequently during the index admission and up to 1 year following minimal access surgery when compared with the conventional approach (P < .049). CONCLUSIONS: In this population-based study, patients selected for laparoscopic colorectal resection were associated with lower risk of mortality as well as reduced cardiorespiratory and venous thromboembolic risk than those undergoing open surgery.

No sex differences in memory formation during general anesthesia.

BACKGROUND: Women respond differently to anesthesia than men, initially recovering more rapidly, but having more postoperative morbidity. Studies on surgical patients report evidence of memory formation during anesthesia. However, sex differences in memory formation have not been explored. Therefore, the authors investigated sex differences in the implicit and explicit memory formation during general anesthesia. METHODS: With ethics committee approval, 120 consenting adult patients scheduled to undergo surgery during general anesthesia were recruited. Intraoperatively, 16 target words were presented to patients via headphones, and the Bispectral Index was recorded. Postoperatively, memory for presented words was tested using a word stem completion test. The test was divided into inclusion and exclusion parts, to delineate implicit and explicit memory contributions. RESULTS: Target and distracter hit rates were similar in men and women. For the whole study group, there was a significant difference between inclusion target hit rate (0.42) and base hit rate (0.39) (P = 0.01). Buchner's model suggested that this memory formation was attributable to both implicit and explicit memory. A Bispectral Index value greater than 50 was the only significant predictor of inclusion target hit rate. None of the patients were able to consciously recall the words presented during surgery. CONCLUSIONS: Patients showed greater memory performance for words presented during general anesthesia than for words not presented. However, sex differences in memory formation were not observed. A relation between hypnotic state and memory during sevoflurane anesthesia was also established, suggesting that memory formation is possible even at hypnotic depths considered to be adequate anesthesia.

Anaesthesia and sedation for gastrointestinal endoscopy.

PURPOSE OF REVIEW: Wide variations exist around the world in the practice of sedation for endoscopy, in terms of the depth of sedation, drug choices, delivery methods and the practitioners involved. These variations are driven by historical, cultural and economic factors. Professional bodies have promulgated guidelines in an attempt to unify and raise standards for sedation and monitoring. Nevertheless, preventable morbidity associated with sedation still occurs. A review of the recent literature is therefore justified. RECENT FINDINGS: The main themes in this literature are the advent of the widespread use of propofol by non-anaesthesiologists, and particularly non-medical staff; novel methods for administering propofol; the acceptability of endoscopy without sedation; and emerging technologies that obviate the need for endoscopy. SUMMARY: There is still much scope to research and refine sedation techniques for endoscopy. We believe that the involvement of anaesthesiologists in this research is vital.