Journal articles: 'Preoperative health status'

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Chipchase, L. S., D. A. O'Connor, J. J. Costi, and J. Krishnan. "Shoulder impingement syndrome: Preoperative health status." Journal of Shoulder and Elbow Surgery 9, no. 1 (January 2000): 12–15. http://dx.doi.org/10.1016/s1058-2746(00)90003-x.

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Lai, Sean Wei Hong, Camelia Qian Ying Tang, Arjunan Edward Kumanan Graetz, and Gowreeson Thevendran. "Preoperative Mental Health Score and Postoperative Outcome After Hallux Valgus Surgery." Foot & Ankle International 39, no. 12 (September 1, 2018): 1403–9. http://dx.doi.org/10.1177/1071100718794661.

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Background: Preoperative mental health status as a predictor of operative outcome has been a growing area of interest. In this paper, the correlation between preoperative mental health status and postoperative functional outcome following scarf osteotomy for hallux valgus correction was explored. Methods: Parameters were tabulated preoperatively and postoperatively at a minimum of 1-year follow-up. They included the Short Form 36 (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) measurements and the visual analog score (VAS) to quantify pain. SF-36 mental component summary (MCS) score was used as a surrogate for patient’s mental health status. Seventy-six consecutive cases were analyzed at a minimum of 1-year follow-up. Results: There were significant improvements in all 8 domains of the SF-36, with the mean MCS score increasing from 52.3 ± 7.6 preoperatively to 55.7 ± 6.8 postoperatively. Preoperative MCS scores were not correlated to changes in AOFAS score, PCS score, VAS pain score, HVA or IMA. Preoperative MCS was observed to be correlated to postoperative AOFAS ( r = 0.381, P = .001) and PCS score ( r = 0.315, P = .006). Patients with a preoperative MCS score ⩾50 had a statistically higher postoperative AOFAS and PCS score than patients with MCS score <50. There was no correlation between preoperative MCS scores and improvements in radiologic parameters. There was also no correlation between the improvements in radiologic parameters and improvements in both the AOFAS and VAS pain scores. Conclusion: Preoperative mental health (as measured by the MCS score) was only correlated to postoperative functional outcome (as measured by the postoperative AOFAS and PCS score), but not other postoperative outcomes (VAS pain score, radiologic parameters). Level of Evidence: Level III, comparative study.

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Sahu, Manoj Kumar, Surbhi Dubey, Mahendra Kumar, and Rajesh Kumar Dubey. "Preoperative Mental Health Status of Living Kidney Donors." Journal of Evolution of Medical and Dental Sciences 9, no. 47 (November 23, 2020): 3547–50. http://dx.doi.org/10.14260/jemds/2020/778.

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MacPhedran, A. Kate, David B. Barker, Mark L. Marbey, Kieran Fogarty, and Eric Vangsnes. "Is Preoperative Functional Status Associated with Postoperative Mortality and Morbidity in Elective Open Heart Patients?" Health 10, no. 05 (2018): 654–66. http://dx.doi.org/10.4236/health.2018.105051.

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DiMaria-Ghalili, Rose Ann. "Changes in Nutritional Status and Postoperative Outcomes in Elderly CABG Patients." Biological Research For Nursing 4, no. 2 (October 2002): 73–84. http://dx.doi.org/10.1177/1099800402238330.

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To systematically examine the pattern of nutritional status over time in older people undergoing elective coronary artery bypass grafting (CABG) and the extent to which nutritional status affects health outcomes postdischarge. Design. The sample consisted of 91 community-dwelling English-speaking persons 65 (72.27 4.85) years of age with normal cognitive function and no active cancer. Data collected prospectively at 3 time points (preoperatively, postoperatively on day 5, and 4 to 6 weeks postdischarge) included serum albumin, transferrin, and calculated Body Mass Index (BMI). The Short-Form 36 Health Status Survey Questionnaire was administered 4 to 6 weeks postdischarge as a primary health outcome measure. Results. Nutritional status changed over time. For albumin and transferrin, the pattern of change corresponded to the phases of surgical stress (P = 0.001). The BMI decreased from preoperative to 4 to 6 weeks postdischarge (P = 0.001), and this decrease explained 13.8% of the variance in physical health 4 to 6 weeks postdischarge (P=0.008). The change in the BMI corresponds to an average weight loss of 5% from preoperative to postdischarge. Conclusions. Older people undergoing CABG who lose significant weight from preoperative to postdischarge aremore likely to have lower self-reported physical health.

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Meguid, Robert A., Michael R. Bronsert, Karl E. Hammermeister, David P. Kao, Anne Lambert-Kerzner, Jacob A. Sinex, Jody M. Myers, and William G. Henderson. "The Surgical Risk Preoperative Assessment System: Determining which predictor variables can be automatically obtained from the electronic health record." Journal of Patient Safety and Risk Management 24, no. 6 (September 24, 2019): 230–37. http://dx.doi.org/10.1177/2516043519876489.

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Introduction The Surgical Risk Preoperative Assessment System is a parsimonious, universal surgical risk calculator integrated into our local electronic health record. We determined how many of its eight preoperative risk predictor variables could be automatically obtained from the electronic health record. This has implications for the usability and adoption of Surgical Risk Preoperative Assessment System, serving as an example of use of electronic health record data for populating clinical decision support tools. Methods We quantified the availability and accuracy in the electronic health record of the eight Surgical Risk Preoperative Assessment System predictor variables (patient age, American Society of Anesthesiology physical status classification, functional health status, sepsis, work Relative Value Unit, in-/outpatient operation, surgeon specialty, emergency status) at the patient’s preoperative encounter of 5205 patients entered into the American College of Surgeons National Surgical Quality Improvement Program. Accuracy was determined by comparing the electronic health record data to the same patient’s National Surgical Quality Improvement Program data, used as the “gold standard.” Acceptable accuracy was defined as a Kappa statistic or Pearson correlation coefficient ≥0.8 when comparing electronic health record and National Surgical Quality Improvement Program data. Acceptable availability was defined as presence of the variable in the electronic health record at the preoperative encounter ≥95% of the time. Results Of the eight predictor variables, six had acceptable accuracy. Only preoperative sepsis and functional health status had Kappa statistics <0.8. However, only patient age and surgeon specialty were ≥95% available in the electronic health record at the preoperative visit. Conclusions Processes need to be developed to populate more of the Surgical Risk Preoperative Assessment System preoperative predictor variables in the patient’s electronic health record prior to the preoperative visit to lessen the burden on the busy surgeon and encourage more widespread use of Surgical Risk Preoperative Assessment System.

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HAHN, R. G., A. LÖFGREN, and A. M. NORDIN. "Health status and the preoperative change in serum potassium concentration." Acta Anaesthesiologica Scandinavica 37, no. 4 (May 1993): 329–33. http://dx.doi.org/10.1111/j.1399-6576.1993.tb03724.x.

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Albright, Emily L., Daniel L. Davenport, and J. Scott Roth. "Preoperative Functional Health Status Impacts Outcomes after Ventral Hernia Repair." American Surgeon 78, no. 2 (February 2012): 230–34. http://dx.doi.org/10.1177/000313481207800244.

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Associated with the aging population is an increase in comorbidities and a decrease in the ability to perform basic daily activities. This is tracked within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) as a patient's preoperative functional health status. Our goal was to evaluate the impact of preoperative functional status upon outcomes after ventral hernia repair. We reviewed all cases of patients that underwent ventral hernia repair from 2005 to 2010 in the ACS-NSQIP database. Patients were identified based on selected Current Procedural Terminology codes and grouped based on functional status as listed in the ACS-NSQIP database—independent, partially dependent, and totally dependent. Preoperative and operative variables were recorded for all patients. Clinical risk factors and short-term outcomes between groups were compared. Multivariable logistic regression was used to adjust for age, wound class, American Society of Anesthesiologists class, and case relative value units. A total of 76,397 patients were identified: 74,785 were independent (97.9%), 1,317 partially dependent (1.7%), and 295 totally dependent (0.4%). Totally dependent patients had an increased risk for all short-term outcomes after ventral hernia repair: wound occurrence, pneumonia, pulmonary embolism, urinary tract infection, myocardial infarction, deep venous thrombosis, sepsis, return to the operating room, and death ( P < 0.001 for all).

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Imamura, Kyoko, and Nick A. Black. "Total Hip Replacement: The Preoperative Health Status of Patients in Japan Compared with England and the United States." International Journal of Technology Assessment in Health Care 13, no. 1 (1997): 1–10. http://dx.doi.org/10.1017/s0266462300010187.

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AbstractTo explore the contribution of health care to the excellent health status enjoyed by the Japanese compared with other industrialized populations, the preoperative health status of a retrospective cohort of 256 patients who underwent total hip replacement in Japan was compared with 301 patients in England (and published data from the United States). Patients in Japan had less severe hip disease, less comorbidity (in particular, less cardiovascular disease), and were in better general health. This finding suggests that health care contributes little to explaining the better health of people in Japan compared with England and the United States.

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Sutherland, Jason, Guiping Liu, Trafford Crump, Matthew Bair, and Ahmer Karimuddin. "Relationship between preoperative patient-reported outcomes and hospital length of stay: a prospective cohort study of general surgery patients in Vancouver, Canada." Journal of Health Services Research & Policy 24, no. 1 (August 13, 2018): 29–36. http://dx.doi.org/10.1177/1355819618791634.

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Objectives As an aging population drives more demand for elective inpatient surgery, one approach to reducing length of stay is enhanced evaluation of patients’ preoperative health status. The objective of this research was to determine whether patient-reported outcome measures collected preoperatively can identify patients at risk for longer lengths of stay. Methods This study was based on a prospectively recruited cohort of patients who were scheduled for elective inpatient general surgery in Vancouver, Canada. All participants completed a number of patient-reported outcome measures preoperatively, including the EQ-5D for general health status, the Patient Health Questionnaire (PHQ-9) for depression, and the pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G), known as the PEG, for pain. Patient-reported outcome data were linked to hospital discharge summaries. Multivariate regression was performed to estimate risk of longer lengths of stay, adjusting for patient and clinical characteristics. The primary outcome was length of stay and its associated cost. Data collection took place between October 2012 and November 2016. Results Participation among the population of 2307 eligible patients was 50.5%, providing 1165 participants. Preoperative patient-reported outcomes were not concordant with hospital reported diagnoses of depression or pain. Patients’ preoperative depression and pain scores were independently positively associated with longer length of stay after adjusting for patient-level characteristics. Patients whose PHQ-9 score was 10, representing clinically significant depression, were estimated to have a 1.53 day longer hospitalization, which was associated with an estimated incremental hospital cost of $1667. Conclusions Preoperative self-reported assessment of depression and pain can assist with identifying patients at higher risk of longer lengths of stay. Patient’s self-reported preoperative measures of depression and pain should be incorporated into patient pathways. They provide opportunities for improving management of general surgery patients and possibly play a role in aligning hospital funding with patients’ needs.

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Hoeks, Sanne E., Wilma J. M. Scholte op Reimer, Yvette R. B. M. van Gestel, Kim G. Smolderen, Hence Verhagen, Ron T. van Domburg, Hero van Urk, and Don Poldermans. "Preoperative Cardiac Risk Index Predicts Long-term Mortality and Health Status." American Journal of Medicine 122, no. 6 (June 2009): 559–65. http://dx.doi.org/10.1016/j.amjmed.2008.10.041.

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Mayo, Benjamin C., Dustin H. Massel, Daniel D. Bohl, Ankur S. Narain, Fady Y. Hijji, William W. Long, Krishna D. Modi, Bryce A. Basques, Alem Yacob, and Kern Singh. "Preoperative mental health status may not be predictive of improvements in patient-reported outcomes following an anterior cervical discectomy and fusion." Journal of Neurosurgery: Spine 26, no. 2 (February 2017): 177–82. http://dx.doi.org/10.3171/2016.7.spine16472.

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OBJECTIVE Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF). METHODS A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014–2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed. RESULTS A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: −0.74, p < 0.001) and preoperative arm VAS score (−0.06, p = 0.026), but not preoperative neck VAS score (−0.03, p = 0.325) or SF-12 PCS score (0.04, p = 0.664). Additionally, there was no association between preoperative MCS score and improvement in NDI, neck VAS, arm VAS, or SF-12 PCS score at any of the postoperative time points (6 weeks, 12 weeks, and 6 months, p > 0.05 for each). The percentage of patients achieving a minimum clinically important difference at 6 months did not differ between the bottom and top MCS score halves (p > 0.05 for each). CONCLUSIONS The results of this study suggest that better preoperative mental health status is associated with lower perceived preoperative disability but is not associated with severity of preoperative neck or arm pain. In contrast to other studies, the present study was unable to demonstrate that preoperative mental health is predictive of improvement in patient-reported outcomes at any postoperative time point following an ACDF.

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Lee, Ji Yeon, Kwang Joon Kim, Chang Oh Kim, and Kyung Hee Lee. "RELATIONSHIP OF PREOPERATIVE COMPREHENSIVE GERIATRIC ASSESSMENT TO HEALTH STATUS IN OLDER ADULTS." Innovation in Aging 3, Supplement_1 (November 2019): S684. http://dx.doi.org/10.1093/geroni/igz038.2525.

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Abstract Although comprehensive geriatric assessment has been widely used in surgical older adults, its relationship to health status has not been fully identified. This study aimed to examine the relationships of preoperative comprehensive geriatric assessment to frailty and length of stay. This was a descriptive study based on multi-professional health assessments found in electronic medical records. Study participants were 150 older adults in a neurosurgical department. The comprehensive geriatric assessment was comprised of nutrition, functional status, physical activity, depression, cognition, and basic items such as the Timed Up and Go test, grip strength, and self-rated health. Frailty level and length of stay were dependent variables which represented health status. The result showed that instrumental activities of daily living, physical activity, nutrition, self-rated health, and cognition were significantly associated with frailty. Specifically, comparing robustness with pre-frail and frail level, worseness in the instrumental activities of daily living, self-rated health, physical activity, and nutrition were associated with frailty. With progression of frailty level from pre-frail to frail, the worse score in the cognitive function and self-rated health were associated with frailty. In addition, more depressive symptoms, postoperative complications, and prolonged in the Timed Up and Go test were associated with lengthened hospital stay. Older adults with worsened status in physical, emotional, or cognitive function tended to be frail and stay longer in the hospital. Clinicians need to pay attention to the subcomponents of the comprehensive geriatric assessment and are encouraged to implement it to improve health status of surgical older adults.

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Richard, Heather M., Shelby P. Cerza, Adriana De La Rocha, and David A. Podeszwa. "Preoperative mental health status is a significant predictor of postoperative outcomes in adolescents treated with hip preservation surgery." Journal of Children's Orthopaedics 14, no. 4 (August 1, 2020): 259–65. http://dx.doi.org/10.1302/1863-2548.14.200013.

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Purpose This study was designed to evaluate predictive factors that influence pain, mental health symptoms and postoperative outcomes at six-months post-hip preservation surgery (HPS) in adolescent surgical candidates. Methods In total, 58 HPS candidates (39 female, 19 male; mean age 15.53 years (10 to 19)) were evaluated. Diagnoses included: acetabular dysplasia (34); idiopathic femoroacetabular impingement (15); Perthes disease (six); avascular necrosis (six); and slipped capital femoral epiphysis (six). All patients underwent periacetabular osteotomy (36), surgical hip dislocation (17) or arthroscopy (five). Patients completed the following: Numerical Pain Rating Scale (NPRS); Child Health Questionnaire-87 (CHQ-87); Pediatric Symptom Checklist-Youth (PSC-Y), preoperatively and six months postoperatively. A single psychologist assessed patients in clinics and one to two additional appointments. Results In all, 78% of patients reported one to three years of pain prior to HPS (modified Harris hip score). All pain scores (NPRS) significantly decreased at six months postoperatively. Preoperative mental health scores (CHQ-87) significantly predicted postoperative pain scores (F(1, 57) = 4.07; p < 0.048; R2 = 0.068). Mental health symptoms (PSC-Y) decreased significantly (p < 0.001). Patients who were seen by a psychologist two or more times reported better six-month postoperative outcomes than those seen once: usual pain (NPRS; p = 0.012); patient-reported physical function (CHQ-87; p = 0.029); and mental health (PSC-Y; p = 0.019). HPS patients seen ≥ 60 days prior to surgery showed marked improvements at six months compared with patients seen < 60 days prior to surgery. Conclusion HPS candidates evaluated preoperatively by psychology, as part of an integrated treatment approach, demonstrated statistically significant improvements in pain, health-related quality of life and mental health symptoms. Two+ visits, more than 60 days prior to surgery appears to be impactful. Preoperative pain and mental health symptoms were predictive of postoperative pain. Level of Evidence: II

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O???Connor, Daniel P., Mark R. Brinker, and G. William Woods. "Preoperative Health Status of Patients With Four Knee Conditions Treated With Arthroscopy." Clinical Orthopaedics and Related Research 395 (February 2002): 164–73. http://dx.doi.org/10.1097/00003086-200202000-00018.

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Cnudde, Peter, Szilard Nemes, Maziar Mohaddes, John Timperley, Göran Garellick, Kristina Burström, and Ola Rolfson. "Is Preoperative Patient-Reported Health Status Associated with Mortality after Total Hip Replacement?" International Journal of Environmental Research and Public Health 14, no. 8 (August 10, 2017): 899. http://dx.doi.org/10.3390/ijerph14080899.

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Isik, Ozgen, Nuri Okkabaz, Jeffrey Hammel, Feza H. Remzi, and Emre Gorgun. "Preoperative functional health status may predict outcomes after elective colorectal surgery for malignancy." Surgical Endoscopy 29, no. 5 (August 27, 2014): 1051–56. http://dx.doi.org/10.1007/s00464-014-3777-2.

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Gotlin, Matthew J., Samuel Baron, Matthew T. Kingery, Joseph McCafferty, Medical Student, Laith M. Jazrawi, and Robert J. Meislin. "Recall Bias in Retrospective Assessment of Preoperative Patient Reported Outcomes." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0033. http://dx.doi.org/10.1177/2325967119s00339.

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Objectives: Patient reported outcomes (PROs) are measures of function, disability, and health status that may offer a unique assessment of provider quality and performance. The gold-standard method for collecting PROs is the prospective assessment of preoperative to postoperative change. This requires data collection before an intervention and then again after the intervention. This method is not always feasible due to unforeseen cases or emergencies, logistical and infrastructure barriers, and cost issues. In such cases a retrospective approach serves as a potential alternative. In this model, a patient is asked to complete an assessment about their perceived preoperative status during a time period sometime after the surgery. Although this method has its advantages, there is a particular risk of recall bias. There are conflicting conclusions regarding the reliability of the recalled preoperative PROs after orthopedic procedures. The aim of our study was to assess the agreement between prospectively and retrospectively collected PROs for a common, low-risk procedure. Methods: Patients that underwent arthroscopic rotator cuff repair between May 2012 and September 2017 at the study institution were identified. Inclusion criteria consisted of primary arthroscopic rotator cuff repair and preoperative prospectively collected American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form (ASES) scores. All of the patients completed the ASES form preoperatively at their pre-assessment appointment. Patients were then contacted in the postoperative period and asked to recall their preoperative condition while completing another ASES form. Results: Seventy-one patients were included in this analysis (mean age 56.18 ± 10.48 years). The mean duration of symptoms from initial onset to the time of surgery was 8.54 ± 9.28 months. There was an average of 37.53 ± 17.02 months between the preoperative ASES and the recall ASES. Recall ASES scores were significantly lower than preoperative ASES scores (31.65 ± 16.87 vs 50.92 ± 19.57, p < 0.001). Less severe preoperative shoulder dysfunction was predictive of a greater difference between preoperative ASES and recall ASES (β = -0.60, R2 = 0.350, p < 0.001) (see Figure). Each 10-point increase in preoperative ASES score was predictive of a 6.04 point greater mismatch between preoperative and recall ASES. Likewise, a longer symptomatic period prior to surgery was associated with a greater ASES mismatch (R2 = 0.063, p = 0.029). The duration of time between surgery and recall was not a significant predictor of a difference between preoperative and recall ASES. Conclusion: This study demonstrated that there is poor agreement between prospectively and retrospectively collected preoperative PROs in the setting of rotator cuff surgery. Patient’s recalled ASES scores were significantly lower than their prospectively recorded ASES scores. This could lead to an overestimation of perceived benefit or effectiveness of the intervention. Our data supports prior studies that demonstrated that retrospective PROs are subject to recall bias and have been found to produce more favorable results than prospectively monitored health status data from the same patient. Our study supports the use of prospectively collected PROs and retrospective PROs should only be used in situations where baseline assessments are not possible.

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Decerle, Nicolas, Pierre-Yves Cousson, Emmanuel Nicolas, and Martine Hennequin. "A Comprehensive Approach Limiting Extractions under General Anesthesia Could Improve Oral Health." International Journal of Environmental Research and Public Health 17, no. 19 (October 8, 2020): 7336. http://dx.doi.org/10.3390/ijerph17197336.

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Access to dental treatment could be difficult for some patients due to dental phobia or anxiety, cognitive or sensorial disabilities, systemic disorders, or social difficulties. General anesthesia (GA) was often indicated for dental surgery, and there is almost no available data on adapted procedures and materials that can be applied during GA for maintaining functional teeth on the arches and limiting oral dysfunctions. This study evaluates changes in oral health-related quality of life and mastication in a cohort of uncooperative patients treated under GA according to a comprehensive and conservative dental treatment approach. Dental status, oral health-related quality of life, chewed bolus granulometry, kinematic parameters of mastication, and food refusals were evaluated one month preoperatively (T0), and then one month (T1) and six months post-operatively (T2). One hundred and two adult patients (mean age ± SD: 32.2 ± 9.9 years; range: 18–57.7) participated in the preoperative evaluation, 87 were treated under GA of which 36 participated in the evaluation at T1 and 15 were evaluated at T2. Preoperative and postoperative data comparisons demonstrated that oral rehabilitation under GA helped increase chewing activity and oral health-related quality of life. The conditions for providing dental treatment under GA could be arranged to limit dental extractions in uncooperative patients.

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Palsgrove, Andrew, Chad Patton, Paul King, Jeffrey Gelfand, and Justin Turcotte. "A comparison of PROMIS Global Health-Mental and legacy orthopedic outcome measures for evaluating preoperative mental health status." Journal of Orthopaedics 19 (May 2020): 98–101. http://dx.doi.org/10.1016/j.jor.2019.11.032.

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Ventola, H., N. Saarinen, J. Jokelainen, A. Grönholm, T. Ylisaukko-oja, and K. Halonen. "Preoperative Smoking Cessation: Recording of Smoking Status in the Porvoo Hospital Area in Finland." Value in Health 20, no. 9 (October 2017): A653. http://dx.doi.org/10.1016/j.jval.2017.08.3049.

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Marsh, Jackie, Dianne Bryant, and Steven J. MacDonald. "Older Patients Can Accurately Recall Their Preoperative Health Status Six Weeks Following Total Hip Arthroplasty." Journal of Bone and Joint Surgery-American Volume 91, no. 12 (December 2009): 2827–37. http://dx.doi.org/10.2106/jbjs.h.01415.

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Mathisen, Lars, Marit Helen Andersen, Per Kristian Hol, Bjørn Tennøe, Christian Lund, David Russell, Runar Lundblad, et al. "Preoperative cerebral ischemic lesions predict physical health status after on-pump coronary artery bypass surgery." Journal of Thoracic and Cardiovascular Surgery 130, no. 6 (December 2005): 1691–97. http://dx.doi.org/10.1016/j.jtcvs.2005.08.008.

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Simon, Kathleen, Melissa Helm, Rana Higgins, Tammy Kindel, and Jon Gould. "Preoperative Functional Health Status is a Predictor of Postoperative Morbidity and Mortality following Bariatric Surgery." Surgery for Obesity and Related Diseases 13, no. 10 (October 2017): S182—S183. http://dx.doi.org/10.1016/j.soard.2017.09.404.

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Jaiswal, Parag, Pam Railton, Hoa Khong, Christopher Smith, and James Powell. "Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty." Canadian Journal of Surgery 6, no. 5 (October 1, 2019): 300–304. http://dx.doi.org/10.1503/cjs.013718.

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Salvetti, David J., Zachary J. Tempel, Ezequiel Goldschmidt, Nicole A. Colwell, Federico Angriman, David M. Panczykowski, Nitin Agarwal, Adam S. Kanter, and David O. Okonkwo. "Low preoperative serum prealbumin levels and the postoperative surgical site infection risk in elective spine surgery: a consecutive series." Journal of Neurosurgery: Spine 29, no. 5 (November 2018): 549–52. http://dx.doi.org/10.3171/2018.3.spine171183.

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OBJECTIVENutritional deficiency negatively affects outcomes in many health conditions. In spine surgery, evidence linking preoperative nutritional deficiency to postoperative surgical site infection (SSI) has been limited to small retrospective studies. Authors of the current study analyzed a large consecutive cohort of patients who had undergone elective spine surgery to determine the relationship between a serum biomarker of nutritional status (preoperative prealbumin levels) and SSI.METHODSThe authors conducted a retrospective review of the electronic medical charts of patients who had undergone posterior spinal surgeries and whose preoperative prealbumin level was available. Additional data pertinent to the risk of SSI were also collected. Patients who developed a postoperative SSI were identified, and risk factors for postoperative SSI were analyzed. Nutritional deficiency was defined as a preoperative serum prealbumin level ≤ 20 mg/dl.RESULTSAmong a consecutive series of 387 patients who met the study criteria for inclusion, the infection rate for those with preoperative prealbumin ≤ 20 mg/dl was 17.8% (13/73), versus 4.8% (15/314) for those with preoperative prealbumin > 20 mg/dl. On univariate and multivariate analysis a low preoperative prealbumin level was a risk factor for postoperative SSI with a crude OR of 4.29 (p < 0.01) and an adjusted OR of 3.28 (p = 0.02). In addition, several previously known risk factors for infection, including diabetes, spinal fusion, and number of operative levels, were significant for the development of an SSI.CONCLUSIONSIn this consecutive series, preoperative prealbumin levels, a serum biomarker of nutritional status, correlated with the risk of SSI in elective spine surgery. Prehabilitation before spine surgery, including strategies to improve nutritional status in patients with nutritional deficiencies, may increase value and improve spine care.

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Goel, Vivek, and Allan S. Detsky. "A Cost-Utility Analysis of Preoperative Total Parenteral Nutrition." International Journal of Technology Assessment in Health Care 5, no. 2 (April 1989): 183–94. http://dx.doi.org/10.1017/s0266462300006413.

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It has been suggested that preoperative total parentetal nutrition may be used to reduce the risk of nutrition-associated postoperative complications in high-risk patients. These patients can be identified based on their nutritional status. The efficiency of this intervention is assessed using the technique of cost-utility analysis. Data from multiple sources is integrated to perform the economic assessment.The cost-utility ratios for treating several malnourished patients with localized upper gastrointestinal cancer are below $40,000. These cost-utility ratios compare favorably with published results of other programs. The ratios increase considerably if patients who are better nourished (at lower risk of postoperative complication) receive the intervention. The analysis is very sensitive to the efficacy of the intervention.

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Jones, C. Allyson, Donald C. Voaklander, and Maria E. Suarez-Almazor. "Determinants of Function After Total Knee Arthroplasty." Physical Therapy 83, no. 8 (August 1, 2003): 696–706. http://dx.doi.org/10.1093/ptj/83.8.696.

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Abstract Background and Purpose. Decreasing hospital stays for patients with total knee arthroplasties (TKAs) have a direct effect on rehabilitation. The identification of modifiable determinants of postsurgical functional status would help physical therapists plan for discharge from hospitals. The purpose of this study was to identify preoperative determinants of functional status after a TKA. Participants. Using a community-based, prospective cohort study, data were collected from 276 patients who received a primary TKA in a Canadian health care region. Data were collected in the month before surgery and 6 months after surgery. Methods. Function was measured using the function subscale of a disease-specific measure—the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index—and a generic health status measure—the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Independent variables examined included demographic variables (eg, age, sex), medical variables (eg, diagnosis, number of comorbid conditions, ambulatory status), surgical variables (eg, type of implant, number of complications), and knee range of motion. Results. At 6 months after surgery, the average WOMAC physical function score was 70.5 (SD=18.2) and the average SF-36 physical function score was 44.8 (SD=25.3). Using multiple regression analyses, baseline function, walking device, walking distance, and comorbid conditions predicted 6-month function (WOMAC: R2=.20; SF-36 physical function: R2=.27). Discussion and Conclusion. Patients who have lower preoperative function may require more intensive physical therapy intervention because they are less likely to achieve functional outcomes similar to those of patients who have less preoperative dysfunction.

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Anderson, Paul A., Aamir Kadri, Kristyn J. Hare, and Neil Binkley. "Preoperative bone health assessment and optimization in spine surgery." Neurosurgical Focus 49, no. 2 (August 2020): E2. http://dx.doi.org/10.3171/2020.5.focus20255.

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OBJECTIVEThe purpose of this investigation was to characterize the bone health in preoperative spine surgery patients. This information will provide a framework to understand the needs and methods for providing bone health optimization in elective spine surgery patients.METHODSA retrospective study of 104 patients undergoing bone health optimization was performed. Patients were selected based on risk factors identified by the surgeon and suspected compromised bone health. Evaluation included history and examination, laboratory investigations, and bone mineral density (BMD) at 3 sites (femoral neck, lumbar spine, and radius). Patients’ bone status was classified using WHO criteria and expanded criteria recommended by the National Osteoporosis Foundation (NOF). The 10-year Fracture Risk Assessment Tool (FRAX) scores of the hip and major osteoporotic fracture (MOF) were calculated with and without femoral neck BMD, with spine BMD, and with the trabecular bone score (TBS). Antiresorptive and anabolic agents were provided in accordance with meeting NOF criteria for treatment of osteoporosis.RESULTSThe mean patient age was 69.0 years, and 81% of patients were female. The mean historical height loss was 5.6 cm, and 54% of patients had a history of fracture. Secondary osteoporosis due to chronic renal failure, inflammatory arthritis, diabetes, and steroid use was common (51%). The mean 25-hydroxy vitamin D was 42.4 ng/ml and was normal in 81% of patients, with only 4 patients being deficient. The mean T-scores were −2.09 (SD 0.71) of the femoral neck, −0.54 (1.71) of the lumbar spine, and −1.65 (1.38) of the distal radius. These were significantly different. The 10-year FRAX MOF score was 20.7%, and that for hip fracture was 6.9% using the femoral neck BMD and was not significantly different without the use of BMD. The FRAX risk-adjusted score using the lumbar spine BMD and TBS was significantly lower than that for the hip. Osteoporosis was present in 32.1% according to WHO criteria compared with 81.6% according to NOF criteria. Antiresorptive medications were recommended in 31 patients and anabolic medications in 44 patients.CONCLUSIONSSurgeons can reliably identify patients with poor bone health by using simple criteria, including historical height loss, history of fracture, comorbidities associated with osteoporosis, analysis of available imaging, and calculation of FRAX score without BMD. High-risk patients should have BMD testing and bone health assessment. In patients with osteoporosis, a comprehensive preoperative bone health assessment is recommended and, if warranted, pharmacological treatment should be started.

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Vereščiagina, Kotryna, Kazys Ambrozaitis, and Bronius Špakauskas. "Health-related quality-of-life assessment in patients with low back pain using SF-36 questionnaire." Medicina 43, no. 8 (June 19, 2007): 607. http://dx.doi.org/10.3390/medicina43080077.

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Objective. For complete assessment of benefits of the surgical intervention, it is essential to provide evidence of the impact on patients in terms of health status and healthrelated quality of life. In the present study, the preoperative 36-item Short Form (SF-36) Health Survey scores were determined in patients before lumbar microdiscectomy due to better preoperative screening likewise in the control group – almost healthy population taken into account any habitual ailments experienced in an appropriate age. Patients and methods. In the present study, we investigated a cohort of 100 patients with disc herniation causing low back pain and another hundred of the control subjects, matched by age and gender. The short form 36 general health questionnaire (SF-36) was applied. Results. Estimation of the SF-36 scores showed that (1) all of the domain values were considerably lower in the preoperative patient group than in the second one (P<0.01); (2) the bodily pain scores were closely correlated to the social function scores (R=0.7, P<0.01), whereas the physical function was less related to the bodily pain (R=0.6, P<0.01). The weakest correlation was observed between bodily pain and mental health and general health (R=0.4, P<0.01). Conclusion. The present study showed that the generic instrument, SF-36 Health Survey, was optimized paraclinical method for patients predisposed to surgical treatment of the lumbar disc herniation disease likewise for normal population individuals, matched by age and sex, in the assessment of health-related quality of life.

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Ferguson, Rory, Daniel Prieto-Alhambra, George Peat, Antonella Delmestri, Kelvin P. Jordan, Vicky Y. Strauss, Jose Maria Valderas, et al. "Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England." BMJ Open 11, no. 9 (September 2021): e046712. http://dx.doi.org/10.1136/bmjopen-2020-046712.

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Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear.ObjectiveTo evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA.SettingLongitudinal record linkage study of a UK sample linking their primary care to their secondary care records.ParticipantsA total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA.Outcome measures(1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score.ResultsPerioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories.ConclusionsIndependent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.

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Strömqvist, Fredrik, Björn Strömqvist, Bo Jönsson, Paul Gerdhem, and Magnus K. Karlsson. "Predictive outcome factors in the young patient treated with lumbar disc herniation surgery." Journal of Neurosurgery: Spine 25, no. 4 (October 2016): 448–55. http://dx.doi.org/10.3171/2016.2.spine16136.

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OBJECTIVE The aim of this study was to evaluate predictive factors for outcome after lumbar disc herniation surgery in young patients. METHODS In the national Swedish spine register, the authors identified 180 patients age 20 years or younger, in whom preoperative and 1-year postoperative data were available. The cohort was treated with primary open surgery due to lumbar disc herniation between 2000 and 2010. Before and 1 year after surgery, the patients graded their back and leg pain on a visual analog scale, quality of life by the 36-Item Short-Form Health Survey and EuroQol–5 Dimensions, and disability by the Oswestry Disability Index. Subjective satisfaction rate was registered on a Likert scale (satisfied, undecided, or dissatisfied). The authors evaluated if age, sex, preoperative level of leg and back pain, duration of leg pain, pain distribution, quality of life, mental status, and/or disability were associated with the outcome. The primary end point variable was the grade of patient satisfaction. RESULTS Lumbar disc herniation surgery in young patients normalizes quality of life according to the 36-Item Short-Form Health Survey, and only 4.5% of the patients were unsatisfied with the surgical outcome. Predictive factors for inferior postoperative patient-reported outcome measures (PROM) scores were severe preoperative leg or back pain, low preoperative mental health, and pronounced preoperative disability, but only low preoperative mental health was associated with inferiority in the subjective grade of satisfaction. No associations were found between preoperative duration of leg pain, distribution of pain, or health-related quality of life and the postoperative PROM scores or the subjective grade of satisfaction. CONCLUSIONS Lumbar disc herniation surgery in young patients generally yields a satisfactory outcome. Severe preoperative pain, low mental health, and severe disability increase the risk of reaching low postoperative PROM scores, but are only of relevance clinically (low subjective satisfaction) for patients with low preoperative mental health.

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Čada, Zdeněk, Zuzana Balatková, Martin Chovanec, Ondřej Čakrt, Silvie Hrubá, Jaroslav Jeřábek, Eduard Zvěřina, et al. "Vertigo Perception and Quality of Life in Patients after Surgical Treatment of Vestibular Schwannoma with Pretreatment Prehabituation by Chemical Vestibular Ablation." BioMed Research International 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/6767216.

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Surgical removal of vestibular schwannoma causes acute vestibular symptoms, including postoperative vertigo and oscillopsia due to nystagmus. In general, the dominant symptom postoperatively is vertigo. Preoperative chemical vestibular ablation can reduce vestibular symptoms postoperatively. We used 1.0 mL of 40 mg/mL nonbuffered gentamicin in three intratympanic installations over 2 days, 2 months preoperatively in 10 patients. Reduction of vestibular function was measured by the head impulse test and the caloric test. Reduction of vestibular function was found in all gentamicin patient groups. After gentamicin vestibular ablation, patients underwent home vestibular exercising for two months. The control group consisted of 10 patients who underwent only home vestibular training two months preoperatively. Postoperative rates of recovery and vertigo in both groups were evaluated with the Glasgow Benefit Inventory (GBI), the Glasgow Health Status Inventory (GHSI), and the Dizziness Handicap Inventory questionnaires, as well as survey of visual symptoms by specific questionnaire developed by us. There were no statistically significant differences between both groups with regard to the results of questionnaires. Patients who received preoperative gentamicin were more resilient to optokinetic and optic flow stimulation (p<0.05). This trial is registered with clinical study registration number NCT02963896.

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Yasui, Kazuaki, Ryota Kondou, Akira Iizuka, Haruo Miyata, Emiko Tanaka, Tadashi Ashizawa, Takeshi Nagashima, et al. "Effect of preoperative chemoradiotherapy on the immunological status of rectal cancer patients." Journal of Radiation Research 61, no. 5 (July 16, 2020): 766–75. http://dx.doi.org/10.1093/jrr/rraa041.

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Abstract The aim of the study was to investigate the effect of chemo-radiation on the genetic and immunological status of rectal cancer patients who were treated with preoperative chemoradiotherapy (CRT). The expression of immune response-associated genes was compared between rectal cancer patients treated (n = 9) and not-treated (n = 10) with preoperative CRT using volcano plot analysis. Apoptosis and epithelial-to-mesenchymal transition (EMT) marker genes were analysed by quantitative PCR (qPCR). Other markers associated with the tumor microenvironment (TME), such as tumor-infiltrating lymphocytes (TIL) and immune checkpoint molecules, were investigated using immunohistochemistry (IHC). The clinical responses of preoperative CRT for 9 rectal cancer patients were all rated as stable disease, while the pathological tumor regression score (TRG) revealed 6 cases of grade2 and 3 cases of grade1. According to the genetic signature of colon cancers, treated tumors belonged to consensus molecular subtype (CMS)4, while not-treated tumors had signatures of CMS2 or 3. CRT-treated tumors showed significant upregulation of EMT-associated genes, such as CDH2, TGF-beta and FGF, and cancer stem cell-associated genes. Additionally, qPCR and IHC demonstrated a suppressive immunological status derived from the upregulation of inflammatory cytokines (IL-6, IL-10 and TGF-beta) and immune checkpoint genes (B7-H3 and B7-H5) and from M2-type macrophage accumulation in the tumor. The induction of EMT and immune-suppressive status in the tumor after strong CRT treatment urges the development of a novel combined therapy that restores immune-suppression and inhibits EMT, ultimately leading to distant metastasis control.

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Kato, Minori, Takashi Namikawa, Akira Matsumura, Sadahiko Konishi, and Hiroaki Nakamura. "Effect of Cervical Sagittal Balance on Laminoplasty in Patients With Cervical Myelopathy." Global Spine Journal 7, no. 2 (April 2017): 154–61. http://dx.doi.org/10.1177/2192568217694011.

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Study Design: Retrospective clinical study. Objective: We evaluated the relationship between cervical sagittal alignment parameters and clinical status in patients with cervical myelopathy and analyzed the effect of cervical sagittal balance on cervical laminoplasty. Methods: Patients with cervical myelopathy (n = 110) who underwent laminoplasty were included in this study. The relationship between cervical sagittal alignment parameters and clinical status was evaluated. The changes in radiographic cervical sagittal parameters and clinical status 2 years after surgery were compared between patients with preoperative C2-7 SVA ≥35 mm (group A) and those with preoperative C2-7 SVA <35 mm (group B). Results: Preoperatively, C2-7 SVA had no correlation with defined health-related quality of life evaluation scores. At 2-year follow-up, the improvement in SF-36 physical component summary was significantly lower in group A than in group B. The postoperative change of C2-7 SVA did not significantly differ in 2 groups. Patients in group A maintained cervical regional balance after laminoplasty but experienced extensive postoperative neck pain. Conclusions: Our patients with a C2-7 SVA of ≥35 mm maintained cervical regional balance after laminoplasty and their improvement in myelopathy was equivalent to that in patients with a C2-7 SVA of <35 mm. However, the patents with a C2-7 SVA of ≥35 mm experienced severe postoperative neck pain. C2-7 SVA is a parameter worth considering because it can lead to poor QOL and axial neck pain after laminoplasty.

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Usuda, Katsuo, Motoyasu Sagawa, Nozomu Motono, Masakatsu Ueno, Makoto Tanaka, Yuichiro Machida, Munetaka Matoba, et al. "Relationships between EGFR Mutation Status of Lung Cancer and Preoperative Factors - Are they Predictive?" Asian Pacific Journal of Cancer Prevention 15, no. 2 (January 30, 2014): 657–62. http://dx.doi.org/10.7314/apjcp.2014.15.2.657.

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Quinn, David I., Susan M. Henshall, Anne-Maree Haynes, Phillip C. Brenner, Raji Kooner, David Golovsky, Jayne Mathews, et al. "Prognostic Significance of Pathologic Features in Localized Prostate Cancer Treated With Radical Prostatectomy: Implications for Staging Systems and Predictive Models." Journal of Clinical Oncology 19, no. 16 (August 15, 2001): 3692–705. http://dx.doi.org/10.1200/jco.2001.19.16.3692.

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PURPOSE: Although predicting outcome for men with clinically localized prostate cancer (PC) has improved, the staging system and nomograms used to do this are based on results from the North American health system. To be internationally applicable, these models require testing in cohorts from a variety of different health systems based on the predominant PC case identification methods used. PATIENTS AND METHODS: We studied 732 men with localized PC treated with radical prostatectomy and no preoperative therapy between 1986 and 1999 at one Australian institution to determine the effect of clinicopathologic features on disease-free survival. RESULTS: Preoperative serum prostate-specific antigen (PSA) concentration, Gleason score, pathologic stage, and year of surgery were independent predictors of outcome. Although margin status demonstrated only a trend toward significance in multivariate modeling overall, it proved to be independent in subgroups based on later year of surgery (1986 to 1994 v 1995 to 1998), preoperative PSA of less than 10 ng/mL, and Gleason score ≥ 7. Adjuvant radiation therapy improved disease-free survival rates in patients with multiple surgical margin involvement. CONCLUSION: This work confirms the prognostic significance of pathologic stage, Gleason score, and preoperative serum PSA. In the context of a contemporaneous screening effect in Australia, these findings may have implications for methods that predict outcome following surgery as screening becomes more prevalent in a population. The independent prognostic effect of margin status may alter with an increase in the proportion of screening-identified PCs. Staging systems and nomograms that predict outcome following surgery require validation in cohorts with different health practices before being universally applied.

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Tolk, Jaap J., Rob P. A. Janssen, Tsjitske M. Haanstra, Marieke M. C. van der Steen, Sita M. A. Bierma Zeinstra, and M. Reijman. "Outcome Expectations of Total Knee Arthroplasty Patients: The Influence of Demographic Factors, Pain, Personality Traits, Physical and Psychological Status." Journal of Knee Surgery 33, no. 10 (July 4, 2019): 1034–40. http://dx.doi.org/10.1055/s-0039-1692632.

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AbstractUnfulfilled preoperative expectations have a strong influence on the outcome after total knee arthroplasty (TKA). More insight into determinants of the level of expectations is useful in identifying patients at risk for having expectations of the treatment result that are too high or too low. This information can be used in optimizing preoperative expectation management. The aim of the current study was to analyze to what extent preoperative outcome expectations of TKA patients are affected by psychological factors, demographic factors, pain, physical function, and general health status. We performed a cross-sectional analysis of 204 patients with symptomatic and radiographic knee osteoarthritis (OA), scheduled for primary TKA. Outcome expectations were measured using the hospital for special surgery knee replacement expectations survey. Independent variables included were age, sex, body mass index, and patient-reported outcome measures for pain, physical function, quality of life, anxiety, depression, catastrophizing, optimism, and pessimism. Multiple linear regression analyses were used to evaluate associations between these variables and preoperative outcome expectations. Female sex, higher age, higher depression score, and duration of complaints > 50 months showed to be significant predictors of lower expectations for the treatment outcome after TKA. Baseline pain and function scores were not related to the level of preoperative expectations. The present study aids in identifying patients at risk for having either too high or too low expectations. This knowledge can be utilized in individualized expectation management interventions.

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Söderlund, Fredrik, Håkan Wåhlander, Emma C. Hansson, and Birgitta S. Romlin. "Preoperative heart failure is not associated with impaired coagulation in paediatric cardiac surgery." Cardiology in the Young 31, no. 6 (February 8, 2021): 979–84. http://dx.doi.org/10.1017/s1047951120005004.

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AbstractObjective:The objectives of the present study were to determine whether there was any association between the grade of heart failure, as expressed by preoperative levels of brain natriuretic peptide and Ross score, and the preoperative coagulation status in patients with non-restrictive ventricular shunts and determine whether there were any postoperative disturbances of the coagulation system in these patients, as measured by thromboelastometry and standard laboratory analyses of coagulation.Design:Perioperative coagulation was analysed with laboratory-based coagulation tests and thromboelastometry before, 8 hours after, and 18 hours after cardiac surgery. In addition, brain natriuretic peptide was analysed before and 18 hours after surgery.Patients:40 children less than 12 months old with non-restrictive congenital ventricular or atrio-ventricular shunts scheduled for elective repair of their heart defects.Results:All coagulation parameters measured were within normal ranges preoperatively. There was a significant correlation between brain natriuretic peptide and plasma fibrinogen concentration preoperatively. There was no statistically significant correlation between brain natriuretic peptide and INTEM-MCF, FIBTEM-MCF, plasma fibrinogen, activated partial thromboplastin time, prothrombin time, or platelet count at any other time point, either preoperatively or postoperatively. Postoperatively, fibrinogen plasma concentration and FIBTEM-MCF decreased significantly at 8 hours, followed by a large increase at 18 hours to higher levels than preoperatively.Conclusions:There was no evidence of children with non-restrictive shunts having coagulation abnormalities before cardiac surgery. Brain natriuretic peptide levels or Ross score did not correlate with coagulation parameters in any clinically significant way.

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Reponen, Elina, Miikka Korja, and Hanna Tuominen. "Simple Preoperative Patient-Reported Factors Predict Adverse Outcome After Elective Cranial Neurosurgery." Neurosurgery 83, no. 2 (July 28, 2017): 197–202. http://dx.doi.org/10.1093/neuros/nyx385.

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Abstract BACKGROUND Patient-reported preoperative factors hold promise in improving the prediction of postoperative adverse events, but they have been poorly studied. OBJECTIVE To study the role of patient-reported factors in the preoperative risk stratification of elective craniotomy patients. METHODS A prospective, unselected cohort of 322 adult patients underwent elective craniotomy in Helsinki, Finland. We preoperatively recorded the American Society of Anesthesiologists (ASA) score, Helsinki ASA score, and 3 questionnaire-based patient-reported factors including overall health status, ability to climb 2 flights of stairs, and cognitive function (Test Your Memory test). Outcome measures comprised in-hospital major and overall morbidity. Receiver-operating characteristic curves served to calculate area under the curve (AUC) values for a composite score of patient-reported factors and both ASA scores with regard to outcomes. RESULTS In-hospital major and overall morbidity rate was 15.2%. Only preoperatively diminished cognitive function remained a significant predictor of major morbidity after multivariable logistic regression analysis (P < .001, odds ratio 1.1, confidence interval 1.0-1.1). A composite score of our 3 patient-reported factors had a higher AUC (0.675) for major morbidity than original ASA score (0.543) or Helsinki ASA score (0.572). In elderly patients, the composite score had an AUC of 0.726 for major morbidity. CONCLUSION Preoperative patient-reported factors had higher sensitivity for detecting major morbidity compared to the ASA scores in this study. Particularly, the simple composite score seems to predict adverse outcomes in elective cranial surgery surprisingly well, especially in the elderly. These results are interesting and worth confirming in other centers.

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Ackermann, Jakob, Takahiro Ogura, Robert A. Duerr, Alexandre Barbieri Mestriner, and Andreas H. Gomoll. "Preoperative Mental Health Has a Stronger Association with Baseline Self-Assessed Knee Scores than Defect Morphology in Patients Undergoing Cartilage Repair." CARTILAGE 11, no. 3 (July 4, 2018): 309–15. http://dx.doi.org/10.1177/1947603518783484.

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ObjectiveThe purpose of this study was to assess potential correlations between the mental component summary of the Short Form–12 (SF-12 MCS), patient characteristics or lesion morphology, and preoperative self-assessed pain and function scores in patients undergoing autologous chondrocyte implantation (ACI).DesignA total of 290 patients underwent ACI for symptomatic cartilage lesions in the knee. One hundred and seventy-eight patients were included in this study as they completed preoperative SF-12, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. Age, sex, smoker status, body mass index, Worker’s Compensation, previous surgeries, concomitant surgeries, number of defects, lesion location in the patella, and total defect size were recorded for each patient. Pearson’s correlation and multivariate regression models were used to distinguish associations between these factors and preoperative knee scores.ResultsThe SF-12 MCS showed the strongest bivariate correlation with all KOOS subgroups ( P < 0.001) (except KOOS Symptom; P = 0.557), Tegner ( P = 0.005), Lysholm ( P < 0.001), and IKDC scores ( P < 0.001). In the multivariate regression models, the SF-12 MCS showed the strongest association with all KOOS subgroups ( P < 0.001) (except KOOS Symptom; P = 0.91), Lysholm ( P = 0.001), Tegner ( P = 0.017), and IKDC ( P < 0.001).ConclusionIn patients with symptomatic cartilage defects of the knee, preoperative patient mental health has a strong association with self-assessed pain and functional knee scores. Further studies are needed to determine if preoperative mental health management can improve preoperative symptoms and postoperative outcomes.

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Stoffel, Michael, Iris Wolf, Florian Ringel, Carsten Stüer, Horst Urbach, and Bernhard Meyer. "Treatment of painful osteoporotic compression and burst fractures using kyphoplasty: a prospective observational design." Journal of Neurosurgery: Spine 6, no. 4 (April 2007): 313–19. http://dx.doi.org/10.3171/spi.2007.6.4.5.

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Object The aim of this study was to test the hypothesis that kyphoplasty is an effective treatment in painful osteoporotic vertebral fractures, even with involvement of the posterior cortical wall. Methods Between December 2001 and May 2004, 74 consecutive patients were treated with kyphoplasty for 118 painful osteoporotic compression (38%) or burst (62%) fractures. Additional decompression of the spinal canal was performed in six patients, internal fixation in three. Data were collected in a prospective observational design until May 2005. The preoperative workup included neuroimaging (plain x-ray films, densitometry, short tau inversion recovery magnetic resonance imaging, and computed tomography scanning) and clinical parameters (general and neurological examinations, visual analog scale [VAS], Karnofsky Performance Scale [KPS], and 36-Item Short Form Health Survey [SF]–36). At predefined time intervals (at discharge and 6 weeks and 3, 6, 12, and 24 months post-therapy) the patients were evaluated (x-ray films, neurological status, VAS, KPS, and SF-36). Kyphoplasty led to a significant reduction in kyphotic deformity (mean ± standard error of the mean, sagittal index: preoperative 10 ± 1°, postoperative 5 ± 1°), and an improvement in pain (VAS: preoperative 70 ± 3, postoperative 23 ± 2), activity (KPS score: preoperative 51 ± 3, postoperative 71 ± 2), and mental and physical health (SF-36, mental status: preoperative 43, postoperative 58; SF-36, physical status: preoperative 24, postoperative 35). No secondary narrowing of the spinal canal by the retropulsed posterior wall was observed after the procedure. Clinical improvement was durable (mean follow up 15 ± 1.1 months), although the VAS score secondarily increased slightly. All patients, who suffered from a compression-induced motor deficit, recovered completely during the follow-up interval. The main procedural complications consisted of one symptomatic extravertebral cement leakage (permanent monoparesis) requiring open revision, two nerve root contusions (transient radiculopathy), and one wound infection. Conclusions Kyphoplasty is effective in the treatment of painful osteoporotic vertebral compression and burst fractures, at least under medium-term conditions. The potential complication of procedure-related secondary narrowing of the spinal canal by the retropulsed posterior wall in burst fractures appears to be more of a theoretical than an actual risk.

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Riegger, Jana, Martin Rehm, Gisela Büchele, Hermann Brenner, Klaus-Peter Günther, Dietrich Rothenbacher, and Rolf E. Brenner. "Serum Cartilage Oligomeric Matrix Protein in Late-Stage Osteoarthritis: Association with Clinical Features, Renal Function, and Cardiovascular Biomarkers." Journal of Clinical Medicine 9, no. 1 (January 18, 2020): 268. http://dx.doi.org/10.3390/jcm9010268.

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This study aimed to assess associations between serum cartilage oligomeric matrix protein (sCOMP) and phenotypic characteristics in late-stage hip and knee Osteoarthritis (OA) as well as its correlation with further serum markers of possible comorbidities in the Ulm Osteoarthritis Study. Moreover, the prognostic relevance of preoperative sCOMP concentrations for short-term functionality and pain outcomes after hip or knee joint replacement was explored. Preoperative serum samples and detailed information about the health status (i.e., WOMAC scores, Hannover Functionality Status (FFbH)) of 754 OA patients undergoing total joint replacement were included. Spearman rank-correlation coefficients and multiple linear regression models were used to evaluate the relationships between sCOMP, other serum markers, and health outcomes. There was a significant positive association between sCOMP and markers of renal (cystatin C, creatinine, and eGFR) and cardiac (e.g., NT-proBNP) impairment. Since renal failure might cause accumulation of sCOMP, additional adjustment with eGFR was performed. Preoperative sCOMP levels in knee OA but not hip OA patients were positively associated with FFbH, WOMAC function sub-scale and total WOMAC scale as well as the post-operative WOMAC stiffness sub-scale six months after surgery. Our data clearly demonstrate an association between sCOMP and renal function as well as other confounding factors, which should be considered in future biomarker studies.

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Mudumbai, Seshadri C., Paul Chung, Nick Nguyen, Brooke Harris, J. David Clark, Todd H. Wagner, Nicholas J. Giori, Randall S. Stafford, and Edward R. Mariano. "Perioperative Opioid Prescribing Patterns and Readmissions After Total Knee Arthroplasty in a National Cohort of Veterans Health Administration Patients." Pain Medicine 21, no. 3 (July 16, 2019): 595–603. http://dx.doi.org/10.1093/pm/pnz154.

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Abstract Objective Among Veterans Health Administration (VHA) patients who undergo total knee arthroplasty (TKA) nationally, what are the underlying readmission rates and associations with perioperative opioid use, and are there associations with other factors such as preoperative health care utilization? Methods We retrospectively examined the records of 5,514 TKA patients (primary N = 4,955, 89.9%; revision N = 559, 10.1%) over one fiscal year (October 1, 2010–September 30, 2011) across VHA hospitals nationwide. Opioid use was classified into no opioids, tramadol only, short-acting only, or any long-acting. We measured readmission within 30 days and the number of days to readmission within 30 days. Extended Cox regression models were developed. Results The overall 30-day hospital readmission rate was 9.6% (N = 531; primary 9.5%, revision 11.1%). Both readmitted patients and the overall sample were similar on types of preoperative opioid use. Relative to patients without opioids, patients in the short-acting opioids only tier had the highest risk for 30-day hospital readmission (hazard ratio = 1.38, 95% confidence interval = 1.14–1.67). Preoperative opioid status was not associated with 30-day readmission. Other risk factors for 30-day readmission included older age (≥66 years), higher comorbidity and diagnosis-related group weights, greater preoperative health care utilization, an urban location, and use of preoperative anticonvulsants. Conclusions Given the current opioid epidemic, the routine prescribing of short-acting opioids after surgery should be carefully considered to avoid increasing risks of 30-day hospital readmissions and other negative outcomes, particularly in the context of other predisposing factors.

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Helsten, Daniel L., Arbi Ben Abdallah, Michael S. Avidan, Troy S. Wildes, Anke Winter, Sherry McKinnon, Mara Bollini, Penny Candelario, Beth A. Burnside, and Anshuman Sharma. "Methodologic Considerations for Collecting Patient-reported Outcomes from Unselected Surgical Patients." Anesthesiology 125, no. 3 (September 1, 2016): 495–504. http://dx.doi.org/10.1097/aln.0000000000001217.

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Abstract Background The impact of surgery on health is only appreciated long after hospital discharge. Furthermore, patients’ perceptions of postoperative health are not routinely ascertained. The authors instituted the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) registry to evaluate patients’ postoperative health based on patient-reported outcomes (PROs). Methods This article describes the methods of establishing the SATISFY-SOS registry from an unselected surgical population, combining perioperative PROs with information from electronic medical records. Patients enrolled during their preoperative visit were surveyed at enrollment, 30 days, and 1-yr postoperatively. Information on PROs, including quality of life, return to work, pain, functional status, medical complications, and cognition, was obtained from online, mail, or telephone surveys. Results Using structured query language, 44,081 patients were identified in the electronic medical records as having visited the Center for Preoperative Assessment and Planning for preoperative assessment between July 16, 2012, and June 15, 2014, and 20,719 patients (47%) consented to participate in SATISFY-SOS. Baseline characteristics and health status were similar between enrolled and not enrolled patients. The response rate for the 30-day survey was 62% (8% e-mail, 73% mail, and 19% telephone) and for the 1-yr survey was 71% (13% e-mail, 78% mail, and 8% telephone). Conclusions SATISFY-SOS demonstrates the feasibility of establishing a PRO registry reflective of a busy preoperative assessment center population, without disrupting clinical workflow. Our experience suggests that patient engagement, including informed consent and multiple survey modalities, enhances PROs collection from a large cohort of unselected surgical patients. Initiatives like SATISFY-SOS could promote quality improvement, enable efficient perioperative research, and facilitate outcomes that matter to surgical patients.

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Lak, Kathleen L., Melissa C. Helm, Rana M. Higgins, Tammy L. Kindel, and Jon C. Gould. "Preoperative functional health status is a predictor of short-term postoperative morbidity and mortality after bariatric surgery." Surgery for Obesity and Related Diseases 15, no. 4 (April 2019): 608–14. http://dx.doi.org/10.1016/j.soard.2019.02.004.

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Pappas, Matthew A., Daniel I. Sessler, Andrew D. Auerbach, Michael W. Kattan, Alex Milinovich, Eugene H. Blackstone, and Michael B. Rothberg. "Variation in preoperative stress testing by patient, physician and surgical type: a cohort study." BMJ Open 11, no. 9 (September 2021): e048052. http://dx.doi.org/10.1136/bmjopen-2020-048052.

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ObjectivesTo describe variation in and drivers of contemporary preoperative cardiac stress testing.SettingA dedicated preoperative risk assessment and optimisation clinic at a large integrated medical centre from 2008 through 2018.ParticipantsA cohort of 118 552 adult patients seen by 104 physicians across 159 795 visits to a preoperative risk assessment and optimisation clinic.Main outcomeReferral for stress testing before major surgery, including nuclear, echocardiographic or electrocardiographic-only stress testing, within 30 days after a clinic visit.ResultsA total of 8303 visits (5.2%) resulted in referral for preoperative stress testing. Key patient factors associated with preoperative stress testing included predicted surgical risk, patient functional status, a previous diagnosis of ischaemic heart disease, tobacco use and body mass index. Patients living in either the most-deprived or least-deprived census block groups were more likely to be tested. Patients were tested more frequently before aortic, peripheral vascular or urologic interventions than before other surgical subcategories. Even after fully adjusting for patient and surgical factors, provider effects remained important: marginal testing rates differed by a factor-of-three in relative terms and around 2.5% in absolute terms between the 5th and 95th percentile physicians. Stress testing frequency decreased over the time period; controlling for patient and physician predictors, a visit in 2008 would have resulted in stress testing approximately 3.5% of the time, while a visit in 2018 would have resulted in stress testing approximately 1.3% of the time.ConclusionsIn this large cohort of patients seen for preoperative risk assessment at a single health system, decisions to refer patients for preoperative stress testing are influenced by various factors other than estimated perioperative risk and functional status, the key considerations in current guidelines. The frequency of preoperative stress testing has decreased over time, but remains highly provider-dependent.

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Ackermann, Jakob, Takahiro Ogura, Robert A. Duerr, Alexandre Barbieri Mestriner, and Andreas H. Gomoll. "Mental Health Has No Predictive Association With Self-Assessed Knee Outcome Scores in Patients After Osteochondral Allograft Transplantation of the Knee." Orthopaedic Journal of Sports Medicine 6, no. 12 (December 1, 2018): 232596711881236. http://dx.doi.org/10.1177/2325967118812363.

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Background: Patient-reported outcome (PRO) measures are progressively utilized as evaluation tools in preoperative and postoperative assessments in orthopaedic practice. Identifying the potential utility of psychosocial factors to predict patient-reported pain and functional outcomes is of increasing interest to determine which patients will derive the greatest benefit from surgical treatment. Purpose/Hypothesis: The purpose of this study was to determine potential predictive associations between the preoperative 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) score, patient characteristics or osteochondral allograft (OCA) morphology, and PROs in patients who underwent OCA transplantation. We hypothesized that poor preoperative mental health is associated with diminished PROs at final follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 67 patients with a mean follow-up of 2.7 ± 1.0 years (range, 2-6 years) with complete preoperative and at least 24-month postoperative SF-12 MCS, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores were included in this study. Pearson correlation coefficients and linear regression models were used to distinguish associations between age, sex, smoking status, body mass index, workers’ compensation, previous surgery, concomitant surgery, number of grafts, defect location, total graft size, SF-12 MCS score, and postoperative PRO scores as well as their improvement from baseline (delta). Results: The SF-12 MCS showed significant correlation with the KOOS Activities of Daily Living subscale ( P = .015), KOOS Sport/Recreation subscale ( P = .024), and IKDC ( P = .039). In the multivariable linear regression models, the SF-12 MCS had no predictive association with any PRO measure. Patient sex contributed significantly to the final regression models of the KOOS Sport/Recreation ( P = .042), Tegner score ( P = .024), and Lysholm score ( P = .031). The SF-12 MCS showed no bivariate correlation with changes in any PRO score (delta) ( P > .05). Conclusion: Preoperative mental health status did not predict perceived functional outcomes as assessed by PRO measures at final follow-up. Female sex was negatively correlated with KOOS Sport/Recreation, Tegner, and Lysholm scores.

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Ghazy, Tamer, Erwin Haeberle, Utz Kappert, Stephan Petzold, Katrin Plötze, Ahmed Mashhour, Klaus Matschke, and Ahmed Ouda. "Sexual Quality of Life in Men <60 Years Old after Coronary Bypass Surgery." Heart Surgery Forum 24, no. 3 (May 25, 2021): E480—E486. http://dx.doi.org/10.1532/hsf.3745.

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Purpose: To explore the effect of undergoing coronary artery bypass grafting on sexual quality of life as an integral part of patients’ health-related quality of life. Methods: This cross-sectional study included 265 men ages 18 to 60 years (median age, 55) who underwent coronary artery bypass grafting 1 to 5 years before the study. Standardized questionnaires were implemented to evaluate participant pre- and postoperative sexual quality of life and the quality of counseling provided to patients. Results: Among the patients, 77% were in a steady relationship. The general health score was 5.5 ± 2.8 (mean ± standard deviation) preoperatively and 6 ± 2.2 at follow-up (P = .01). No sexual counseling was given to 83% and 77% of the patients pre- and postoperatively, respectively. The mean sexual satisfaction score dropped from 6.5 ± 2.6 preoperatively to 4.7 ± 3 postoperatively (P < .001). The decline in sexual intercourse frequency and masturbation frequency was significant (P < .001 and P = .006, respectively). Linear regression analysis showed that general health status (P = .008), higher-quality counseling (P = .027), and preoperative sexual quality of life (P < .001) correlated positively with sexual quality of life, whereas sternal pain (P < .001), erectile dysfunction (P < .001), and fear of excessive cardiac burden (P < .001) correlated negatively. Conclusions: Middle-aged men experience decreased sexual quality of life after coronary artery bypass grafting. Preoperative sexual quality of life, general health, and higher-quality counseling positively affect postoperative sexual quality of life, whereas sternal pain, fear, and erectile dysfunction play a negative role. Pre- and postoperative care guidelines should be improved. Further prospective large cohort studies for males and females are required.

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He, Yingke, Monica Tan, Michelle Shi, Xiu Ling Jacqueline Sim, Elaine Lum, Sungwon Yoon, and Hairil Rizal Abdullah. "Smoking Characteristics and Readiness-to-Quit Status Among Smokers Attending Preoperative Assessment Clinic – A Prospective Cohort Study." Risk Management and Healthcare Policy Volume 14 (June 2021): 2483–90. http://dx.doi.org/10.2147/rmhp.s312950.

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Journal articles on the topic 'Preoperative health status'

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