Introduction Flashcards
Give one definition of surgical outcomes research.
Surgical outcomes research is a science focused on assessing the quality and effectiveness of surgical care at a patient and population level.
Explain how tissue injury can lead to constipation and decreased tolerance to food
- Tissue injury causes inflammation (cytokine release) + Hypothalamus activates sympathetic NS
- -> decreased GI motility
- -> Constipation, decreased tolerance to food
Explain how tissue injury can lead to sleep disturbances and fatigue.
Tissue injury causes inflammation (cytokine release) –> hypothalamus tells the pituitary gland to release adreno-corticotrophic hormone –> This hormone tells the adrenal cortex to release cortisol and GH, both of which increase catabolism, which causes an increase in tryptophan/5-TH.
*Pain associated with surgery also leads to sleep disturbances, thus leading to fatigue
Explain how tissue injury can lead to decreased exercise tolerance.
Tissue injury causes inflammation (cytokine release) –> hypothalamus tells the pituitary gland to release adreno-corticotrophic hormone –> This hormone tells the adrenal cortex to release cortisol and GH, both of which increase catabolism, which causes a decrease in muscle mass.
*Pain also has an impact on decreasing exercise tolerance.
Why did the WHO deem that improving the quality of surgical care is a global public health concern?
- A meta-analysis showed that post-op complications occur in about 14.4% of surgical patients, 36% of which were deemed preventable
- In Canada, post-op complications are responsible for 51.4% of adverse events occurring in hospitals (36.9% of adverse events deemed preventable)
- Patients after surgical procedure are responsible for the highest rate of adverse events among all medical specialties
- This causes a 5x increase in healthcare costs
Define post-operative recovery
The period from surgical trauma until return to baseline level of health
How long does it typically take for patients to recovery (i.e., get back to ‘normal’) after undergoing a major surgery?
A study looking at physical, mental and cognitive outcome measures (in > 60 yrs) showed that for physical function, most people return to pre-op state or above 3 months after surgery (results vary when using PROMs or performance-based measures).
- Mental and cognitive functions back to baseline and above early after surgery (within <1-2 wk)
Recovery takes longer with more invasive procedures, like Whipple or abdominal peritoneal resection.
Name 3 predictors of slower recovery.
- Post-operative complications
- Poor preoperative physical performance
- Preoperative depression
Name and explain the 3 stages of recovery
Early: From OR to discharge to Post-Anesthesia Care Unit (PACU)
Intermediate: From PACU to discharge from hospital
Late: From discharge to return to usual activities or above
Name 3 interventions to improve recovery/post-operative outcomes.
- Preoperative optimization (e.g. prehabilitation)
- Process of enhancing patient’s functional capacity in anticipation of the physiological stress imposed by surgery. - Minimizing surgical trauma (e.g. laparoscopic surgeries)
- Minimally invasive surgery: Surgical procedures involving a smaller incisions and less-extensive manipulation of tissues (i.e., laparoscopic, thoracoscopic surgery).
- Decreased tissue trauma –> reduced surgical stress response –> acceleration of recovery - Standardizing care processes (e.g. ERAS or ERP)
- Enhanced recovery pathways: Standardized, coordinated, multidisciplinary peri-operative care plans incorporating multiple interventions shown to improve recovery into one integrated package.
What are the 2 quotes from Lord Kelvin? lol
“To measure is to know”
“if you cannot measure it, you cannot improve it”
What does recovery involve in terms of dimensions of health?
o Symptom experiences (e.g. pain, fatigue, nausea)
o Functional status (e.g. walking capacity, bowel function)
o Well-being (e.g. physical, mental, social)
Name 3 frameworks in the literature for the classification of outcome measures
- International Classification of Functioning, Disability and Health (ICF) by the WHO
- Wilson Cleary model (more towards patient QOL)
- ISPOR
Explain the Wilson Cleary model
Conceptual model to integrate clinical and psychosocial approaches to health care. Their model links the biological and physiological (objective health) variables to the measure of HRQL or subjective health constructs.
What is an outcome measure?
A measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient’s medical status.
