Measuring morbidity following major surgery

A systematic review of the efficacy of a specific perioperative haemodynamic management strategy was performed to explore the balance between therapeutic benefit and adverse effects. Whilst mortality and length of hospital stay were reduced in the intervention group, pooling of morbidity data for between-group comparisons was limited by the heterogeneity of morbidity reporting between different studies. Classification, criteria and summation of morbidity outcome variables were inconsistent between studies, precluding analyses of pooled data for many types of morbidity. A similar pattern was observed in a second systematic review of randomised controlled trials of perioperative interventions published in high impact surgical journals. The Post-operative Morbidity Survey (POMS), a previously published method of describing short-term postoperative morbidity, lacked validation. The POMS was prospectively collected in 439 patients undergoing elective major surgery in a UK teaching hospital. The prevalence and pattern of morbidity was described and compared with data from a similar study using the POMS in a US institution. The type and severity of surgery was reflected in the frequency and pattern of POMS defined postoperative morbidity. In the UK institution, many patients remained in hospital without morbidity as defined by the POMS, in contrast to the US institution, where very few patients remained in hospital in the absence of POMS defined morbidity. The POMS may have utility as a tool for recording bed occupancy and for modelling bed utilization. Inter-rater reliability was adequate and a priori hypotheses that the POMS would discriminate between patients with known measures of morbidity risk, and predict length of stay were generally supported through observation of data trends. The POMS was a valid descriptor of short-term post-operative morbidity in major surgical patients

Survival after postoperative morbidity: a longitudinal observational cohort study

Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complication

Exercise intervention in people with cancer undergoing adjuvant cancer treatment following surgery: a systematic review

BackgroundRemaining physically active during and after cancer treatment is known to improve associated adverse effects, improve overall survival and reduce the probability of relapse. This systematic review addresses the question: is an exercise training programme beneficial in people with cancer undergoing adjuvant cancer treatment following surgery.MethodsA systematic database search of Embase, Ovid, Medline without Revisions, SPORTDiscus, Web of Science, Cochrane Library and ClinicalTrials.gov for any randomised controlled trials (RCT) or non-RCT addressing the effect of an exercise training programme in those having adjuvant cancer treatment following surgery was conducted.ResultsThe database search yielded 6489 candidate abstracts of which 94 references included the required terms. A total of 17 articles were included in this review. Exercise training is safe and feasible in the adjuvant setting and furthermore may improve measures of physical fitness and health related quality of life (HRQoL).ConclusionThis is the first systematic review on exercise training interventions in people with cancer undergoing adjuvant cancer treatment following surgery. Due to the lack of adequately powered RCTs in this area, it remains unclear whether exercise training in this context improves clinical outcomes other physical fitness and HRQoL. It remains unclear what is the optimal timing of initiation of an exercise programme and what are the best combinations of elements within an exercise training programme to optimise training efficacy. Furthermore, it is unclear if initiating such exercise programmes at cancer diagnosis may have a long-lasting effect on physically activity throughout the subsequent life course

Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study

Background. Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement. Methods. This cross-sectional observational study in UK National Health Service hospitals, recruited adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period. Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes. Results. 257 hospitals in 171 NHS Trusts participated (97% of eligible organisations). Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires. Anxiety was most frequently cited as the worst aspect of the perioperative experience. Thirty-five per cent of patients reported severe discomfort in at least one domain: thirst (18.5%; 95% CI 17.8-19.1), surgical pain (11.0%; 10.5-11.5) and drowsiness (10.1%; 9.6-10.5) were most common. Despite this, only 5% reported dissatisfaction with any aspect of anaesthesia-related care. Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%) Conclusions. Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care

SafeFit Trial: Virtual clinics to deliver a multimodal intervention to improve psychological and physical wellbeing in people with cancer. Protocol of a COVID-19 targeted non-randomised phase III trial

Introduction: The impact of the COVID-19 pandemic (caused by the SArS-CoV-2 virus), on individuals with cancer has been profound. It has led to increased anxiety, distress and deconditioning due to reduced physical activity. We aim to investigate whether SafeFit; a multi-modal intervention of physical activity, nutrition and psychological support delivered virtually by cancer exercise specialists (CES) can improve physical and emotional functioning during the COVID-19 pandemic.Methods and analysis: A phase III non-randomised intervention trial, target recruitment of 1050 adults with suspected or confirmed diagnosis of cancer. All recruited participants will receive the multimodal intervention delivered by CES for six months. Sessions will be delivered 1-to-1 using telephone/video conferencing consultations. CES will work with each participant to devise a personalised programme of 1) physical activity, 2) basic dietary advice and 3) psychological support, all underpinned by a behaviour change intervention.Primary outcome: Physical and emotional functioning as measured by the EORTC-QLQ-C30. Secondary outcomes: Overall quality of life measured by EORTC-QLQ-C30 and EQ-5D-5L, health economics, patient activation, self-efficacy to self-manage chronic disease, distress, Impact of Covid-19 on emotional functioning, self-reported physical activity, functional capacity and nutrition. Adherence to the intervention will also be measured and a process evaluation conducted. Ethics and dissemination: Ethical approval was obtained from the Health Research Authority (reference number: 20/NW/0254). Results of this trial will be disseminated through publication of peer reviewed articles, presentations at scientific conferences and to the public and people with cancer in collaboration with our patient and public involvement representatives and partners. Trial registration: NCT0442561

Strengthening altitude knowledge: a delphi study to define minimum knowledge of altitude illness for laypersons traveling to high altitude

Introduction: A lack of knowledge among laypersons about the hazards of high-altitude exposure contributes to morbidity and mortality from acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE) among high-altitude travelers. There are guidelines regarding the recognition, prevention, and treatment of acute-altitude illness for experts, but essential knowledge for laypersons traveling to high altitudes has not been defined. We sought expert consensus on the essential knowledge required for people planning to travel to high altitudes. Methods: The Delphi method was used. The panel consisted of two moderators, a core expert group and a plenary expert group. The moderators made a preliminary list of statements defining the desired minimum knowledge for laypersons traveling to high altitudes, based on the relevant literature. These preliminary statements were then reviewed, supplemented, and modified by a core expert group. A list of 33 statements was then presented to a plenary group of experts in successive rounds. Results: It took three rounds to reach a consensus. Of the 10 core experts invited, 7 completed all the rounds. Of the 76 plenary experts, 41 (54%) participated in Round 1, and of these 41 a total of 32 (78%) experts completed all three rounds. The final list contained 28 statements in 5 categories (altitude physiology, sleeping at altitude, AMS, HACE, and HAPE). This list represents an expert consensus on the desired minimum knowledge for laypersons planning high-altitude travel. Conclusion: Using the Delphi method, the STrengthening Altitude Knowledge initiative yielded a set of 28 statements representing essential learning objectives for laypersons who plan to travel to high altitudes. This list could be used to develop educational interventions

Measuring morbidity following major surgery.

A systematic review of the efficacy of a specific perioperative haemodynamic management strategy was performed to explore the balance between therapeutic benefit and adverse effects. Whilst mortality and length of hospital stay were reduced in the intervention group, pooling of morbidity data for between-group comparisons was limited by the heterogeneity of morbidity reporting between different studies. Classification, criteria and summation of morbidity outcome variables were inconsistent between studies, precluding analyses of pooled data for many types of morbidity. A similar pattern was observed in a second systematic review of randomised controlled trials of perioperative interventions published in high impact surgical journals. The Post-operative Morbidity Survey (POMS), a previously published method of describing short-term postoperative morbidity, lacked validation. The POMS was prospectively collected in 439 patients undergoing elective major surgery in a UK teaching hospital. The prevalence and pattern of morbidity was described and compared with data from a similar study using the POMS in a US institution. The type and severity of surgery was reflected in the frequency and pattern of POMS defined postoperative morbidity. In the UK institution, many patients remained in hospital without morbidity as defined by the POMS, in contrast to the US institution, where very few patients remained in hospital in the absence of POMS defined morbidity. The POMS may have utility as a tool for recording bed occupancy and for modelling bed utilization. Inter-rater reliability was adequate and a priori hypotheses that the POMS would discriminate between patients with known measures of morbidity risk, and predict length of stay were generally supported through observation of data trends. The POMS was a valid descriptor of short-term post-operative morbidity in major surgical patients.