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Preoperative Nutrition Consults Associated with Decreased Postoperative Complication Rate and Decreased Length of Hospital Stay After Spine Metastasis Surgery.

术前营养咨询与脊柱转移术后并发症发生率降低和住院时间缩短相关。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.08.197
  • 作者列表:"Ehresman J","Ahmed AK","Schilling A","Pennington Z","Lubelski D","Cottrill E","Goodwin ML","Liddy A","Abu-Bonsrah N","Goodwin CR","Sciubba DM
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Preoperative malnutrition is associated with increased postoperative complication rate and hospital length of stay. However, the degree to which these risks can be mitigated by nutritional consultation has not been well described. To address this, we sought to determine if a preoperative nutrition consult was associated with decreased 30-day complication rate and hospital length of stay. METHODS:Adult patients who underwent neurosurgical intervention for spinal metastases at a tertiary care institution between 2008 and 2016 were retrospectively reviewed. Stepwise multivariable linear regression analyses were used to identify associations with 30-day complication rate and hospital length of stay. RESULTS:Among 95 patients who met inclusion criteria, the average length of stay was 8.9 days and 40 patients (42.1%) experienced one or more postoperative complications. On multivariable analysis, 30-day complication rates were higher in patients with the absence of a preoperative nutrition consult, a Modified Charlson Comorbidity Index score of greater than 2 points, greater operative blood loss, and malnutrition (Nutritional Risk Index score <97.5). Furthermore, hospitalization duration was increased with the absence of a nutrition consult, malnutrition, congestive heart failure, and prior systemic therapy in the multivariable analysis. CONCLUSIONS:On multivariable analysis, receipt of a preoperative nutrition consult was associated with both decreased 30-day complication rate and shorter hospitalization. We therefore posit that greater implementation of nutritional counseling may help to decrease complication rates and expedite discharge in patients undergoing surgical intervention for spinal metastases.

摘要

背景: 术前营养不良与术后并发症发生率和住院时间增加有关。然而,营养咨询可以减轻这些风险的程度尚未得到很好的描述。为了解决这个问题,我们试图确定术前营养咨询是否与降低 30 天并发症发生率和住院时间相关。 方法: 回顾性分析 2008 年至 2016 年间在三级医疗机构接受脊柱转移瘤神经外科干预的成人患者。采用逐步多变量线性回归分析确定与 30 天并发症发生率和住院时间的相关性。 结果: 在符合纳入标准的 95 例患者中,平均住院时间为 8.9 天,40 例 (42.1%) 患者发生了一次或多次术后并发症。在多变量分析中,术前营养咨询、改良Charlson合并症指数评分大于 2 分、手术失血量较大的患者 30 天并发症发生率较高,和营养不良 (营养风险指数评分 <97.5)。此外,在多变量分析中,住院时间随着缺乏营养咨询、营养不良、充血性心力衰竭和既往系统治疗而增加。 结论: 在多变量分析中,接受术前营养咨询与降低 30 天并发症发生率和缩短住院时间相关。因此,我们假设更大程度地实施营养咨询可能有助于降低脊柱转移瘤手术干预患者的并发症发生率和加快出院。

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DOI:10.1259/bjr.20180883
作者列表:["Tran S","Puric E","Walser M","Poel R","Datta NR","Heuberger J","Pica A","Marder D","Lomax N","Bolsi A","Morach P","Bachtiary B","Seddon BM","Schneider R","Bodis S","Weber DC"]

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

翻译标题与摘要 下载文献
影响因子:2.83
发表时间:2020-01-01
DOI:10.1007/s00520-019-04843-9
作者列表:["Dohzono S","Sasaoka R","Takamatsu K","Hoshino M","Nakamura H"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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