Prevalence and severity of pain, anxiety, stress, and sleep disturbances among surgical patients:A nationwide single-day multicentre flash mob study

Background Patient-reported outcomes (PROs) are subjective health indicators including pain, anxiety, stress, and sleep disturbances. Despite their frequent occurrence in the perioperative period and potentially severe consequences for postoperative recovery (for example prolonged length of hospital stay, cardiovascular events, development of chronic pain), these are not acknowledged as complications and their exact prevalence remains unclear. This study aims to assess the prevalence and severity of pre- and postoperative pain, anxiety, stress, and sleep disturbances among surgical patients. Methods A nationwide single-day multicentre cross-sectional flash mob study was conducted in 29 Dutch hospitals. Adult surgical patients with an expected hospital stay of at least one night were included. Patients admitted for neurosurgery, cardiothoracic surgery, or orthopaedic surgery were excluded. Primary outcomes were self-reported pain, anxiety, stress, and sleep disturbances, as assessed with the Numeric Rating Scale, Visual Analogue Scale for Anxiety, Perceived Stress Scale, and the adapted Patient-Reported Outcome Measurement Information System respectively. Results Of the 1077 eligible patients, 733 (68%) patients (mean age of 64 ± 15.9 s.d. years, 51.8% male) completed participation. Moderate to severe pain was prevalent in 509 patients (69.7%) and occurred most frequently post-surgery. Anxiety occurred in 278 patients (38.1%) and was more prevalent preoperatively. Moderate to severe stress was reported by 272 patients (37.8%) with similar findings pre- and post-surgery. Sleep disturbances were prevalent in 440 patients (64.1%). Pain and anxiety were more severe in females. Sleep disturbances were more severe in patients with lower socioeconomic status. Conclusion Pain, anxiety, stress, and sleep disturbances are highly frequent complications among surgical patients in Dutch hospitals. Considering the prevalence and severity, we suggest implementing these relevant additional measures for PROs as indicators for routine postoperative evaluation to facilitate their management.</p

Gastrointestinal obstruction by solidification of enteral nutrition: a result of impaired digestion in critically ill patients

Introduction:Solidification of enteral nutrition may cause gastrointestinal obstruction, with severe complications. The effect of the composition of enteral nutrition on the tendency of casein to coagulate is increasingly acknowledged and new formulas may prevent solidification. To recognize patients in need of specific enteral nutrition, we have to identify the clinical risk factors for the development of gastrointestinal obstruction by the solidification of enteral nutrition. Materials and methods:The 58 cases summarized in this review were identified through a PubMed search. Results:Critically ill patients have several risk factors, including impaired digestion, and they are treated with medication that interferes with gastrointestinal function. Surgery of the upper gastrointestinal tract is thought to be the most important risk factor, leading to changes in both the anatomical structure and neurohormonal functioning of the gastrointestinal tract, and to altered secretion of digestive enzymes. Conclusions:Awareness of risk factors in critically ill patients may help intensivists and surgeons take appropriate measures to prevent this complication. Critically ill patients with impaired digestion (e.g. after Whipple surgery) should be considered for alternative enteral nutrition formulas with noncoagulating proteins or hydrolyzed proteins

Endoscopic Vacuum Therapy for Esophageal Perforation: A Multicenter Retrospective Cohort Study

BACKGROUND AND STUDY AIM: Endoscopic vacuum therapy (EVT) is a novel treatment for esophageal perforations. The aim of this study was to describe initial experiences with EVT of esophageal perforations due to iatrogenic cause, Boerhaave syndrome or other perforations not related to prior upper gastrointestinal surgery. PATIENTS AND METHODS: Data from patients treated with EVT for esophageal perforation at five hospitals in three European countries, between January 2018 and October 2021, were retrospectively collected. The primary endpoint was successful defect closure by EVT, with or without the use of other endoscopic treatment modalities, and secondary endpoints included mortality and adverse events. RESULTS: 27 patients were included (median age 71). The success rate was 89% (24/27, 95% CI [77-100]). In 3 patients EVT failed: two deceased during EVT (septic embolic stroke, pulmonary embolism) and one underwent esophagectomy, due to a persisting defect. Two adverse events occurred: one iatrogenic defect expansion during sponge exchange and one hemorrhage during sponge removal. Median treatment duration was 12 days (IQR 6-16) with 1 sponge exchange (IQR 1-3). CONCLUSION: EVT is a promising organ-preserving treatment for esophageal perforations, with a success rate of 89%. More experience with the technique and indications will likely improve success rate

Preoperative anatomic considerations for a cervical or intrathoracic anastomosis: a retrospective cohort study

Background: Continuity after esophagectomy is restored by creating an intrathoracic or cervical anastomosis. Although the single most important factor for determining the suitability for intrathoracic anastomosis is the location of the tumor, current literature only grossly distinguishes proximal, mid or distal esophageal tumors. This study offers precise anatomic considerations for the assessment of suitability for an intrathoracic anastomosis. Methods: In this anatomical cohort study, all consecutive patients after esophagectomy for cancer who underwent a postoperative endoscopy between 2010 and 2018 were analyzed. The clinical postoperative anatomy was assessed and the level of the anastomosis was measured in distance from the incisors. Computed tomography imaging was used to confirm postoperative localization. These data were compared to preoperative localization of the tumor and proximal resection margins. Results: A total of 208 patients who underwent esophageal cancer surgery were included, comprising 61 (29.3%) intrathoracic and 147 (70.7%) cervical reconstructions. The mean distance was 28.2±2.3 and 19.6±1.7 cm from the incisors for an intrathoracic and cervical anastomosis respectively (P<0.001). The proximal margin was 4.5±1.9 for intrathoracic anastomosis and 8.9±3.4 for cervical anastomosis (P=0.405). Conclusions: The difference in distance from the incisors between an intrathoracic anastomosis and a cervical anastomosis was assessed by endoscopic evaluation after esophagectomy is approximately 9 centimeters. Preoperatively, these findings enable assessing suitability for an intrathoracic anastomosis when endoscopic localization of the tumor and Barret's segment is known as well as planned radiotherapy fields

Jejunal Casein Feeding Is Followed by More Rapid Protein Digestion and Amino Acid Absorption When Compared with Gastric Feeding in Healthy Young Men

Background: Dietary protein is required to attenuate the loss of muscle mass and to support recovery during a period of hospitalization. Jejunal feeding is preferred over gastric feeding in patients who are intolerant of gastric feeding. However, the impact of gastric vs. jejunal feeding on postprandial dietary protein digestion and absorption kinetics in vivo in humans remains largely unexplored. Objective: We compared the impact of gastric vs. jejunal feeding on subsequent dietary protein digestion and amino acid (AA) absorption in vivo in healthy young men. Methods: In a randomized crossover study design, 11 healthy young men (aged 21 ± 2 y) were administered 25 g specifically produced intrinsically l-[1-13C]phenylalanine–labeled intact casein via a nasogastric and a nasojejunal tube placed ~30 cm distal to the ligament of Treitz. Protein was provided in a 240-mL solution administered over a 65-min period in both feeding regimens. Blood samples were collected during the 7-h postprandial period to assess the increase in plasma AA concentrations and dietary protein–derived plasma l-[1-13C]phenylalanine enrichment. Results: Jejunal feeding compared with gastric feeding resulted in higher peak plasma phenylalanine, leucine, total essential AA (EAA), and total AA concentrations (all P &lt;0.05). This was attributed to a more rapid release of dietary protein–derived AAs into the circulation, as evidenced by a higher peak plasma l-[1-13C]phenylalanine enrichment concentration (2.9 ± 0.2 vs. 2.2 ± 0.2 mole percent excess; P &lt;0.05). The total postprandial plasma AA incremental area under the curve and time to peak did not differ after jejunal vs. gastric feeding. Plasma insulin concentrations increased to a greater extent after jejunal feeding when compared with gastric feeding (275 ± 38 vs. 178 ± 38 pmol/L; P &lt;0.05). Conclusions: Jejunal feeding of intact casein is followed by more rapid protein digestion and AA absorption when compared with gastric feeding in healthy young men. The greater postprandial increase in circulating EAA concentrations may allow a more robust increase in muscle protein synthesis rate after jejunal vs. gastric casein feeding. This trial was registered at trialregister.nl as NTR2801

The effect of fibers on coagulation of casein-based enteral nutrition in an artificial gastric digestion model

A serious complication seen in critically ill patients is the solidification of enteral nutrition causing gastrointestinal obstruction.</p