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Background: To investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA). Methods: We enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes. Results: An under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888–0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50–2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30–37.3 g/L, 25–30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37–1.99, P < 0.001), 5.4 (95% CI 3.08–9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively. Conclusion: In TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion. Trial registration: 28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether 6 months of preoperative apalutamide for intermediate‐risk prostate cancer (IRPCa) reduces the aggregate postoperative radiotherapy risk and to evaluate associations of molecular perturbations with clinical outcomes in this study cohort. Patients and Methods: Between May 2018 and February 2020, eligible patients with IRPCa (Gleason 3 + 4 or 4 + 3 and clinical T2b‐c or prostate‐specific antigen level of 10–20 ng/mL) were treated with apalutamide 240 mg/day for 6 months followed by radical prostatectomy (RP) in this single‐arm, phase II trial. The primary endpoint was presence of any adverse pathological feature at risk of pelvic radiation (pathological T stage after neoadjuvant therapy [yp]T3 or ypN1 or positive surgical margins). Translational studies, including germline and somatic DNA alterations and RNA and protein expression, were performed on post‐apalutamide RP specimens, and assessed for associations with clinical outcomes. Results: A total of 40 patients underwent a RP, and only one patient discontinued apalutamide prior to 6 months. In all, 40% had adverse pathological features at time of RP, and the 3‐year biochemical recurrence (BCR) rate was 15%, with 27.5% being not evaluable. Genomic alterations frequently seen in metastatic PCas, such as androgen receptor (AR), tumour protein p53 (TP53), phosphatase and tensin homologue (PTEN), or BReast CAncer associated gene (BRCA1/2) were underrepresented in this localised cohort. Adverse pathological features and BCR at 3‐years were associated with increased expression of select cell cycle (e.g., E2F targets: adjusted P value [Padj] < 0.001, normalised enrichment score [NES] 2.47) and oxidative phosphorylation (Padj < 0.001, NES 1.62) pathways. Conclusions: Preoperative apalutamide did not reduce the aggregate postoperative radiation risk to the pre‐specified threshold in unselected men with IRPCa. However, transcriptomic analysis identified key dysregulated pathways in tumours associated with adverse pathological outcomes and BCR, which warrant future study. Further investigation of preoperative therapy is underway for men with high‐risk PCa. [ABSTRACT FROM AUTHOR]

Surgical treatment of Hirschsprung's disease (HSCR) in Sweden was centralized to two tertiary pediatric surgery centers 1st of July 2018. Although complex surgical care in adults seems to benefit from centralization there is little evidence to support centralization of pediatric surgical care. The aim of this study was to assess centralization of HSCR in Sweden, with special consideration to preoperative management and outcomes in this group of patients. This study retrospectively analyzed data of patients with HSCR that had undergone or were planned to undergo pull-through at our center, from 1st of July 2013 to 30th of June 2023. Patients managed from 1st of July 2013 to 30th of June 2018 were compared with patients managed from 1st of July 2018 to 30th of June 2023 regarding diagnostic procedures, preoperative treatment, complications and time to definitive surgery. Thirty-six patients were managed during the first five-year period compared to 57 during the second period. There was an increased number of patients referred from other Swedish regions to our center following the centralization. Time from diagnosis to pull-through increased from 33 to 55 days after centralization. There were no significant differences in pre-operative management or complications, general or related to stoma. Despite increasing patient volumes and longer time from diagnosis to pull through, centralization of care for HSCR does not seem to change the preoperative management and risk of complications. With access to support from the specialist center, transanal irrigations remain a safe mode of at home management until surgery, regardless of distance to index hospital. Level III. • There is little evidence supporting the centralization of pediatric surgical care and no evidence for centralization of care for HSCR. • Our results suggest that despite increasing patient volumes, centralization of care for HSCR does not have a negative impact on the preoperative course including efficient diagnostics, preoperative management and risk of complications. [ABSTRACT FROM AUTHOR]

Background: Anxiety before surgery is one of the most challenging aspects of preoperative care. Preoperative anxiety has a number of postoperative complications. There are only a few studies that report on preoperative anxiety in surgical patients in Ethiopia, and their prevalence differs from one study to the next. Objective: The aim of this study was to assess the level of preoperative anxiety and associated factors among surgical patients admitted at public hospitals in southern Ethiopia. Methods: From July to August 2022, a facility-based cross-sectional study was conducted among patients admitted to surgical wards at public hospitals. Data collection was conducted using a pretested, structured questionnaire administered by an interviewer. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory scale. The data were coded and entered in Epi Data Version 4.6, then exported to Statistical Package for Social Sciences version 25 for analysis. To describe the study variables, descriptive statistics were used. The associated factors were then identified using bivariate and multivariate logistic regression analyses. Results were declared at a p-value of less than 0.05 based on an adjusted odds ratio with a 95% confidence interval. Result: A total of 220 patients were enrolled, with a 99.5% response rate. The observed preoperative anxiety level was 57.5% (95%CI: 54.63–62.35). High preoperative anxiety was associated with no formal educational status (AOR: 3.75; 95%CI = 1.36, 10.39), fear of death (AOR =2.01; 95%CI = 1.09, 3.73), fear of waking up in middle of surgery (AOR =3.42; 95%CI =1.19, 9.77), fear of postoperative pain (AOR = 2.56; 95%CI = 1.15, 5.74). Conclusion: This study found that five out of ten patients scheduled for surgery in public hospitals had high levels of preoperative anxiety. Anxiety levels were associated with factors such as the educational status of respondents, fear of death, fear of waking up in the middle of surgery, and fear of postoperative pain. Preoperative anxiety assessments should be conducted regularly in each hospital, and appropriate anxiety-reducing methods must be implemented. [ABSTRACT FROM AUTHOR]

Aim: To evaluate preoperative and postoperative levels of anxiety according to visual acuity and sociodemographic characteristics in patients undergoing cataract surgery. Materials and Methods: The study included 100 patients who were planned to undergo cataract surgery because of reduced vision. One day preoperatively and at one month postoperatively, all the patients were administered the sociodemographic data form and the Spielberger State-Trait Anxiety Inventory (STAI TX-1 and TX-2). All the patients underwent a detailed preoperative and postoperative ophthalmological examination. Visual acuity was evaluated with a logMAR Chart. Results: The visual acuity on the LogMAR chart of the patients was mean 1.1±0.3 preoperatively and 0.1±0.1 postoperatively. Visual acuity was determined to have significantly increased postoperatively and the STAI FORM TX-2 points significantly decreased (p=0.04). The postoperative decrease in the LogMAR chart was statistically significant (p<0.001). A significant positive correlation was determined between the preoperative STAI FORM TX-1 points and the preoperative STAI FORM TX-2 points. The mean STAI FORM TX-1 points of the patients with an education level of middle school or below were found to be significantly higher than those of patients educated to university level or higher (p=0.012). The visual acuity (LogMAR) of patients who had previously received psychiatric treatment were found to be significantly lower than those of patients who had not received any psychiatric drug treatment (p=0.027). Conclusion: Patients with cataracts are anxious in a general sense, independently of surgery. The increase in vision after cataract surgery is important in respect of decreasing levels of trait anxiety. [ABSTRACT FROM AUTHOR]

Breast conserving treatment typically involves surgical excision of tumor and adjuvant radiotherapy targeting the breast area or tumor bed. Accurately defining the tumor bed is challenging and lead to irradiation of greater volume of healthy tissues. Preoperative stereotactic body radiotherapy (SBRT) which target tumor may solves that issues. We conducted a systematic literature review to evaluates the early toxicity and cosmetic outcomes of this promising treatment approach. Secondary we reviewed pathological complete response (pCR) rates, late toxicity, patient selection criteria and radiotherapy protocols. We retrieved literature from PubMed, Scopus, Web of Science, Cochrane, ScienceDirect, and ClinicalTrials.gov. The study adhered to the PRISMA 2020 guidelines. Ten prospective clinical trials (7 phase II, 3 phase I), encompassing 188 patients (aged 18–75 years, cT1-T3 cN0-N3 cM0, primarily with ER/PgR-positive, HER2-negative status,), were analyzed. Median follow-up was 15 months (range 3–30). Treatment involved single-fraction SBRT (15-21Gy) in five studies and fractionated (19.5–31.5Gy in 3 fractions) in the rest. Time interval from SBRT to surgery was 9.5 weeks (range 1–28). Acute and late G2 toxicity occurred in 0–17% and 0–19% of patients, respectively, G3 toxicity was rarely observed. The cosmetic outcome was excellent in 85–100%, fair in 0–10% and poor in only 1 patient. pCR varied, showing higher rates (up to 42%) with longer intervals between SBRT and surgery and when combined with neoadjuvant systemic therapy (up to 90%). Preoperative SBRT significantly reduce overall treatment time, enabling to minimalize volumes. Early results indicate excellent cosmetic effects and low toxicity. [ABSTRACT FROM AUTHOR]

Summary: Surgery and general anaesthesia have deleterious effects on sleep and disrupted perioperative sleep health is a risk factor for poor surgical outcomes. The objective of this systematic review was to summarise preoperative interventions that report sleep outcomes. Studies that delivered an intervention initiated >24 h prior to surgery among an adult sample without a diagnosed sleep disorder were included. Studies were excluded if they were preclinical or were not published in English. MEDLINE, MEDLINE ePubs Ahead of Print and In‐process Citations, Embase, Cochrane Central Register of Controlled Trials, APA PsycINFO, CINAHL, and the Web of Science were searched on February 2, 2023. This review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42021260578). Risk of bias was assessed using the Cochrane Risk‐of Bias 2 tool for randomised trials and the Risk Of Bias In Non‐randomised Studies ‐ of Interventions for non‐randomised trials. Certainty of findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. The searching yielded 10,938 total citations, and after screening resulted in 28 randomised and 19 non‐randomised trials (47 total) with 4937 participants. Sleep was a primary outcome in 16 trials; a sleep outcome was significantly improved relative to comparator in 23 trials. This review demonstrates that preoperative sleep is modifiable via a variety of interventions, including pharmacological, non‐pharmacological, and nursing interventions delivered preoperatively or perioperatively. Our results should be considered with caution due to an overall intermediate to high risk of bias in the included trials, and low to very low certainty of evidence. This review supports the modifiability of sleep health among surgical patients and provides the groundwork for preoperative sleep optimisation research. [ABSTRACT FROM AUTHOR]

There is no universally accepted definition for surgical prehabilitation. The objectives of this scoping review were to (1) identify how surgical prehabilitation is defined across randomised controlled trials and (2) propose a common definition. The final search was conducted in February 2023 using MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane. We included randomised controlled trials (RCTs) of unimodal or multimodal prehabilitation interventions (nutrition, exercise, and psychological support) lasting at least 7 days in adults undergoing elective surgery. Qualitative data were analysed using summative content analysis. We identified 76 prehabilitation trials of patients undergoing abdominal (n=26, 34%), orthopaedic (n=20, 26%), thoracic (n=14, 18%), cardiac (n=7, 9%), spinal (n=4, 5%), and other (n=5, 7%) surgeries. Surgical prehabilitation was explicitly defined in more than half of these RCTs (n=42, 55%). Our findings consolidated the following definition: 'Prehabilitation is a process from diagnosis to surgery, consisting of one or more preoperative interventions of exercise, nutrition, psychological strategies and respiratory training, that aims to enhance functional capacity and physiological reserve to allow patients to withstand surgical stressors, improve postoperative outcomes, and facilitate recovery.' A common definition is the first step towards standardisation, which is needed to guide future high-quality research and advance the field of prehabilitation. The proposed definition should be further evaluated by international stakeholders to ensure that it is comprehensive and globally accepted. [ABSTRACT FROM AUTHOR]

A total of 151 patients with 151 operations were observed and retrospectively recorded. All medical staff (including doctors, nurses, and midwives) participating in the preparation of patients were invited to participate in the study. A total of 38 health workers were observed and evaluated. Seven in-depth interviews and focus group discussions were performed. Compliance preparation for preoperative preparation among medical staff is low, with only 45.7% adherence to the process, while 76.8% comply with physical preparation. The overall compliance rate is 67.5%. The study also reveals incomplete surgical review systems, inadequate human resources, and insufficient supervision. Type of surgery and surgical department are factors associated with poor preoperative preparation. Study results highlighted that the level of compliance with the pre-operative patient preparation process of the private hospital in this study was still low. Appropriate strategies are needed to improve human resource barriers and monitor and improve administrative systems, thereby improving the ability of medical staff to comply with the process at the hospital. [ABSTRACT FROM AUTHOR]

Purpose: To build an Mult-Task Learning (MTL) based Artificial Intelligence(AI) model that can simultaneously predict clinical stage, histology, grade and LNM for cervical cancer before surgery. Methods: This retrospective and prospective cohort study was conducted from January 2001 to March 2014 for the training set and from January 2018 to November 2021 for the validation set at Beijing Chaoyang Hospital, Capital Medical University. Preoperative clinical information of cervical cancer patients was used. An Artificial Neural Network (ANN) algorithm was used to build the MTL-based AI model. Accuracy and weighted F1 scores were calculated as evaluation indicators. The performance of the MTL model was compared with Single-Task Learning (STL) models. Additionally, a Turing test was performed by 20 gynecologists and compared with this AI model. Results: A total of 223 cervical cancer cases were retrospectively enrolled into the training set, and 58 cases were prospectively collected as independent validation set. The accuracy of this cervical cancer AI model constructed with ANN algorithm in predicting stage, histology, grade and LNM were 75%, 95%, 86% and 76%, respectively. And the corresponding weighted F1 score were 70%, 94%, 86%, and 76%, respectively. The average time consumption of AI simultaneously predicting stage, histology, grade and LNM for cervical cancer was 0.01s (95%CI: 0.01–0.01) per 20 patients. The mean time consumption doctor and doctor with AI were 581.1s (95%CI: 300.0-900.0) per 20 patients and 534.8s (95%CI: 255.0-720.0) per 20 patients, respectively. Except for LNM, both the accuracy and F-score of the AI model were significantly better than STL AI, doctors and AI-assisted doctors in predicting stage, grade and histology. (P < 0.05) The time consumption of AI was significantly less than that of doctors' prediction and AI-assisted doctors' results. (P < 0.05 Conclusion: A multi-task learning AI model can simultaneously predict stage, histology, grade, and LNM for cervical cancer preoperatively with minimal time consumption. To improve the conditions and use of the beneficiaries, the model should be integrated into routine clinical workflows, offering a decision-support tool for gynecologists. Future studies should focus on refining the model for broader clinical applications, increasing the diversity of the training datasets, and enhancing its adaptability to various clinical settings. Additionally, continuous feedback from clinical practice should be incorporated to ensure the model's accuracy and reliability, ultimately improving personalized patient care and treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: A fistula is an unusual communication between the skin and an inward organ or between the organs. The current study aimed to determine the role of magnetic resonance imaging (MRI) in the diagnosis, description, and classification of fistula-in-ano. Additionally, the study aimed to compare the MRI findings with the operative findings, which is considered the gold standard in our study. Methods: The present study is a prospective study and was carried out on a group of 61 patients: 52 males and 9 females with a mean age of 41 years, who were suspected to have perianal fistulae presented clinically with discharge or localized pain or were asymptomatic. A preoperative MRI was conducted for fistula-in-ano evaluation in these patients from October 2019 till the end of October 2021. A surgeon conducted a physical examination of all patients to document the number and location of cutaneous openings following a full medical history. The MRI images were evaluated and interpreted by multiple expert radiologists who had more than 5 years of experience in analyzing MRI. In the cases (in 3 cases, 4.92%) where there were discrepancies in their interpretations, a senior radiologist's evaluation was considered the final result and was confirmed surgically. Subsequently, the MRI findings were correlated with surgical findings to indicate the specificity, sensitivity, and accuracy of such MRI findings. Results: The MRI technique was the routine (i.e., without contrast administration) technique in 36 (59.02%) patients, with contrast administration in 21 (34.43%) patients and with anesthesia/sedation (uncomfortable, anxious, and claustrophobic patients need to minimize their motion artifact to improve the quality and obtain more detailed images) in 4 (6.56%) patients. The MRI pathology of the studied patients revealed normal findings in 1 (1.64%) patient, anal fissure/early developing tract in 6 (9.84%) patients, and established tract (sinus/fistula) in 54 (88.52%) patients. Park's and St. James's University Hospital classifications were utilized to categorize the patients, with the most common fistula types based on the Park's classification: intersphincteric (44.3%) and transsphincteric (29.5%). Based on the St. James's classification, grade 1 (intersphincteric (34.4%)) and grade 4 (transsphincteric with abscess/side branch (16.4%)) were the most prevalent. A substantial consensus was reached between MRI and surgery findings for classifying tracts, side branches, and abscesses formation with sensitivity, specificity, and accuracy of 100%, 85.71%, and 98.36%, respectively. Conclusions: MRI is a valuable tool in managing patients with perianal fistulas due to its ability to detect hidden areas of infection (such as abscesses) and secondary extensions. These factors contribute to the high recurrence rate after surgery. Additionally, MR imaging can define the anatomical relationships between the fistula and anal sphincters, helping to predict the likelihood of fecal incontinence following surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: Estimating the risk of postoperative complications is important for shared decision-making with the patient. This also helps multidisciplinary teams to plan preoperative management and postoperative care and predict duration of recovery. In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological–oncological (GO) robotic surgery (RS). We were able to demonstrate that the ACS-NSQIP risk tool showed 90% accuracy in prediction of five major complications and mortality. Purpose: In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological–oncological (GO) robotic surgery (RS). Methods: Retrospective data collection undertaken through a dedicated GO database and patient notes at a tertiary referral cancer centre. Following data lock with the actual post-op event/complication, the risk calculators were used to measure predictive scores for each patient. Baseline analysis of 153 patients, based on statistician advice, was undertaken to evaluate P-POSSUM and ACS-NSQIP validity and relevance in GO patients undergoing RS performed. Results: P-POSSUM reports on mortality and morbidity only; ACS-NSQIP reports some individual complications as well. ACS-NSQIP risk prediction was most accurate for venous thromboembolism (VTE) (area under the curve (AUC)-0.793) and pneumonia (AUC-0.657) and it showed 90% accuracy in prediction of five major complications (Brier score 0.01). Morbidity was much better predicted by ACS-NSQIP than by P-POSSUM (AUC-0.608 vs. AUC-0.551) with the same result in mortality prediction (Brier score 0.0000). Moreover, a statistically significant overestimation of morbidity has been shown by the P-POSSUM calculator (p = 0.018). Conclusions: Despite the limitations of this pilot study, the ACS-NSQIP risk calculator appears to be a better predictor of major complications and mortality, making it suitable for use by GO surgeons as an informed consent tool. Larger data collection and analyses are ongoing to validate this further. [ABSTRACT FROM AUTHOR]

Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. Adults undergoing major elective abdominal surgery. Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. PPC, hospital length of stay and 12-month mortality. Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain. There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients presenting for gynecologic surgery are a heterogeneous group. Preoperative quality of life may be a useful tool to guide postoperative management. OBJECTIVE: This study aimed to examine the key drivers of preoperative quality of life to improve counseling and postoperative management. STUDY DESIGN: This study analyzed preoperative survey results from 154 participants using the following surveys: National Institutes of Health Toolbox Global Health v1.2, Gastrointestinal: Gas and Bloating v1.1 13a, Gastrointestinal: Diarrhea v1.0 6a, and Sexual Function and Satisfaction Brief Profile (Female) v2.0, Perceived Stress Scale, the Vaginal Assessment Scale, and the Vulvar Assessment Scale. Survey results in the form of T-scores were compared in patients with endometrial cancer and patients with benign gynecologic conditions using the Kruskal-Wallis test. The multivariate analysis was performed using linear regression to adjust the comparisons for age, body mass index, and comorbidity. RESULTS: Of the 154 patients, preoperative diagnosis was benign in 66% (n=102) and endometrial cancer in 34% (n=52). Patients with endometrial cancer were more likely to be older, non-White, in lower income brackets, have higher body mass index, and be postmenopausal (P.05), when adjusted for age, the differences in global health quality of life between patients with benign gynecologic conditions and those with endometrial cancer became significant, because the endometrial cancer group was older than the benign group (P.05). Sexual interest was decreased in the patients with endometrial cancer both in the unadjusted and adjusted model; and vulvar complaints became significantly different between the groups when controlling for body mass index, age, and comorbidities (P

Summary: Background & aims: Poor nutritional status has been shown to have a detrimental effect on the prognosis of patients undergoing surgery. Oral nutritional supplements (ONS) are commonly used in the preoperative period to improve the nutritional status of patients. However, the impact of ONS on postoperative clinical outcomes remains controversial. This systematic review aims to evaluate the effectiveness of preoperative ONS on clinical outcomes of patients undergoing colorectal cancer surgery. Methods: Nine databases, including English databases (PubMed, Embase, the Cochrane Library, Web of Science, CINAHL) and Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal Database, China Biology Medicine disc), were searched from their establishment to October 2022. The last search was conducted in June 2023, and the language was limited to Chinese and English. The secondary outcomes included wound infection, anastomotic leakage, and length of hospital stay. A meta-analysis was performed using RevMan 5.4 software. Results: Seven randomized controlled trials involving 737 subjects were included, 363 in the treatment group and 374 in the control group. All seven trials involved patients with colorectal cancer. Patients in the intervention group received ONS, while those in the control group received a conventional diet or an isoenergetic and isonitrogenous diet. The fixed effect model showed that the total incidence of postoperative complications in the intervention group was significantly lower than that in the control group [RR=0.83, 95%CI (0.70, 0.98), P=0.03, I2=29%, n=737]. However, there was no statistical significance in reducing wound infection, anastomotic leakage, or urinary tract infection. Conclusion: This study provides evidence that preoperative ONS can reduce the incidence of postoperative complications, but there is still a need for further research to support their routine use as preoperative nutritional support.

Abstract Background A fistula is an unusual communication between the skin and an inward organ or between the organs. The current study aimed to determine the role of magnetic resonance imaging (MRI) in the diagnosis, description, and classification of fistula-in-ano. Additionally, the study aimed to compare the MRI findings with the operative findings, which is considered the gold standard in our study. Methods The present study is a prospective study and was carried out on a group of 61 patients: 52 males and 9 females with a mean age of 41 years, who were suspected to have perianal fistulae presented clinically with discharge or localized pain or were asymptomatic. A preoperative MRI was conducted for fistula-in-ano evaluation in these patients from October 2019 till the end of October 2021. A surgeon conducted a physical examination of all patients to document the number and location of cutaneous openings following a full medical history. The MRI images were evaluated and interpreted by multiple expert radiologists who had more than 5 years of experience in analyzing MRI. In the cases (in 3 cases, 4.92%) where there were discrepancies in their interpretations, a senior radiologist’s evaluation was considered the final result and was confirmed surgically. Subsequently, the MRI findings were correlated with surgical findings to indicate the specificity, sensitivity, and accuracy of such MRI findings. Results The MRI technique was the routine (i.e., without contrast administration) technique in 36 (59.02%) patients, with contrast administration in 21 (34.43%) patients and with anesthesia/sedation (uncomfortable, anxious, and claustrophobic patients need to minimize their motion artifact to improve the quality and obtain more detailed images) in 4 (6.56%) patients. The MRI pathology of the studied patients revealed normal findings in 1 (1.64%) patient, anal fissure/early developing tract in 6 (9.84%) patients, and established tract (sinus/fistula) in 54 (88.52%) patients. Park’s and St. James's University Hospital classifications were utilized to categorize the patients, with the most common fistula types based on the Park’s classification: intersphincteric (44.3%) and transsphincteric (29.5%). Based on the St. James’s classification, grade 1 (intersphincteric (34.4%)) and grade 4 (transsphincteric with abscess/side branch (16.4%)) were the most prevalent. A substantial consensus was reached between MRI and surgery findings for classifying tracts, side branches, and abscesses formation with sensitivity, specificity, and accuracy of 100%, 85.71%, and 98.36%, respectively. Conclusions MRI is a valuable tool in managing patients with perianal fistulas due to its ability to detect hidden areas of infection (such as abscesses) and secondary extensions. These factors contribute to the high recurrence rate after surgery. Additionally, MR imaging can define the anatomical relationships between the fistula and anal sphincters, helping to predict the likelihood of fecal incontinence following surgery.

Abstract Purpose To build an Mult-Task Learning (MTL) based Artificial Intelligence(AI) model that can simultaneously predict clinical stage, histology, grade and LNM for cervical cancer before surgery. Methods This retrospective and prospective cohort study was conducted from January 2001 to March 2014 for the training set and from January 2018 to November 2021 for the validation set at Beijing Chaoyang Hospital, Capital Medical University. Preoperative clinical information of cervical cancer patients was used. An Artificial Neural Network (ANN) algorithm was used to build the MTL-based AI model. Accuracy and weighted F1 scores were calculated as evaluation indicators. The performance of the MTL model was compared with Single-Task Learning (STL) models. Additionally, a Turing test was performed by 20 gynecologists and compared with this AI model. Results A total of 223 cervical cancer cases were retrospectively enrolled into the training set, and 58 cases were prospectively collected as independent validation set. The accuracy of this cervical cancer AI model constructed with ANN algorithm in predicting stage, histology, grade and LNM were 75%, 95%, 86% and 76%, respectively. And the corresponding weighted F1 score were 70%, 94%, 86%, and 76%, respectively. The average time consumption of AI simultaneously predicting stage, histology, grade and LNM for cervical cancer was 0.01s (95%CI: 0.01–0.01) per 20 patients. The mean time consumption doctor and doctor with AI were 581.1s (95%CI: 300.0-900.0) per 20 patients and 534.8s (95%CI: 255.0-720.0) per 20 patients, respectively. Except for LNM, both the accuracy and F-score of the AI model were significantly better than STL AI, doctors and AI-assisted doctors in predicting stage, grade and histology. (P

Introduction A previous report has shown that cyclooxygenase‐2 inhibitors can prevent the recurrence of cystitis glandularis postoperatively. Herein, we present a case of cystitis glandularis in which the tumor volume was markedly reduced by preoperative oral administration of a cyclooxygenase‐2 inhibitor. Case presentation A 45‐year‐old man with voiding difficulty and lower abdominal pain during urination was referred to our hospital. Cystoscopy revealed multiple cystitis glandularis‐like edematous masses on the trigone and the neck of the bladder, completely involving the bilateral ureteral orifices. Cyclooxygenase‐2 inhibitor was orally administered at the patient's request. Six weeks later, the tumor volume was markedly reduced, bilateral ureteral orifices were identified, and the voiding difficulty and pain on urination disappeared. Complete transurethral resection of the residual tumor was performed, and the pathological diagnosis was intestinal‐type cystitis glandularis. Conclusion Cyclooxygenase‐2 inhibition can be considered a useful therapeutic strategy for cystitis glandularis.

BACKGROUND: High-risk alcohol use is a common preventable risk factor for postoperative complications, admission to intensive care, and longer hospital stays. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications. OBJECTIVE: The study aimed to explore the acceptability and feasibility of 2 brief counseling approaches to reduce alcohol use in elective surgical patients with high-risk alcohol use in the perioperative period. METHODS: A semistructured interview study was conducted with a group of high responders (who reduced alcohol use ≥50% postbaseline) and low responders (who reduced alcohol use by ≤25% postbaseline) after their completion of a pilot trial to explore the acceptability and perceived impacts on drinking behaviors of the 2 counseling interventions delivered remotely by phone or video call. Interview transcripts were analyzed using thematic analysis. RESULTS: In total, 19 participants (10 high responders and 9 low responders) from the parent trial took part in interviews. Three main themes were identified: (1) the intervention content was novel and impactful, (2) the choice of intervention modality enhanced participant engagement in the intervention, and (3) factors external to the interventions also influenced alcohol use. CONCLUSIONS: The findings support the acceptability of both high- and low-intensity brief counseling approaches. Elective surgical patients are interested in receiving alcohol-focused education, and further research is needed to test the effectiveness of these interventions in reducing drinking before and after surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT03929562; https://clinicaltrials.gov/ct2/show/NCT03929562.

Abstract Background Oncologic surgical resection is the standard of care for extremity and truncal soft tissue sarcoma (STS), often accompanied by the addition of pre- or postoperative radiation therapy (RT). Preoperative RT may decrease the risk of joint stiffness and fibrosis at the cost of higher rates of wound complications. Hypofractionated, preoperative RT has been shown to provide acceptable outcomes in prospective trials. Proton beam therapy (PBT) provides the means to decrease dose to surrounding organs at risk, such as the skin, bone, soft tissues, and adjacent joint(s), and has not yet been studied in patients with extremity and truncal sarcoma. Methods Our study titled “PROspective phase II trial of preoperative hypofractionated protoN therapy for extremity and Truncal soft tissue sarcOma (PRONTO)” is a non-randomized, prospective phase II trial evaluating the safety and efficacy of preoperative, hypofractionated PBT for patients with STS of the extremity and trunk planned for surgical resection. Adult patients with Eastern Cooperative Group Performance Status ≤ 2 with resectable extremity and truncal STS will be included, with the aim to accrue 40 patients. Treatment will consist of 30 Gy radiobiological equivalent of PBT in 5 fractions delivered every other day, followed by surgical resection 2–12 weeks later. The primary outcome is rate of major wound complications as defined according to the National Cancer Institute of Canada Sarcoma2 (NCIC-SR2) Multicenter Trial. Secondary objectives include rate of late grade ≥ 2 toxicity, local recurrence-free survival and distant metastasis-free survival at 1- and 2-years, functional outcomes, quality of life, and pathologic response. Discussion PRONTO represents the first trial evaluating the use of hypofractionated PBT for STS. We aim to prove the safety and efficacy of this approach and to compare our results to historical outcomes established by previous trials. Given the low number of proton centers and limited availability, the short course of PBT may provide the opportunity to treat patients who would otherwise be limited when treating with daily RT over several weeks. We hope that this trial will lead to increased referral patterns, offer benefits towards patient convenience and clinic workflow efficiency, and provide evidence supporting the use of PBT in this setting. Trial registration: NCT05917301 (registered 23/6/2023).

Cancer surgery places a significant burden on a patients’ functional status and quality of life. In addition, cancer surgery is fraught with postoperative complications, themselves influenced by a patient’s functional status. Prehabilitation is a unimodal or multimodal strategy that aims to increase a patient’s functional capacity to reduce postoperative complications and improve postoperative recovery and quality of life. In most cases, it involves exercise, nutrition, and anxiety-reducing interventions. The impact of prehabilitation has been explored in several types of cancer surgery, most commonly colorectal and thoracic. Overall, the existing evidence suggests prehabilitation improves physiological outcomes (e.g., lean body mass, maximal oxygen consumption) as well as clinical outcomes (e.g., postoperative complications, quality of life). Notably, the benefit of prehabilitation is additional to that of enhanced recovery after surgery (ERAS) programs. While safe, prehabilitation programs require multidisciplinary coordination preoperatively. Despite the existence of numerous systematic reviews and meta-analyses, the certainty of evidence demonstrating the efficacy and safety of prehabilitation is low to moderate, principally due to significant methodological heterogeneity and small sample sizes. There is a need for more large-scale multicenter randomized controlled trials to draw strong clinical recommendations.

Background: The preoperative period is known as one of the disturbing events. It habitually prompts cognitive, physiological, and emotional reactions. Depression, anxiety, and stress are considered emotional states usually found in preoperative surgical patients. Objective: To find out the frequency and association of depression, anxiety, and stress with socio-demographic variables among preoperative patients. Methods: This cross-sectional analytical study of 258 preoperative patients was conducted at Dow University Hospital and Dr. Ruth Pfau Civil Hospital, Karachi from August 01, 2019, to July 31, 2020. Ethical approval was obtained before conducting the study. Depression, Anxiety, and Stress Scale-42 tool was used for the data collection. The data was analyzed by using SPSS version 21. Mean and frequency analyses were performed for demographic characteristics. Moreover, a chi-square test was performed to check the association of socio-demographic characteristics of study participants with depression, anxiety, and stress. Results: The majority of the participants (72.5%) in this study were male and 59.7% were between the ages of 20-35 years. The finding of this study revealed that most of the patients had moderate depression (43.02%), extreme anxiety (54.26%), and moderate stress 36.04%. Significant associations were found for depression with gender and monthly income, with a p-value of 0.035 and 0.003 respectively. Gender (p=0.021) and level of education (p=0.013) were significantly associated with stress levels. Conclusion: This study concluded that patients before surgeries had different levels of depression, anxiety, and stress. Age is the only variable that showed a significant association with stress and depression. Furthermore, anxiety is the only domain that is not significantly associated with any demographic characteristics.

Background: Bimaxillary surgery is an elemental procedure in the field of cranio-maxillofacial surgery. It allows for the correction of even the most challenging cases of maxillomandibular disorders, malocclusion, facial asymmetry, and disproportion. The osteotomies and maneuvers carried out during the procedure result in changes to the surrounding tissues, including the maxillary sinuses (MS). The aim of this study was to assess the change in the maxillary sinus volume and the thickness of the mucosa after maxillomandibular advancement (MMA) surgeries. Methods: A group of 25 patients who underwent MMA surgery were included in the study. Computed tomography (CT) of the head and neck region was performed 2 weeks preoperatively and 6 months postoperatively. Acquired Digital Imaging and Communications in Medicine (DICOM) files were analyzed using different software programs to calculate the medium MS mucosa thickness and MS volume. Results: A statistically significant reduction in MS volume was observed (p = 0.015). The change in the median thickness of the MS mucosa was not statistically significant. The median sella-nasion-A point angle (SNA angle) value of the group increased from 80.2 to 83.4 degrees. A weak negative correlation between the SNA delta and the MS volume delta was observed. Spearman's rank coefficient: (ρ s = −0.381, p = 0.060). Conclusions: The MMA surgery results in a reduction in the MS volume. The amount of forward movement of the maxilla may be correlated with the extent of the MS volume reduction. [ABSTRACT FROM AUTHOR]

Purpose: Depression is one of the main psychological responses experienced by patients with breast cancer perioperatively. Therefore, this review aimed to synthesize the prevalence rate of depression preoperatively among patients with breast cancer. Methods: Six databases were searched for published articles, which recruited female patients aged 18 years and above, diagnosed with breast cancer and planned for breast surgery. Grey literatures were searched from ProQuest Theses and Dissertations, Science.gov and CogPrints. Studies published in English from the inception of databases to January 2023 were considered. Two reviewers screened, extracted, and appraised the data independently. Joanna Briggs Institute data collection form was used for data collection. Hoy's Risk of Bias Tool was utilized to assess the individual study's quality. Review Manager 5.4 software was utilized for meta-analysis. Subgroup analyses were conducted to explore the reasons for any heterogeneity. Publication bias was evaluated by Egger's test and funnel plot. Results: Twenty studies involving 32,143 patients with breast cancer were included. Meta-analyses revealed an overall preoperative prevalence of 30% among all studies. Subgroup analyses showed that studies conducted in the Middle East and North Africa used purposive sampling, with patients undergoing mastectomy and lumpectomy and with moderate risk of bias reported higher prevalence of preoperative depression (54%, 44%, 40%, and 49%, respectively) as compared to other respective subgroups. Conclusion: The high prevalence of preoperative depression among women with breast cancer indicated the need for health care professionals to provide more psychological support to them. [ABSTRACT FROM AUTHOR]

Introduction: The views of patients and carers are important for the development of research priorities. This study aimed to determine and compare the top research priorities of cancer patients and carers with those of multidisciplinary clinicians with expertise in prehabilitation. Materials and methods: This cross-sectional study surveyed patients recovering from cancer surgery at a major tertiary hospital in Sydney, Australia, and/or their carers between March and July 2023. Consenting patients and carers were provided a list of research priorities according to clinicians with expertise in prehabilitation, as determined in a recent International Delphi study. Participants were asked to rate the importance of each research priority using a 5-item Likert scale (ranging from 1 = very high research priority to 5 = very low research priority). Results: A total of 101 patients and 50 carers participated in this study. Four areas were identified as research priorities, achieving consensus of highest importance (> 70% rated as “high” or “very high” priority) by patients, carers, and clinical experts. These were “optimal composition of prehabilitation programs” (77% vs. 82% vs. 88%), “effect of prehabilitation on surgical outcomes” (85% vs. 90% vs. 95%), “effect of prehabilitation on functional outcomes” (83% vs. 86% vs. 79%), and “effect of prehabilitation on patient reported outcomes” (78% vs. 84% vs. 79%). Priorities that did not reach consensus of high importance by patients despite reaching consensus of highest importance by experts included “identifying populations most likely to benefit from prehabilitation” (70% vs. 76% vs. 90%) and “defining prehabilitation core outcome measures” (66% vs. 74% vs. 87%). “Prehabilitation during neoadjuvant therapies” reached consensus of high importance by patients but not by experts or carers (81% vs. 68% vs. 69%). Conclusion: This study delineated the primary prehabilitation research priorities as determined by patients and carers, against those previously identified by clinicians with expertise in prehabilitation. It is recommended that subsequent high-quality research and resource allocation be directed towards these highlighted areas of importance. [ABSTRACT FROM AUTHOR]

An intestinal stoma creation is one of the most common surgical procedures. Despite benefits, a stoma can have serious effects on a patient's quality of life. Multiple dimensions of everyday life can be affected such as social life, body image, as well as ability to participate in some religious practices, with some faith groups being disproportionately affected. This study sought to understand the extent to which faith is addressed during these sessions given the integral role it plays for some patients. A survey was developed based on literature review and expert consultation. This was distributed to ostomy certified nursing staff, inflammatory bowel disease gastroenterologists and colorectal surgeons caring for patients requiring a permanent stoma at a high-volume academic institution. Follow-up semistructured interviews were conducted to delve deeper into themes identified in the surveys. The overall survey response rate was 57%. Only 35% reported training on how stomas interface with religious practices. Religious services were either rarely or never present during preoperative counseling discussions. During interviews, it was noted that religious beliefs often impact after care but are not always discussed during preoperative sessions. Interviewees found these conversations to be difficult with minimal support or direction on how to navigate them. Although very important, health-care providers are not including faith-based issues surrounding stomas in perioperative counseling partly due to lack of training or awareness of existing support systems. As our population diversifies, understanding cultural and religious practices that influence care is increasingly important. [ABSTRACT FROM AUTHOR]

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Management of stage II–III non-small cell lung cancer (NSCLC) has been dramatically revolutionized by studies testing the addition of immunotherapy (IO) to chemotherapy in the pre- or perioperative setting. That is because the integration of chemoimmunotherapy (chemo-IO) with surgery has consistently shown a significant improvement in pathological complete response (path CR) rate, event-free survival, and, more recently, overall survival, versus preoperative chemotherapy alone. Particularly, resectable stage III NSCLCs represent a disease entity with a high risk of distant recurrence after radical surgery, for whom pre- or perioperative chemo-IO should be considered as the preferential treatment option. However, owing to the heterogeneity of stage III NSCLC, a standard definition of resectability is not established yet, being often subjective according to the expertise and clinical background of the thoracic surgeon. In addition, careful patient selection on the basis of tumor biomarkers, meticulous staging of the disease, and accurate monitoring of treatment-related adverse events are critical factors that could prevent the ineligibility for surgery of patients treated with pre- or perioperative chemo-IO. Finally, the impact of downstaging for initially borderline resectable tumors, as well as the exact number of preoperative chemo-IO cycles needed and the indications for adjuvant IO, still need to be fully elucidated. In this podcast, we will touch upon the above-mentioned topics from the perspectives of the thoracic surgeon and the oncologist, and suggest a shared agreement between two of the main actors involved in the treatment of resectable stage III NSCLCs. Podcast audio available for this publication. [ABSTRACT FROM AUTHOR]

Background: Oncologic surgical resection is the standard of care for extremity and truncal soft tissue sarcoma (STS), often accompanied by the addition of pre- or postoperative radiation therapy (RT). Preoperative RT may decrease the risk of joint stiffness and fibrosis at the cost of higher rates of wound complications. Hypofractionated, preoperative RT has been shown to provide acceptable outcomes in prospective trials. Proton beam therapy (PBT) provides the means to decrease dose to surrounding organs at risk, such as the skin, bone, soft tissues, and adjacent joint(s), and has not yet been studied in patients with extremity and truncal sarcoma. Methods: Our study titled "PROspective phase II trial of preoperative hypofractionated protoN therapy for extremity and Truncal soft tissue sarcOma (PRONTO)" is a non-randomized, prospective phase II trial evaluating the safety and efficacy of preoperative, hypofractionated PBT for patients with STS of the extremity and trunk planned for surgical resection. Adult patients with Eastern Cooperative Group Performance Status ≤ 2 with resectable extremity and truncal STS will be included, with the aim to accrue 40 patients. Treatment will consist of 30 Gy radiobiological equivalent of PBT in 5 fractions delivered every other day, followed by surgical resection 2–12 weeks later. The primary outcome is rate of major wound complications as defined according to the National Cancer Institute of Canada Sarcoma2 (NCIC-SR2) Multicenter Trial. Secondary objectives include rate of late grade ≥ 2 toxicity, local recurrence-free survival and distant metastasis-free survival at 1- and 2-years, functional outcomes, quality of life, and pathologic response. Discussion: PRONTO represents the first trial evaluating the use of hypofractionated PBT for STS. We aim to prove the safety and efficacy of this approach and to compare our results to historical outcomes established by previous trials. Given the low number of proton centers and limited availability, the short course of PBT may provide the opportunity to treat patients who would otherwise be limited when treating with daily RT over several weeks. We hope that this trial will lead to increased referral patterns, offer benefits towards patient convenience and clinic workflow efficiency, and provide evidence supporting the use of PBT in this setting. Trial registration: NCT05917301 (registered 23/6/2023). [ABSTRACT FROM AUTHOR]

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n = 111 dietitians, n = 72 physicians, n = 42 allied HCPs), 96%–100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n = 142/220; dietitians: 88% vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period (n = 117) by dietitians (n = 94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n = 121/212), time (40%, n = 84/212) and support from others (38%, n = 80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier. [ABSTRACT FROM AUTHOR]

Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events. Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania. Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims. Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10th Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. Total costs, prevalence, and strength of association as indicated by odds ratios. Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107–$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level. The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

Introduction: Outcomes of long-term (5–10-year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12 week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery. Methods: Data were collected prospectively from a bariatric center (2008–2022). Excess weight loss (EWL) ≥ 50% and ≥ 70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL ≥ 50% and ≥ 70%. Results: Three hundred thirty-nine patients (median age, 49 years; median follow-up, 7 years [0.5–11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both < 10.5% and > 10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p < 0.001) and EWL ≥ 70% (HR 3.24, p < 0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥ 50% (OR, 2.36; p = 0.013) and EWL ≥ 70% (OR, 2.03; p = 0.011) at the end of follow-up. Conclusions: IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up. [ABSTRACT FROM AUTHOR]

Surgical procedures often improve health and function but can sometimes also result in iatrogenic effects, including chronic pain and opioid misuse. Due to the known risks of opioids and the physical, emotional, and financial suffering that often accompanies chronic pain, there has been a call for greater use of complementary non-pharmacological treatments like mindfulness-based interventions. Mindfulness can be broadly described as an attentional state involving moment-by-moment meta-awareness of thoughts, emotions, and body sensations. An expanding number of randomized clinical trials have found strong evidence for the value of mindfulness techniques in alleviating clinical symptomology relevant to surgical contexts. The purpose of this review is to examine the empirical evidence for the perioperative use of mindfulness interventions. We present a mindfulness-based stepped care approach that first involves brief mindfulness to treat preoperative pain and anxiety and prevent development of postoperative chronic pain or opioid misuse. More extensive mindfulness-based interventions are then provided to patients who continue to experience high pain levels or prolonged opioid use after surgery. Finally, we review psychophysiological mechanisms of action that may be integral to the analgesic and opioid sparing effects of mindfulness. [ABSTRACT FROM AUTHOR]

Purpose: The utility of pulmonary function testing (PFT) in pectus excavatum (PE) has been subject to debate. Although some evidence shows improvement from preoperative to postoperative values, the clinical significance is uncertain. A high failure-to-completion rate for operative PFT (48%) was identified in our large institutional cohort. With such a high non-completion rate, we questioned the overall utility of PFT in the preoperative assessment of PE and sought to evaluate if other measures of PE severity or cardiopulmonary function could explain this finding. Methods: Demographics, clinical findings, and results from cardiac MRI, PFT (spirometry and plethysmography), and cardiopulmonary exercise tests (CPET) were reviewed in 270 patients with PE evaluated preoperatively between 2015 and 2018. Regression modeling was used to measure associations between PFT completion and cardiopulmonary function. Results: There were no differences in demographics, symptoms, connective tissue disorders, or multiple indices of pectus severity and cardiac deformation in PFT completers versus non-completers. While regression analysis revealed higher RVEF, LVEF, and LVEF-Z scores, lower RV-ESV/BSA, LV-ESV/BSA, and LV-ESV/BSA-Z scores, and abnormal breathing reserve in PFT completers vs. non-completers, these findings were not consistent across continuous and binary analyses. Conclusions: We found that PFT completers were not significantly different from non-completers in most structural and functional measures of pectus deformity and cardiopulmonary function. Inability to complete PFT is not an indicator of pectus severity. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing use of preoperative ultrasound evaluation for melanoma, there is limited research on the use of this technique for Acral Melanoma (AM). Methods: This retrospective study analyzed the electronic medical records of patients who underwent preoperative evaluation for cutaneous melanoma maximum thickness using an 18 MHz probe and histopathological examination between December 2017 and March 2021 at the Department of Dermatology in Xiangya Hospital, Central South University. Results: A total of 105 patients were included in the study. The mean tumor thicknesswas 3.9mm(s.d., 2.3), with 63%of the specimens showing ulceration and 44 patients showing lymph node metastasis. The results showed a good correlation between the high-frequency ultrasonography (HFUS) and histopathological thickness measurements, with a Spearman's correlation coefficient of 0.83 [(95% CI 0.73-0.90) (P < 0.001)]. The positive predictive value (PPV) of sonography in identifying tumor thickness was also found to be high. Conclusion: Our study suggests that high-frequency 18 MHz ultrasonography is an effective tool for the preoperative evaluation of AM thickness. The HFUS measurements correlated well with the histopathological thickness measurements, making it a valuable and reliable method for clinicians to assess the thickness of melanoma lesions preoperatively. [ABSTRACT FROM AUTHOR]

Cancer surgery places a significant burden on a patients' functional status and quality of life. In addition, cancer surgery is fraught with postoperative complications, themselves influenced by a patient's functional status. Prehabilitation is a unimodal or multimodal strategy that aims to increase a patient's functional capacity to reduce postoperative complications and improve postoperative recovery and quality of life. In most cases, it involves exercise, nutrition, and anxiety-reducing interventions. The impact of prehabilitation has been explored in several types of cancer surgery, most commonly colorectal and thoracic. Overall, the existing evidence suggests prehabilitation improves physiological outcomes (e.g., lean body mass, maximal oxygen consumption) as well as clinical outcomes (e.g., postoperative complications, quality of life). Notably, the benefit of prehabilitation is additional to that of enhanced recovery after surgery (ERAS) programs. While safe, prehabilitation programs require multidisciplinary coordination preoperatively. Despite the existence of numerous systematic reviews and meta-analyses, the certainty of evidence demonstrating the efficacy and safety of prehabilitation is low to moderate, principally due to significant methodological heterogeneity and small sample sizes. There is a need for more large-scale multicenter randomized controlled trials to draw strong clinical recommendations. [ABSTRACT FROM AUTHOR]

Beginning January 1, 2022, the Council on Accreditation is requiring student registered nurse anesthetists (SRNAs) matriculating into nurse anesthesia programs to track preanesthetic comprehensive history and physical (H&P) assessment completion numbers. This quality improvement (QI) project aimed to create a new clinical rotation for SRNAs to practice their preanesthetic H&P assessment skills through video telehealth. A quality improvement project. Likert-style and free-text surveys were administered to both the SRNA students and the expert provider to assess for improvements, viability, and effectiveness of the clinical rotation. SRNAs used a curated library of evidence-based resources and instructions for conducting their assessments. Expert guidance was provided through a single experienced provider. Eight SRNAs performed one preanesthetic telehealth H&P assessment and four of the eight performed a second assessment. Pre-QI surveys indicated 75% were not comfortable with their ability in performing a competent assessment. Initial post-QI surveys indicated 88% were more comfortable with their abilities and 100% of those who completed a second-time post-QI survey 100% were more comfortable. Provider feedback indicated full-day clinical rotations were feasible and important. Results revealed SRNAs desire and need for more preanesthetic comprehensive H&P appointments. Expansion into full-scale, full-day, and in-person assessments was also indicated. QI projects at other clinical sites can determine if similar rotations can also create similar clinical rotations. [ABSTRACT FROM AUTHOR]

Surgical interventions are known to induce anxiety in patients due to the associated risks and potential complications. Various methods are employed to alleviate preoperative anxiety. This study aimed to investigate the impact of lavender oil application on the anxiety levels of patients scheduled for surgical procedures. Systematic review and meta-analysis. Studies were accessed using the keywords "preoperative and lavender oil and stress" in Turkish and English between July 1 and 30, 2022, through PubMed (including MEDLINE), Cochrane, EBSCOhost, Web of Science, YÖK National Thesis Center, and Google Scholar. The standardized mean difference was calculated using random-effects models, and the Cochrane Collaboration tool was used to assess the risk of bias in each study. The study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist. Twenty studies were included in the analysis. The anxiety level of the experimental group to which lavender oil was applied before the surgical intervention was significantly lower than that of the control group (standardized mean difference:−5.40; 95% CI: −8.76 to −2.04). Preoperative lavender oil application was found to be an effective method for relieving patients' anxiety. Lavender oil is thought to be a potential standalone treatment for preoperative anxiety. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). Materials and Methods: A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. Results: This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473–799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350–624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11–32%), and vagal nerve deficits in 22% (95% CI 13–31%). Conclusion: This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data. [ABSTRACT FROM AUTHOR]

The general world population is aging and patients are often diagnosed with early-stage lung cancer at an advanced age. Several studies have shown that age is not itself a contraindication for lung cancer surgery, and therefore, more and more octogenarians with early-stage lung cancer are undergoing surgery with curative intent. However, octogenarians present some peculiarities that make surgical treatment more challenging, so an accurate preoperative selection is mandatory. In recent years, new artificial intelligence techniques have spread worldwide in the diagnosis, treatment, and therapy of lung cancer, with increasing clinical applications. However, there is still no evidence coming out from trials specifically designed to assess the potential of artificial intelligence in the preoperative evaluation of octogenarian patients. The aim of this narrative review is to investigate, through the analysis of the available international literature, the advantages and implications that these tools may have in the preoperative assessment of this particular category of frail patients. In fact, these tools could represent an important support in the decision-making process, especially in octogenarian patients in whom the diagnostic and therapeutic options are often questionable. However, these technologies are still developing, and a strict human-led process is mandatory. [ABSTRACT FROM AUTHOR]

As part of their treatment, lung cancer patients frequently endure thoracic oncological surgery, with preoperative chemotherapeutic interventions being the common approach. However, the potential impact of these chemotherapeutic regimens on cutaneous wound healing outcomes following surgery remains the topic of considerable clinical interest. This meta‐analysis sought to evaluate comprehensively the effect of preoperative chemotherapeutic regimens on cutaneous wound healing in lung cancer patients following thoracic oncological surgery. Extensive literature searches were conducted using the leading databases PubMed, Embase, Cochrane Library and Scopus. Eight studies out of 1342 identified satisfied the inclusion criteria. Consideration was given to both randomized controlled trials (RCTs) and observational studies. Data pertaining to study characteristics, patient demographics, chemotherapeutic regimens and wound healing outcomes were extracted with great attention to detail. The examination of these varied studies provided insights into the fluctuations in rates of recovery following treatment, incidences of wound infections and frequencies of surgical complications. The research studies provided odds ratios for recovery that varied significantly in magnitude from 0.95 to 0.38, with regard to the probability of wound infection. Furthermore, a range of odds ratios for complications were disclosed, with certain odds ratios displaying narrow confidence intervals. The complexity of the effect of preoperative chemotherapy on wound closure subsequent to thoracic oncologic surgery is highlighted by our findings. The results underscore the need for individualized treatment strategies for lung cancer patients undergoing surgical procedures that strike a balance between patient safety and optimal clinical outcomes. [ABSTRACT FROM AUTHOR]

Sodium glucose cotransporter 2 inhibitors (SGLT2i) are an established treatment for heart failure and type 2 diabetes. Guidelines suggest withholding SGLT2i preoperatively due to the risk of ketoacidosis. Orthotopic heart transplantation (OHT) occurs without sufficient notice to cease SGLT2i treatment before surgery. In a retrospective analysis of 163 OHT recipients (40 exposed to SGLT2i, 123 not exposed), we show no increase in rates of mild, moderate, or severe acidosis postoperatively. No cases of ketoacidosis occurred, likely due to the fact that 97% of patients received insulin infusions postoperatively for transient postoperative hyperglycemia. Patients exposed to SGLT2i had shorter length of stay in the intensive care unit and improved adjusted survival overall. These findings support the safety of SGLT2i use up to the time of OHT with routine use of a postoperative insulin infusion.