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Research Article
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Anesthetists and surgeons in ensuring preoperative optimization

Year 2019, Volume: 41 Issue: 3, 626 - 636, 30.09.2019

Sevgi Kesici , Ülkü Aygen Türkmen

https://doi.org/10.7197/cmj.vi.585082

Abstract

Objective:
This survey study was
designed with the aim of questioning tobacco and alcohol use as two major
components of preoperative optimization, evaluating the elements of the
preoperative period other than the treatment of anemia, evaluating whether
these elements were performed in compliance with the protocols by anesthetists
and surgeons, and suggesting solutions for overcoming deficiencies.

Method:
Specialist physicians
in anesthesia and surgeons from several branches, who worked in 4 different
healthcare centers in Istanbul, were included in this 15-question survey.

Results: A total of 116 physicians participated in this survey
study. Of the participating physicians, 47 (40.5%) were anesthetists and 69
(59.5%) were surgeons.  A total of 115
(99.1%) physicians answered “yes” to the following question: “Do you inform and
train your patient in the preoperative period about the scheduled surgical
procedure/anesthesia method and the essential principles?”. To the question “do
you stress to your patients in the preoperative period that stopping smoking is
necessary for the period of 4 weeks prior to surgery?”, 88 (75.9%) physicians
answered “yes”. Only 47 (40.5%) physicians answered “yes” to the following
question: “In the preoperative period, do you stress to your patients using
alcohol that stopping alcohol use is necessary for the period of 4 weeks prior
to surgery?” 







Conclusions:
Our survey study conducted with the participation of
physicians with an experience of more than 10 years demonstrated favorable
outcomes, revealing that all physicians provided information and training for
their patients in the preoperative period and all but 1 physician followed up
the blood sugar level of diabetic patients for regulating the blood sugar
levels. However; we are of the opinion that further collaboration of physicians
within a team concept and in compliance with the preoperative optimization
guidelines will be useful to ensure early and fast recovery in the
postoperative period by limiting the tobacco/alcohol use of patients in the
preoperative period, providing appropriate nutrition preoperatively, enabling
access of patients to prehabilitation, administering adequate premedication,
and providing anemia management.   

Keywords

Preoperative Optimization ERAS Anesthetist Surgeon

References

  • Reference1 Dağıstanlı S, Kalaycı MU, Kara Y. Genel Cerrahide ERAS Protokolünün Değerlendirilmesi. İKSST Derg 2018;10(Ek sayı):9-20.
  • Reference2 Martin D, Roulin D, Grass F, et al. A multicentre qualitative study assessing implementation of an Enhanced Recovery After Surgery program. Clin Nutr. 2018 Dec;37:2172-2177.
  • Reference3 D'Andrilli A, Rendina EA. Enhanced recovery after surgery (ERAS) and fast-track in video-assisted thoracic surgery (VATS) lobectomy: preoperative optimisation and care-plans. J Vis Surg. 2018 Jan 5;4:4.
  • Reference4 Aasa A, Hovbäck M, Berterö CM. The importance of preoperative information for patient participation in colorectal surgery care. J Clin Nurs. 2013 Jun;22(11-12):1604-12.
  • Reference5 Lindstrom D, Sadr Azodi O, Wladis A, Tonnesen H, Linder S, Nasell H, et al. Effects of a perioperative smoking cessation intervention on postoperatife complications: a randomized trial. Ann Surg. 2008;248(5):739-45.
  • Reference6 Thomsen T, Villebro N, Moller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2010;7(7):CD002294.
  • Reference7 Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg. 2003 Jul;238(1):1-5.
  • Reference8 Tuna PT, Kurşun Ş. Kolorektal Cerrahisinde Hızlandırılmış Bakım Protokolleri ve Hemşirelik Bakımı. DEUHFED 2018, 11 (2), 180-8.
  • Reference9 Tonnesen H, Kehlet H. Preoperative alcoholism and postoperatife morbidity. Br J Surg. 1999;86(7):869-74.
  • Reference10 Tonnesen H, Rosenberg J, Nielsen HJ, Rasmussen V, Hauge C, Pedersen IK, et al. Effect of preoperative abstinence on poor postoperatife outcome in alcohol misusers: randomised controlled trial. BMJ. 1999;318(7194):1311-6.
  • Reference11 Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2013). Guidelines for perioperative care in elective colonic surgery: Enhanced recovery after surgery (ERAS) society recommendations. World Journal of Surgery, 37, 259-84.
  • Reference12 Faraoni D, DiNardo JA, Goobie SM. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery. Anesth Analg. 2016 Dec;123(6):1582-1587.
  • Reference13 Muñoz M, Gómez-Ramírez S, Kozek-Langeneker S, Shander A, Richards T, Pavía J. 'Fit to fly': overcoming barriers to preoperative haemoglobin optimization in surgical patients. Br J Anaesth. 2015 Jul;115(1):15-24.
  • Reference14 Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015 Oct;102(11):1314-24.
  • Reference15 World Health Organization. Nutritional anaemias. 1968. https://apps.who.int/iris/bitstream/handle/10665/40707/WHO_TRS_405.pdf?sequence=1 (accessed 27/06/2019).
  • Reference16 Gustafsson UO, Nygren J, Thorell A, Soop M, Hellstrom PM, Ljungqvist O, et al. Preoperative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand. 2008;52:946e51.
  • Reference17 Breuer JP, von DV, von Heymann C, Griesbach M, von Schickfus M, Mackh E, et al. Preoperative oral carbohydrate administration to ASA III-IV patients undergoing elective cardiac surgery. Anesth Analg. 2006;103:1099e108.
  • Reference18 Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery. 2016 Nov;160(5):1189-1201.
  • Reference19 Fleming FJ, Kim MJ, Salloum RM, Young KC, Monson JR. How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum 2010 Oct;53(10):1355-60.
  • Reference20 Ersoy E, Gündoğdu H. Cerrahi sonrası iyileşmenin hızlandırılması. Turk J Surg. 2007;23(1):035-40.
  • Reference21 Kadoi Y. Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus. J Anesth. 2010 Oct;24(5):739-47.
  • Reference22 Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009 Sep;111(3):657-77.

Year 2019, Volume: 41 Issue: 3, 626 - 636, 30.09.2019

Sevgi Kesici , Ülkü Aygen Türkmen

https://doi.org/10.7197/cmj.vi.585082

Abstract


References

  • Reference1 Dağıstanlı S, Kalaycı MU, Kara Y. Genel Cerrahide ERAS Protokolünün Değerlendirilmesi. İKSST Derg 2018;10(Ek sayı):9-20.
  • Reference2 Martin D, Roulin D, Grass F, et al. A multicentre qualitative study assessing implementation of an Enhanced Recovery After Surgery program. Clin Nutr. 2018 Dec;37:2172-2177.
  • Reference3 D'Andrilli A, Rendina EA. Enhanced recovery after surgery (ERAS) and fast-track in video-assisted thoracic surgery (VATS) lobectomy: preoperative optimisation and care-plans. J Vis Surg. 2018 Jan 5;4:4.
  • Reference4 Aasa A, Hovbäck M, Berterö CM. The importance of preoperative information for patient participation in colorectal surgery care. J Clin Nurs. 2013 Jun;22(11-12):1604-12.
  • Reference5 Lindstrom D, Sadr Azodi O, Wladis A, Tonnesen H, Linder S, Nasell H, et al. Effects of a perioperative smoking cessation intervention on postoperatife complications: a randomized trial. Ann Surg. 2008;248(5):739-45.
  • Reference6 Thomsen T, Villebro N, Moller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2010;7(7):CD002294.
  • Reference7 Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg. 2003 Jul;238(1):1-5.
  • Reference8 Tuna PT, Kurşun Ş. Kolorektal Cerrahisinde Hızlandırılmış Bakım Protokolleri ve Hemşirelik Bakımı. DEUHFED 2018, 11 (2), 180-8.
  • Reference9 Tonnesen H, Kehlet H. Preoperative alcoholism and postoperatife morbidity. Br J Surg. 1999;86(7):869-74.
  • Reference10 Tonnesen H, Rosenberg J, Nielsen HJ, Rasmussen V, Hauge C, Pedersen IK, et al. Effect of preoperative abstinence on poor postoperatife outcome in alcohol misusers: randomised controlled trial. BMJ. 1999;318(7194):1311-6.
  • Reference11 Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2013). Guidelines for perioperative care in elective colonic surgery: Enhanced recovery after surgery (ERAS) society recommendations. World Journal of Surgery, 37, 259-84.
  • Reference12 Faraoni D, DiNardo JA, Goobie SM. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery. Anesth Analg. 2016 Dec;123(6):1582-1587.
  • Reference13 Muñoz M, Gómez-Ramírez S, Kozek-Langeneker S, Shander A, Richards T, Pavía J. 'Fit to fly': overcoming barriers to preoperative haemoglobin optimization in surgical patients. Br J Anaesth. 2015 Jul;115(1):15-24.
  • Reference14 Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015 Oct;102(11):1314-24.
  • Reference15 World Health Organization. Nutritional anaemias. 1968. https://apps.who.int/iris/bitstream/handle/10665/40707/WHO_TRS_405.pdf?sequence=1 (accessed 27/06/2019).
  • Reference16 Gustafsson UO, Nygren J, Thorell A, Soop M, Hellstrom PM, Ljungqvist O, et al. Preoperative carbohydrate loading may be used in type 2 diabetes patients. Acta Anaesthesiol Scand. 2008;52:946e51.
  • Reference17 Breuer JP, von DV, von Heymann C, Griesbach M, von Schickfus M, Mackh E, et al. Preoperative oral carbohydrate administration to ASA III-IV patients undergoing elective cardiac surgery. Anesth Analg. 2006;103:1099e108.
  • Reference18 Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery. 2016 Nov;160(5):1189-1201.
  • Reference19 Fleming FJ, Kim MJ, Salloum RM, Young KC, Monson JR. How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum 2010 Oct;53(10):1355-60.
  • Reference20 Ersoy E, Gündoğdu H. Cerrahi sonrası iyileşmenin hızlandırılması. Turk J Surg. 2007;23(1):035-40.
  • Reference21 Kadoi Y. Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus. J Anesth. 2010 Oct;24(5):739-47.
  • Reference22 Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009 Sep;111(3):657-77.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Surgical Science Research Articles
Authors

Sevgi Kesici 0000-0002-8276-6039

Ülkü Aygen Türkmen 0000-0002-7280-6420

Publication Date September 30, 2019
Acceptance Date September 25, 2019
Published in Issue Year 2019 Volume: 41 Issue: 3

Cite

AMA Kesici S, Türkmen ÜA. Anesthetists and surgeons in ensuring preoperative optimization. CMJ. September 2019;41(3):626-636. doi:10.7197/cmj.vi.585082