Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer.

Importance A combined subjective and objective wireless monitoring program of patient-centered outcomes can be carried out in patients before and after major abdominal cancer surgery. Objective To conduct a proof-of-concept pilot study of a wireless, patient-centered outcomes monitoring program before and after major abdominal cancer surgery. Design, Setting, and Participants In this proof-of-concept pilot study, patients wore wristband pedometers and completed online patient-reported outcome surveys (symptoms and quality of life) 3 to 7 days before surgery, during hospitalization, and up to 2 weeks after discharge. Reminders via email were generated for all moderate to severe scores for symptoms and quality of life. Surgery-related data were collected via electronic medical records, and complications were calculated using the Clavien-Dindo classification. The study was carried out in the inpatient and outpatient surgical oncology unit of one National Cancer Institute–designated comprehensive cancer center. Eligible patients were scheduled to undergo curative resection for hepatobiliary and gastrointestinal cancers, were English speaking, and were 18 years or older. Twenty participants were enrolled over 4 months. The study dates were April 1, 2015, to July 31, 2016. Main Outcomes and Measures Outcomes included adherence to wearing the pedometer, adherence to completing the surveys (MD Anderson Symptom Inventory and EuroQol 5-dimensional descriptive system), and satisfaction with the monitoring program. Results This study included a final sample of 20 patients (median age, 55.5 years [range, 22-74 years]; 15 [75%] female) with evaluable data. Pedometer adherence (88% [17 of 20] before surgery vs 83% [16 of 20] after discharge) was higher than survey adherence (65% to 75% [13 of 20 and 15 of 20] completed). The median number of daily steps at day 7 was 1689 (19% of daily steps at baseline), which correlated with the Comprehensive Complication Index, for which the median was 15 of 100 ( r  = −0.64, P Conclusions and Relevance Wireless monitoring of combined subjective and objective patient-centered outcomes can be carried out in the surgical oncology setting. Preoperative and postoperative patient-centered outcomes have the potential of identifying high-risk populations who may need additional interventions to support postoperative functional and symptom recovery.

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Wireless Monitoring Program of Patient-Centered Outcomes and Recovery Before and After Major Abdominal Cancer Surgery.

Berry & Kohn's Operating Room Technique

Complications After Esophagectomy.

It is inherently challenging to achieve successful surgical outcomes for ventral hernia repairs. For complex ventral hernias, attempts to reconstruct the abdomen in patients who are overweight, deconditioned, malnourished, chronically infected or inflamed, have previous hernia recurrence, or otherwise carry a number of serious comorbidities affecting their surgical fitness are a major undertaking requiring careful preparation and planning. As the rate of abdominal wall reconstructions rises, so does the complexity of these procedures. One could argue that the prehabilitation of these patients is equally, if not more, important than the surgical technique itself. To achieve desirable outcomes and avoid surgical-site occurrences (SSOs), the surgeon must familiarize him/herself with ways to optimize a patient preoperatively. Understanding and identifying the aforementioned modifiable risk factors for SSOs is crucial. It is also important to recognize the impact that acute changes in the microbiome perioperatively can have on the postoperative success. Familiarizing oneself with the available literature for these patients is imperative. This review presents discussion and guidance for understanding the challenges and best practices for providing hernia surgery and abdominal wall reconstruction and achieving durable outcomes, with minimal SSOs.

Evidence-Based Strategies for the Prehabilitation of the Abdominal Wall Reconstruction Patient.

Background Current methods to predict patients' perioperative morbidity use complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the current study was to determine the value of a timed stair climb in predicting perioperative complications for patients undergoing abdominal surgery. Study Design From March 2014 to July 2015, three hundred and sixty-two patients attempted stair climbing while being timed before undergoing elective abdominal surgery. Vital signs were measured before and after stair climb. Ninety-day postoperative complications were assessed by the Accordion Severity Grading System. The prognostic value of stair climb was compared with the American College of Surgeons NSQIP risk calculator. Results A total of 264 (97.4%) patients were able to complete the stair climb. Stair climb time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower stair climb times had increased complication rates (p Conclusions Stair climb provides measurable stress, accurately predicts postoperative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to validate the use of stair climbing in risk-prediction models.

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery.

Perioperative communication between surgeons and caregivers is an important aspect of patient care, with postoperative conversations (POCs) being critical. Literature suggests current communication practices may be suboptimal. Identifying barriers and opportunities could improve patient and caregiver satisfaction and increase surgeon efficiency. This mixed method study included 1) prospective study of all patients undergoing a surgery at an academic medical center between September 2014 and March 2016 and 2) nominal groups of physicians, caregivers, and waiting room personnel (WRP). Nominal groups ranked standard of care themes needing intervention. Multivariate logistic regression estimated the association of surgeon and procedure characteristics with POC practices considering both location and contact method. Data on 15,820 operations showed that surgical specialty (P ≤ 0.0001), inpatient status (P ≤ 0.0001), planned discharge destination (P = 0.0003), patient race (P = 0.02), and caregiver relationship (P ≤ 0.0001) were all significantly associated with receiving a private POC. Nominal group results provided opportunities for improvement: regular updates (caregivers), locating the caregivers postoperation (surgeons), clear communication between caregivers and surgeons (WRP). This study examines the perioperative communication. Surgeons, caregivers, and WRP identified effective communication as a top intervention priority. Managing caregiver expectations, addressing concerns of WRP, and creating an efficient environment for surgeons appear to be critical components to communication.

Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel.

147Background: The CROSS trial established the role of neoadjuvant radiation in the treatment of esophageal adenocarcinoma (EAC). While response to radiation is an important factor in predicting long-term outcomes, the vast majority of patients succumb to systemic disease. The purpose of this study is to assess predictors of survival in patients with EAC following radiation therapy. Methods: All patients who underwent resection after radiation therapy for EAC at a single institution were retrospectively identified from January 2004 to December 2014. Patients who died within 30 days of surgery were excluded. Cox-proportional hazard analyses were performed to identify clinico-pathological factors associated with survival after surgery. Results: In the time period, 334 patients underwent esophagectomy for EAC. Univariable/multivariable analyses are shown in the table. The presence of a pathologic complete response (pCR) did not correlate to survival. The most important factors in predicting outcome were pre-...

Jacob A. Swords

Papers

Timed Stair Climbing Is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery.

Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel.

Effect of nodal status compared to tumor response after neoadjuvant radiation on outcomes for patients with esophageal cancer.