Handgrip Strength Predicts Persistent Walking Recovery After Hip Fracture Surgery

Background

In older people, hip fractures often lead to disability and death. We evaluated handgrip strength, an objective measure of physical function for bedridden patients, as a predictor of walking recovery in the year after fracture surgery.

Methods

This multicenter prospective cohort study included 504 patients, aged 70 years or more, who were admitted to the hospital for hip fracture surgery and were formerly able to walk independently. A multidimensional geriatric evaluation that included a physical examination, Short Portable Mental Status Questionnaire, Geriatric Depression Scale, Charlson Index, Basic Activities of Daily Living, and grip strength was administered at the time of admission. Follow-ups were performed every 3 months for 1 year after surgery to assess functional status and survival. The walking recovery probability was evaluated using multivariable logistic regression models.

Results

The mean age of the participants was 85.3 ± 5.5 years, and 76.1% of the participants were women. The mean grip strength was greater in men (β: 6.6 ± 0.62, P < .001) and was directly related to the Short Portable Mental Status Questionnaire results (P < .001), Basic Activities of Daily Living results (P < .001), serum vitamin D levels (P = .03), and time before surgery (P < .001), whereas it was inversely related to age (P < .001), Geriatric Depression Scale score (P < .001), and Charlson Index (P < .001). After adjusting for confounders, the grip strength was directly associated with the probability of both incident and persistent walking recovery (odds ratio highest tertile vs lowest tertile, 2.84, confidence interval, 1.76-4.59 and 2.79, confidence interval, 1.35-5.79, respectively).

Conclusions

In older patients with hip fractures, early grip strength evaluation might provide important prognostic information regarding the patient's future functional trajectory.     

Predictors of Graft Patency 3 Years After Coronary Artery Bypass Graft Surgery

Objectives. The purpose of this analysis was to define the factors that predict 3-year graft patency.

Background. The success of coronary artery bypass graft surgery (CABG) is dependent on vein graft patency after the operation. It has been well established by a series of Department of Veterans Affairs Cooperative Trials that aspirin (325 mg daily) improves saphenous vein graft patency early (7 to 10 days) and at 1 year, but not at 3 years after CABG. This analysis, based on one of these trials, defined factors that predict 3-year graft patency.

Methods. This analysis consisted of 266 patients, with 656 grafts that were patent 7 to 10 days after the operation, who underwent 3-year catheterization. To determine which patient-specific and/or graft-specific factors, or both, predict graft occlusion, a multivariate logistic regression analysis in terms of latent variables was used. It yielded a model that also took into account possible intraclass correlations.

Results. For a vein graft that was patent at 7 to 10 days after the operation, the positive predictors, according to univariate analysis, for that graft being patent at 3 years were cross-clamp time ≤80 min (p < 0.001), vein preservation solution temperature ≤5°C (p = 0.009), bypass time ≤2 h (p = 0.042), number of proximal anastomoses ≤2 (p = 0.018), operation time ≤5 h (p = 0.044) and continuous versus intermittent cross-clamp technique (p = 0.024). There was also a trend with regard to recipient artery diameter >1.5 mm (p = 0.063), serum cholesterol ≤225 mg/dl (p = 0.084) and single versus sequential or Y vein graft (p = 0.060). Factors not predictive of 3-year patency were age, race, smoking history, high density lipoprotein cholesterol, vein source (thigh vs. calf), coronary artery grafted and aspirin treatment. Of all the predictors obtained in the univariate analysis, the only variables that were sufficient to yield a good model within the multivariate analysis were solution temperature (p = 0.004), serum cholesterol (p = 0.024), number of proximal anastomoses (p = 0.032) and recipient artery diameter (p = 0.034).

Conclusions. For a patient with patent vein grafts 7 to 10 days after the operation, predictors of 3-year graft patency are more closely related to operative techniques and underlying disease and not to aspirin treatment.

(J Am Coll Cardiol 1997;29:1563–8)     

Thirty-Day Readmission After Bariatric Surgery: Causes,Effects on Outcomes,and Predictors

Digestive Diseases and Sciences - Bariatric surgery (BSx) is one of the most common surgical procedures in North America. Readmissions may be associated with a high burden to the healthcare system....     

Da-Cheng-Qi-Tang Promotes the Recovery of Gastrointestinal Motility After Abdominal Surgery in Humans

In order to examine the effects of Da-Cheng-Qi-Tang (DCQT) on gastrointestinal motility functions after abdominal surgery in humans, 33 patients with abdominal surgeries and 36 patients with cholecystectomies were divided into the DCQT and the control groups at random. Electrogastrography (EGG) and gastroduodenojejunal manometry was performed and the levels of plasma motilin were measured by radioimmunoassay. The results were as follows: (1) on the day of surgery, the ratio of EGG normal frequency in the DCQT group was higher than in the control group (P=0.0016); (2) the power of EGG in the DCQT group was higher than in the control group on the second and third days after surgeries (P=0.0011 and P=0.0215, respectively); (3) the percentage of normal bowel peristalsis was significantly higher in the DCQT group than in the control group (P<0.01); and (4) in the DCQT group, the plasma motilin level reached its peak earlier than in the control group. Our results suggest that DCQT can increase plasma motilin, enhance gastrointestinal motility, improve gastric dysrythmia, and reduce gastroparesis after abdominal surgery.     

Quality of Life and Chronic Pain Four Years After Gastrointestinal Surgery

Purpose Little is known about the prevalence of chronic postsurgical pain after gastrointestinal surgery. This study was designed to assess the prevalence of chronic pain andquality of life in a cohort of patients who underwent surgery for benign and malignant gastrointestinal disease. Methods A prospective cohort design was used to assess quality of life and morbidity at four years postoperatively in435 patients who had upper, hepatopancreaticobiliary, small-bowel, and/or colorectal anastomotic surgery in 1999 at one regional center in Northeast Scotland. Chronic pain and quality of life were assessed by postal survey using the European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaire and McGill Pain Questionnaire. Results Of the 435 patients recruited in 1999, 135 (31 percent) had died by censor date in 2003. There was a 74 percent (n = 202) response rate from surviving patients eligible for follow-up. Prevalence of chronic pain at four years postoperatively was 18 percent (95 percent confidence interval, 13–23 percent). Pain was predominantly neuropathic in character; a subgroup reported moderate-to-severe pain. Risk factors for chronic postsurgical pain included female gender, younger age, and surgery for benign disease. Compared with those who were pain-free at follow-up, patients with chronic pain had poorer functioning, poorer global quality of life, and more severe symptoms, independent of age, gender, and cancer status. Conclusions The prevalence of chronic pain after laparotomy for gastrointestinal malignancy and nonmalignant conditions at four years after surgery was 18 percent. These patients had significantly poorer quality of life scores independent of age, gender, and cancer status. Supported by the Departments of Surgery and Public Health at the University of Aberdeen. Dr. Julie Bruce is funded by the Medical Research Council (MRC) Special Training Fellowship in Health Services & Health of the Public Research. Presented at the meeting of the Society for Social Medicine, Glasgow, United Kingdom, September 14 to 16, 2005.     

Successful Voiding After Trial Without Catheter Is Not Synonymous With Recovery of Bladder Function After Colorectal Surgery

Purpose The need for monitoring postoperative urine output and the possibility of lower urinary tract dysfunction following colorectal surgery necessitates temporary urinary drainage. Current practice assumes recovery of lower urinary tract function to coincide with successful micturition after removal of urethral catheter. The aim of this study was to analyze the recovery of bladder function following colorectal surgery. Methods Patients undergoing colorectal operations underwent preoperative and postoperative uroflowmetry and residual urine estimation. All patients were catheterized suprapubically at surgery. Uroflowmetry and postvoid residual volumes were recorded postoperatively until recovery of bladder function was complete. Results Thirty consecutive patients underwent suprapubic catheterization, 25 of whom completed the study. Seventeen (68 percent) patients were able to pass urine within 72 hours of surgery. Recovery of lower urinary tract function was delayed in patients undergoing rectal vs. colonic resections (median, 6 vs. 3 days, P = 0.0015). Postvoid residual volumes greater than 200 ml were noted in three (20 percent) patients following rectal resections beyond the tenth postoperative day, with complete emptying achieved by six weeks. Conclusions Apparent successful micturition following rectal resections does not always indicate recovery of bladder function. The use of suprapubic catheters, in addition to being safe and effective, allows assessment of residual volumes postoperatively and smoothes the path to full recovery of lower urinary tract function. Presented at the Tripartite Colorectal Meeting, Melbourne, Australia, October 27 to 30, 2002.     

Use of Acid Suppressive Medications After Laparoscopic Antireflux Surgery: Prevalence and Clinical Indications

Laparoscopic antireflux surgery (LARS) provides effective control of gastroesophageal reflux (GER) in more than 90% of patients. Despite this high success rate, some patients continue to consume acid suppressive medications after surgical intervention. In this study we evaluate the prevalence, clinical indications, and cause of use of acid reducing drugs in patients after LARS. Consecutive patients undergoing LARS for GERD were surveyed 2–3 years after surgery regarding use of acid suppressive medications, surgical outcome, and GERD specific symptoms. During the study period, 119 patients underwent LARS at our center. Ninety-eight (82%) were available for interview. Two patients died of unrelated causes and two declined to be interviewed. The remaining 94 individuals are the subject of this report. Ninety-four percent were satisfied with the outcome of surgery. Despite this high satisfaction rate, 37 of 94 (39%) were on antireflux medication (ARM; 62% proton pump inhibitors, 22% H2-receptor antagonists, and 16% others), with 70% using continuous medication. Of these patients, 54% took ARM after surgery for GERD-related symptoms, 95% of these patients responded to medical therapy, and yet again, 85% remained satisfied with the surgical outcome. Forty-six percent of patients on ARM after surgery had no GERD symptoms and took ARM for nonappropriate indications such as bloating. Only 47% of these responded to ARM; 82% of this group was satisfied with the surgical outcome. In conclusion, the use of ARM after LARS is a common occurrence despite a high satisfaction rate with this operation. Nearly half of patients consuming ARS after LARS are taking these medications for symptoms not necessarily related to GER. These findings underscore the importance of patient education in the use of these agents. The first two authors contributed equally to this article.     

Impact of Functional Results on Quality of Life After Rectal Cancer Surgery

Purpose Quality of life is an important outcome measure that has to be considered when deciding treatment strategy for rectal cancer. The aim of this study was to find out the impact of surgery-related adverse effects on quality of life. Methods The RAND-36 questionnaire and questionnaires assessing urinary, sexual, and bowel dysfunction were administered to 94 patients with no sign of recurrence a minimum of one year after curative surgery. Results were compared with age-matched and gender-matched general population. Results Eighty-two (87 percent) patients answered the questionnaires. Major bowel dysfunction was as common after high anterior resection as after low anterior resection. Urinary complaints occurred as often after anterior resection as after abdominoperineal resection, but sexual dysfunction was more common after abdominoperineal resection. Overall, the patients reported better general health perception but poorer social functioning than population controls. In particular, elderly patients reported a significantly better quality of life in many dimensions than their population controls. There was no significant difference in quality of life between treatment groups. Major bowel dysfunction after anterior resection impaired social functioning compared with that of patients without such symptoms. Urinary dysfunction impaired social functioning and impotence impaired physical and social functioning. Conclusions Quality of life after rectal cancer surgery is not worse than that of the general population. The major adverse impact of bowel and urogenital dysfunction is on social functioning. These adverse effects need to be discussed with the patient and preoperative function needs to be taken into account when choosing between treatment options. Permanent colostomy is not always the factor that disrupts a person's quality of life most. Presented at the annual meeting of Finnish Digestive Surgeons, Jyv?skyl?, Finland, February 17 to 18, 2005. Reprints are not available.     

Implementation of an Enhanced Recovery After Surgery (ERAS) protocol for acute complicated and uncomplicated appendicitis

Techniques in Coloproctology - Enhanced Recovery After Surgery (ERAS) protocols are well-documented logistic programs in elective surgery but it is still uncertain whether ERAS can benefit...     

Factors associated with failure of Enhanced Recovery After Surgery (ERAS) in colorectal and gastric surgery

Abstract

Background: The Enhanced Recovery After Surgery (ERAS) pathway is widely applied in the perioperative period of stomach and colorectal surgery, and can decrease the length of hospital stay of the patients without compromising the safety of the patients. However, some patients are removed from this pathway for various reasons. Here we found some factors that taking the patients out from the procedures.

Methods: A retrospective analysis of collected data of 550 patients over a 3-year period was conducted, with 292 in the ERAS group and 258 in the conventional care group. Then various basic elements were analyzed to explore the reasons for the failure to complete the ERAS program.

Results: Total length of hospital stay after surgery was significantly shorter in the ERAS group, and a similar incidence of complication rates were observed in the two groups. In this study, the significant factors that associated with complications were advanced age (OR 2.18; p?=?.031), history of abdominal surgery (OR 2.03; p?=?.04), incomplete gastrointestinal obstruction (OR 3.42; p?p?=?.004) and intraoperative neostomy (OR 2.37; p?=?.006).

Conclusions: We found that advanced age (>80?years old), history of abdominal surgery, gastrointestinal obstruction and stoma formation were the risk factors. We anticipated to design a risk assessment system upon the high-risk patients from the present ERAS pathway, and make a modified ERAS pathway for those patients.