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Purpose: In adults, diets rich in protein seem beneficial in relation to satiety, weight loss, and weight management; however, studies investigating dietary protein and weight development in children are scarce and inconsistent. This nonrandomized controlled trial aimed to investigate the effect of a higher protein diet during lifestyle intervention on anthropometry and metabolic biomarkers in children with overweight and obesity., Methods: Children (n:208) were recruited from two multicomponent lifestyle camps. One camp was assigned as the intervention group. In the intervention group, carbohydrates-rich foods at breakfast and two in-between-meals were replaced with protein-containing foods to increase the amount of protein from ~ 10-15 energy percent (E%) per day to ~ 25E% per day. Other components were similar between groups. Anthropometry and biochemical measurements were collected at baseline, 10 weeks (after camp) and 52 weeks., Results: The intervention group had a non-significant improvement in BMI-SDS (- 0.07 SD (- 0.19; 0.05), p = 0.24) compared to the control group, but in general, there was no effect of a higher protein diet on anthropometry and metabolic biomarkers. Overall, 10 weeks at camp resulted in a more favorable body composition [- 6.50 kg (p < 0.00), - 0.58 BMI-SDS (p < 0.00), and - 5.92% body fat (p < 0.00)], and improved metabolic health, with most changes maintained at 52 weeks., Conclusion: A higher protein diet had no significant effect on body composition and metabolic health; however, these lifestyle camps are an efficiatious treatment strategy for childhood obesity., Clinical Trial Registration: clinicaltrials.gov with ID: NCT04522921. Preregistered August 21st 2020., (© 2024. The Author(s).)

Background: Eating-related problems (e.g., binge eating (BE)) and impaired quality of life (QoL) is more prevalent in children with overweight and obesity. This study aimed to investigate changes in self-reported overeating (OE), BE, and QoL in children with overweight or obesity attending multicomponent 10-week lifestyle camps with a 52-weeks follow-up. Additionally, the study sought to investigate whether self-reported OE/BE before camp was associated with changes in QoL., Methods: Children aged 7 to 14-years could attend camp if they had overweight/obesity, were lonely, unhappy, or had social or family-related problems. In this study only children with overweight and obesity were included (n:185). OE, BE, and QoL were measured using self-reported questionnaires., Results: In total, 38 % of the children reported regular BE at baseline. Regular OE, occasional BE, and occasional OE was reported by 14 %, 13 %, and 11 %, respectively, while 24 % reported no eating-related problems. The relative risk of experiencing eating-related problems decreased at 10-weeks compared to baseline. Additionally, the probability of regular OE (RR 0.12 (95 % CI 0.04;0.38) (X 2 = 8.44, p = 0.004)) and regular BE (RR 0.01 (95 % CI 0.00;0.11) (X 2 = 9.91, p = 0.002)) remained lower at 52-weeks relative to baseline. All QoL dimensions improved after camp, and the presence of self-reported OE and regular BE at baseline was significantly associated with lower QoL at baseline, 10 and 52-weeks., Conclusion: Children self-reporting OE and BE may be a particular vulnerable group that needs more support from camp staff and healthcare professionals to improve QoL., Clinical Trial Registration: clinicaltrials.gov with ID: NCT04522921., Competing Interests: Declaration of Competing Interest The authors declare no competing interest related to the present study., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Emotional eating seems to emerge during the transition from childhood to adulthood; however, limited research has explored the association between emotional overeating and quality of life (QoL) in children with overweight and obesity. Therefore, the aim of this study was to examine the association between QoL and emotional overeating in a Danish sample of children with overweight and obesity. The present cross-sectional study is based on baseline questionnaire data from a nonrandomized controlled trial. Children attending a 10-week multicomponent lifestyle camp from October 2020 to March 2022 was invited to participate. Multiple linear regressions were used to examine if QoL was associated with emotional overeating before starting camp. In total, 229 children were included, and 45 children were excluded due to missing data, leaving 184 children in this study. The children had a mean age of 11.8 years (SD ± 1.38), with 60.9% girls and 39.1% boys, and the majority (94.6%) had overweight or obesity defined by a Body Mass Index Standard Deviation Score (BMI-SDS) > 1 SD. On average, children with a high tendency of emotional overeating had a 13.7 (95% CI 18.9; 8.5, p < 0.01) lower QoL score compared to children with a low tendency of emotional overeating.  Conclusions: This study shows that children with a high tendency of emotional overeating have lower quality of life, compared to children with a lower tendency of emotional overeating. Due to study limitations, the findings should be supported by further research. (Trial registration: clinicaltrials.gov with ID: NCT04522921). What is Known: • Emotional eating seems to emerge during the transition from childhood to adulthood. • Limited research has explored the association between quality of life and emotional overeating in children with overweight and obesity. What is New: • Children with a high tendency of emotional overeating had a lower quality of life compared to children with a lower tendency of emotional overeating. • Emotional overeating was negatively associated with quality of life in children with overweight and obesity., (© 2023. The Author(s).)

Objectives: The prevalence of childhood obesity increases globally, and noninvasive methods are needed to identify metabolic dysfunction and obesity-related complications such as pediatric metabolic associated fatty liver disease (MAFLD). We investigated whether uric acid (UA) and the macrophage marker soluble form of cysteine scavenger receptor CD163 (sCD163) can be used as biomarkers for deteriorated metabolism or pediatric MAFLD in children with overweight or obesity., Methods: Cross-sectional clinical and biochemical data from 94 children with overweight or obesity was included. Surrogate liver markers were calculated, and correlations were investigated using Pearson's or Spearman's correlation test., Results: UA and sCD163 correlated with BMI standard deviation score (r=0.23, p<0.05; r=0.33, p<0.01) and body fat (r=0.24, p<0.05; r=0.27, p=0.01). UA correlated with triglycerides (ρ=0.21, p<0.05), fat free mass (r=0.33, p<0.01), and gamma-glutamyl transferase (r=0.39, p<0.01). sCD163 correlated with the pediatric NAFLD fibrosis score (r=0.28, p<0.01) and alanine aminotransferase (r=0.28, p<0.01). No correlation was found between UA and pediatric MAFLD., Conclusions: UA and sCD163 was identified as markers of a deranged metabolic profile, thus acting as easily accessible biomarkers for obesity and an obesity-related deranged metabolism. Furthermore, increasing levels of sCD163 could be a useful biomarker of pediatric MAFLD. Future prospective studies are warranted., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

A healthy diet is essential to prevent childhood obesity, however, adherence to a healthy diet is challenging. The aim of this study was to give a comprehensive overview of the literature investigaating associations between food and beverages and overweight/obesity in children and adolescents in order to identify dietary risk factors. A systematic search was performed in four databases and observational studies were included. Meta-analysis was performed using the random effect model. Sixty records met inclusion criteria and 14 different food or beverage categories were identified. A higher intake of sugar-sweetened beverages increased the odds of overweight/obesity by 1.20 ( p < 0.05) ( n = 26) and higher intake of fast food increased the odds of overweight/obesity by 1.17 ( p < 0.05) ( n = 24). Furthermore, higher intake of meat (OR 1.02, p < 0.05 ( n :7)) and refined grains (OR 1.28, p < 0.05 ( n :3)) was associated with an increased risk of overweight/obesity. In contrast, higher intake of whole grain (OR 0.86, p = 0.04 ( n :5)) and more surprisingly sweet bakery (OR 0.59, p < 0.05 ( n :3)) was associated with a decreased risk of overweight/obesity. In conclusion, a higher intake of sugar-sweetened beverages and a higher intake of fast food was identified as the primary dietary risk factors for overweight/obesity. Future research is needed to strengthen the generalizability of these results.

Purpose: A healthy diet is fundamental for healthy growth and for future disease prevention. However, scientific consensus on how to compose healthy diets for children has not been established. Therefore, a systematic review and meta-analysis was performed to investigate if an independent effect exists between foods, beverages or the composition of macronutrients and body composition in children and adolescents., Methods: A systematic search was performed in four databases up to July 2021. A systematic review of randomized controlled studies (RCTs) and meta-analyses were carried out by extracting mean difference (MDs) and standard deviation (SD) and performed using the random effect model., Results: Sixteen RCTs met inclusion criteria. Beyond dairy, sugar-sweetened beverages and macronutrient composition, no trials were identified for other food groups. Based on five RCTs (n:5), a higher-dairy diet was found to reduce body fat percentage - 0.47 [- 0.92, - 0.03] (p = 0.04). A higher-dairy diet was also found to increase lean body mass (kg) 0.34 [0.06, 0.62] (p = 0.02) (n:2), but did not affect BMI z-score - 0.05 [- 0.16, 0.06] (p = 0.39) (n:4). Substituting sugar-sweetened beverage with non-caloric beverages or flavored milk reduced body fat percentage (- 0.70 [- 0.78, - 0.62] (p < 0.001)) (n:3) but did not change BMI z-score (- 0.05 [- 0.20, 0.09] (p = 0.48)) (n:2). No significant effects were found between different macronutrient compositions and BMI z-score or body fat percentage., Conclusion: Changes in diet from low to higher-dairy consumption and from sugar-sweetened beverages to non-caloric beverages or flavored milk resulted in favorable changes in body composition among children and adolescents. Eligible studies investigating other foods are lacking., Trial Registration: PROSPERO registration number (CRD42020173201)., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Enhanced recovery after surgery (ERAS) pathways have been proven to expedite recovery after many procedures and reduce lengths of stay in hospital and surgical complications. However, improvements are still needed, especially in postoperative ERAS components delivered by nurses such as early mobilisation and oral feeding. This article summarises the current and possible future role of nurses within ERAS, and recommends areas for future research., Discussion: Nurses are the professionals who spend the most time with patients throughout the perioperative pathway and are known to play a vital role in delivering many components of an ERAS pathway. They frequently co-ordinate care across disciplines and ensure continuity of care. However, there is a paucity of ERAS research specific to nurses compared to other professional groups. Continual training on ERAS will be required to ensure nurses are highly educated and for the best possible ERAS implementation. In certain types of surgery, nurses may fulfil extended roles in the postoperative period, such as taking over responsibility and leadership for co-ordinating pain management, mobilisation and discharge. However, this requires a well-defined care programme, a clear definition of nursing responsibilities from surgeons, agreed discharge criteria and highly qualified nurses, along with the collection and analysis of data to test safety and efficacy., Conclusion: Increasing nurse involvement in ERAS research is vital to drive improvements in care and to develop nursing roles. Nurses should have a major role in the preoperative clinic, the early postoperative phase and the follow-up post-discharge period, where the benefits of ERAS need to be further documented.

Background: Postoperative mobilisation is an important part of fundamental care. Increased mobilisation has positive effect on recovery, but immobilisation is still a challenge in postoperative care., Aims: To report how the establishment of a national nursing database was used to measure postoperative mobilisation in patients undergoing surgery for ovarian cancer., Methods: 'Mobilisation' was defined as at least 3 hours out of bed on postoperative day 1, with the goal set at achieving this in 60% of patients. Data entry was performed by clinical nurses on 4400 patients with ovarian cancer., Findings: 46.7% of patients met the goal for mobilisation on the first postoperative day, but variations in duration and type of mobilisation were observed. Of those mobilised, 51.8% had been walking in the hallway., Conclusions: A national nursing database creates opportunities to optimise fundamental care. By comparing nursing data with oncological, surgical and pathology data it became possible to study mobilisation in relation to cancer stage, comorbidity, treatment and extent of surgery.

Introduction: Length of hospital stay after birth has decreased during the last decades, but nationwide data on length of hospital stay after cesarean section are lacking. Elements of Enhanced Recovery Programs were reported to reduce the length of hospital stay. The aim of this nationwide study was to describe the length of hospital stay after cesarean section in Denmark from 2004 to 2016 taking into account birth- and health-related factors as well as demographic changes and, further, to assess potential differences between the five Danish regions., Material and Methods: Length of hospital stay was assessed in 164 209 deliveries by cesarean section in Denmark from 2004 to 2016. Data were obtained from the Danish National Patient Register. All deliveries by cesarean section at gestational age <22 weeks were excluded. Median length of hospital stay was reported based on crude and adjusted analyses., Results: The median length of hospital stay was significantly reduced by 39 hours (95% confidence interval [CI] 37.9-40.1), from 97 hours (4.0 days) in 2004 to 58 hours (2.4 days) in 2016. Reductions were observed among both planned and emergency cesarean sections. When birth- and health-related factors as well as demographic changes were accounted for, median length of hospital stay was reduced by 30 hours (95% CI 29.3-30.8) in the period. The decrease in length of hospital stay from 2004 to 2016 varied between the five Danish regions, with adjusted reductions between 19 and 46 hours., Conclusions: A nationwide decrease in length of hospital stay after cesarean section was observed from 2004 to 2016 across all five regions but with significant regional variations. Further studies on the optimal length of hospital stay are needed, especially with regard to implementation of enhanced recovery programs., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.)

Background: In Denmark, most children are not sufficiently physically active and only a few interventions have been found to increase long-term physical activity among overweight and obese children. The aim of our study was to investigate if children are physically active in correspondence to Danish recommendations after attending a multicomponent-overnight camp., Methods: A questionnaire was developed to estimate children's physical activity level and behavior and investigate how transport, economy, availability, time, motivation, and knowledge about physical activity affect children's physical activity level and behavior., Results: In this study, 60.9% of the children did vigorous physical activity (VPA) minimum 30 minutes 3 times per week up to 3 years after camp. Most children were physically active at a sports club (44.3%) and only 5.7% of the children did not participate in physical activity. Parental physical activity and child motivation toward physical activity were significantly (P < .05) associated with children doing VPA., Conclusion: Our findings suggest that 60.9% of children who attended camp engage in VPA after camp, which compared with a recent Danish study, is more frequent than children who did not attend camp. Further investigations are needed to determine the long-term health effects in children attending interventions such as multicomponent-overnight camps.

Background & Aims: Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. The ESPEN Symposium on perioperative nutrition was held in Nottingham, UK, on 14-15 October 2018 and the aims of this document were to highlight the scientific basis for the nutritional and metabolic management of surgical patients., Methods: This paper represents the opinion of experts in this multidisciplinary field and those of a patient and caregiver, based on current evidence. It highlights the current state of the art., Results: Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. Preoperative optimization can help improve outcomes. Perioperative fluid therapy should aim at keeping the patient in as near zero fluid and electrolyte balance as possible. Similarly, glycemic control is especially important in those patients with poorly controlled diabetes, with a stepwise increase in the risk of infectious complications and mortality per increasing HbA1c. Immobilization can induce a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition and muscle strength, all of which impair clinical outcomes. There is a role for pharmaconutrition, pre-, pro- and syn-biotics, with the evidence being stronger in those undergoing surgery for gastrointestinal cancer., Conclusions: Nutritional assessment of the surgical patient together with the appropriate interventions to restore the energy deficit, avoid weight loss, preserve the gut microbiome and improve functional performance are all necessary components of the nutritional, metabolic and functional conditioning of the surgical patient., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Purpose: To evaluate short and long-term effects of a multifactorial and multidisciplinary in-patient municipality intervention including training of activities of daily living, cardiovascular exercise, resistance training and social activities on quality-of-life, need-of-care, and physical function in older adults at risk of further functional decline., Method: A cohort study including data collected rigorously during 3.5 years at an in-patient municipality rehabilitation center in Aalborg, Denmark. Patients received a multifactorial and multidisciplinary intervention. Outcomes were quality-of-life (EQ5D), weekly need-of-care hours, and test of physical functioning (sit-to-stand, 6-min walking test, tandem balance)., Results: Data was collected from 532 patients (63.3% women). The median [5; 95 percentiles] age was 79 [55; 92] years with a length-of-stay of 21 [8; 55] days. The mean (95% CI) EQ5D index score showed a clinically relevant improvement from admission 0.46 (0.44; 0.48) to discharge 0.69 (0.67; 0.71) and there was no decline 6-month postdischarge 0.67 (0.64; 0.70). The weekly need-of-care decreased significantly by 7.2 (6.6, 7.9) h from a mean of 9.8 h before admission to 2.6 h 6-month postdischarge. Sit-to-stand improved from 6.3 (6.0; 6.7) to 9.3 (8.9; 9.6) repetitions, 6-min walking test from 147 (138; 156) to 217 (207; 227) m, and tandem balance from 20.7 (19.8; 21.6) to 25.2 (24.8; 26.2) s., Conclusion: Our results were remarkable and highlight that a well-structured multifactorial and interdisciplinary intervention with a clear aim and inclusion criteria related to functional decline may lead to long-term clinically relevant improvements in functionally declining older adults. Future studies should, however, explore similar interventions in comparable populations preferably in randomized controlled designs.

Background: Enhanced recovery after surgery (ERAS) programmes have been adopted to a varying degree by most surgical departments, not only in Denmark, but worldwide., Aims: To report the process from a local ERAS unit in a tertiary university hospital to accelerate implementation of ERAS programmes in all surgical specialties., Methods: All surgical departments receive twice-yearly procedure-specific data on length of stay (LOS), readmission rates and death within 30 days, based on surgical codes and the Danish National Patient Register. The ERAS unit and clinical experts review data followed by a clinical audit where appropriate., Findings: Setting up data presentation for clinical and nurse leaders has documented progress in implementing ERAS. The combination of outcome data, together with audits have been essential., Conclusion: The local ERAS unit has been shown to accelerate implementation of ERAS programmes in all surgical specialties, facilitated by procedure-specific LOS and re-admission data, combined with audit data.

Background: Enhanced Recovery After Surgery (ERAS) is widely accepted in current surgical practice due to its positive impact on patient outcomes. The successful implementation of ERAS is challenging and compliance with protocols varies widely. Continual staff education is essential for successful ERAS programmes. Teaching modalities exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed. We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS., Methods: A modified Delphi technique was used; three rounds of questionnaires were sent to 58 selected international experts from 11 countries across multiple ERAS specialities and multidisciplinary teams (MDT) between January 2016 and February 2017. We interrogated opinion regarding four topics: (1) the components of a training curriculum and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to define ERAS training centres of excellence., Results: An ERAS training course must cover the evidence-based principles of ERAS with team-oriented training. Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of training can be measured by improved compliance. A training centre of excellence should show a willingness to teach and demonstrable team working., Conclusions: We propose an international expert consensus providing an ERAS training curriculum, a framework for successful implementation, methods for assessing effectiveness of training and a definition of ERAS training centres of excellence.

Introduction: Clinical practice guidelines (CPGs) support enhanced post-operative recovery and decrease morbidity. In addition, patient information leaflets (PILs) are associated with enhanced overall outcomes and improved patient satisfaction. The aim of this study was to provide an overview of the quality of CPGs and PILs in cancer surgery departments undertaking pulmonary lobectomy, nephrectomy, cystectomy, whipples, colorectal and ovarian surgery., Methods: We conducted a cross-sectional descriptive study within 44 surgical departments in six cancer subspecialties: lung (n = 4), kidney (n = 9), bladder (n = 5), pancreas (n = 4), colorectal (n = 18) and ovarian (n = 4). Local CPGs were assessed according to nine key elements, i.e. discharge criteria and plans for mobilisation, pain management, nutrition, fluid, nausea and vomiting, antibiotics, bowel movements and urinary drainage. The PILs were evaluated using the DISCERN tool., Results: All departments had CPGs and PILs. Overall, 43% of the departments incorporated all nine key elements in the CPGs. Yet, a third of the CPGs lacked well-defined discharge criteria, and half of the PILs were of poor/very poor quality (48%); the remainder were fair (43%) or good (10%)., Conclusions: CPGs and PILs are highly available in Danish departments that perform cancer surgery. However, this study revealed that local CPGs lacked discharge criteria, and the majority of the PILs were considered of poor quality, suggesting that post-operative management after cancer surgery is of varying quality., Funding: not relevant., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Objective: Quality of preoperative and postoperative care is crucial to improve postoperative outcome of cancer surgery and to ensure that neither complications nor a poor general condition delays any subsequent radiochemotherapy or recovery. On this background, the Danish Gynecological Cancer Database (DGCD) established a nursing database in 2011. The aim of DGCD Nursing is to monitor the quality of preoperative and postoperative care and to generate data for research., Material and Methods: In accordance with the current data protection legislation, real-time data are entered by clinical nurses at all national cancer centers. The DGCD Nursing includes data of preoperative and postoperative care, and nurses are independently represented in the steering committee. The aim of the present article is to present the first results from DGCD Nursing and the national care improvements that have followed., Results: With national coverage of an average of 94%, 5726 patients have been registered since 2011. In patients undergoing surgery for ovarian, endometrial, and cervical cancer, 436 different variables monitor central preoperative and postoperative care elements within mobilization, nutritional status, pain score, vital functions, and psychosocial support., Conclusions: At national level, DGCD offers a comprehensive overview of the total patient pathway within gynecological cancer surgery. The DGCD Nursing has added to the quality and implementation of evidence-based preoperative and postoperative care and in addition supported formation of professional networks. With a continued validation of data, DGCD Nursing now constitutes a sound and unique basis for research within the field of preoperative and postoperative cancer care.

Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.

Introduction: Besides intraoperative efforts, the perioperative care is essential to improve the postoperative outcome following ovarian cancer surgery. Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery and reduces morbidity. The purpose of this study was to assess and discuss perioperative care principles in patients undergoing ovarian cancer surgery with stage IIIC at the six centres in Denmark performing this surgical procedure., Material and Methods: The study was a retrospective audit. The study included 90 consecutive patients, 15 from each of the centres at which operations were performed in 2007. Data was obtained from medical and nursing files. The extent of the surgical procedure was recorded., Results: For patients without extensive surgery effort, the median hospital stay was six days; for patients with extensive surgery, the median hospital stay was 13 days. A total of 48 percent of the patients without maximal surgery effort fulfilled the goals for mobilization on the day of surgery, and 19 percent on the first postoperative day. A total of 35 percent of the patients with maximal surgery effort fulfilled the goals for mobilization on the day of the surgery, and 24 percent on the first postoperative day. Less than half of the patients had regular oral diet and protein enriched drinks on or before the third postoperative day., Conclusion: Mobilization, nutrition, nausea and pain are severe problems for patients undergoing ovarian cancer surgery. Optimized perioperative care is needed including a procedure-specific, evidence-based clinical guideline for patients receiving extensive surgery.

The benefits of fast-track surgery are improved recovery and a shorter period of postoperative convalescence. After uncomplicated colonic resection, there is no pathophysiological basis for recommending a postoperative convalescence of more than 2-3 weeks. Advice after discharge - Convalescence: Daily activities and light exercise should be resumed as soon as possible. Physically moderate work should be resumed after two weeks. Physically severe exercise and lifts (> 10 kg) as well as physically strenuous work may be resumed after 3-4 weeks.

Introduction: Evidence-based guidelines for perioperative care facilitate the recovery process and decrease morbidity and hospital stay. The aim of this study was to evaluate the availability and content of guidelines for perioperative care in all departments performing colonic resection, nephrectomy, ovarian cancer surgery, pulmonary resection and total knee replacement., Materials and Methods: Based upon nationwide workshops and agreement on clinical guidelines for perioperative care a questionnaire was sent to all surgical departments which perform the five procedures. Where available, the guidelines were assessed for presence of written information at admission and discharge, expected hospital stay, plan for mobilisation, nutrition and pain control as well as information on care after discharge., Results: Between 59% and 88% of the departments within each subspecialty had clinical guidelines for perioperative care. The content in the existing guidelines often lacked accurate information regarding preoperative information, objective pain assessment and well-defined discharge criteria., Conclusion: The number of clinical guidelines is increasing, but there is a need for further implementation of clinical guidelines for perioperative care in order to improve outcome.

Introduction: Introduction of principles for postoperative multimodal rehabilitation (fast track surgery) has decreased hospital stay from about 8-10 days to 2-4 days after colonic resection. The aim of this study was to investigate the effect of a similar fast track regimen in patients operated for ovarian cancer., Method: 72 consecutive patients operated with a conventional perioperative treatment regimen (group 1) were compared with the initial 69 consecutive patients (group 2) with a multimodal rehabilitation regimen and the next 50 consecutive patients (group 3) where the fast track regimen was implemented as a routine., Results: Patients demographics and surgical characteristics were comparable between groups. Median postoperative hospital stay was reduced from six days in group 1, to five days in group 2, and four days in group 3 (p < 0,05). Surgical complications were similar while medical complications were reduced from 12% to 1% (p < 0,05) and readmissions from 10% to 2% (p < 0,05) with the fast track regimen., Conclusion: Principles for postoperative multimodal rehabilitation from colonic surgery lead to faster rehabilitation, decreased risk of medical complications and hospital stay in patients operated for ovarian cancer.

Background: In patients undergoing colonic surgery the postoperative hospital stay has been reduced from 8-12 days to 2-4 days with multimodal rehabilitation programs. The aim of this study was to evaluate the postoperative outcome after surgery for ovarian malignancy with conventional care compared to fast-track multimodal rehabilitation., Methods: Seventy-two consecutive patients receiving conventional care (group 1) were compared with 69 consecutive patients receiving multimodal, fast-track rehabilitation with a planned care program including continuous epidural analgesia, early oral feeding and mobilization (group 2) in the same department. Outcome was postoperative hospital stay and morbidity during the first postoperative month., Results: Median age was 63 years (group 1) and 62 years (group 2). Median postoperative hospital stay was reduced from 6 days in group 1 (mean 7.3) to 5 days in group 2 (mean 5.4) (p < 0.05). There was no difference in the overall complication rate, although severe medical complications were reduced in group 2 (14% versus 2%; p < 0.01). Readmission rate was 10% in group 1 and 3% in group 2 (p > 0.05)., Conclusions: The concept of fast-track multimodal rehabilitation appears to be beneficial in patients operated for ovarian malignancy, as hospital stay and medical morbidity are reduced.

Background: Laparoscopic colonic surgery has been claimed to hasten recovery and reduce hospital stay compared with open operation. Recently, enforced multimodal rehabilitation (fast-track surgery) has improved recovery and reduced hospital stay in both laparoscopic and open colonic surgery. Since no comparative data between laparoscopic and open colonic resection with multimodal rehabilitation are available, the value of laparoscopy per se is unknown., Methods: In a randomized, observer-and-patient, blinded trial, 60 patients (median age 75 years) underwent elective laparoscopic or open colonic resection with fast-track rehabilitation and planned discharge after 48 hours. Functional recovery was assessed in detail during the first postoperative month., Results: Median postoperative hospital stay was 2 days in both groups, with early and similar recovery to normal activities as assessed by hours of mobilization per day, computerized monitoring of motor activity assessed, pulmonary function, cardiovascular response to treadmill exercise, pain, sleep quality, fatigue, and return to normal gastrointestinal function. There were no significant differences in postoperative morbidity, mortality, or readmissions, although 3 patients died in the open versus nil in the laparoscopic group., Conclusion: Functional recovery after colonic resection is rapid with a multimodal rehabilitation regimen and without differences between open and laparoscopic operation. Further large-scale studies are required on potential differences in serious morbidity and mortality.