Prostate Restored
Prostate Restored
Photo: MART PRODUCTION
Prolonged surgery carries a significant short and long-term mortality and disability.
And a recent analysis of research published in the Journal of Medicinal Food on turmeric extracts concluded that eight to 12 weeks of treatment...
Read More »
The 5-year survival rate for people with prostate cancer in the United States is 98%. The 10-year survival rate is also 98%. Approximately 84% of...
Read More »Value-based medicine is gaining acceptance as a means to assess the net benefit form medical interventions not only in terms of immediate survival, but also in terms of long-term outcomes, quality of life and cost-benefit. It is proposed as a new assessment tool because the increasing financial demands on the healthcare system driven by technological innovations, new developments in the pharmacological and imaging areas and industrial pressure, often do not translate into improvements of health indices. Some examples drawn from different areas of surgical care follow to illustrate this paradox. (1) Ten-year survival from pancreatic, gastric, lung or brain malignancies has remained almost identical at a low 1–10% for the last 40 years despite massive financial resources have been invested into their treatment and into basic and clinical research8. (2) Despite pleas to implement new expensive technologies in simple cholecystectomy, requiring a steep learning curve, clinical outcomes are similar or even worse using sophisticated surgical approaches (NOTES, single-port, robotic) than those obtained by standard laparoscopy9 or through a small subcostal incision10. (3) Screening for colonic cancer results in more patients being diagnosed with this malignancy and a marginal reduction of disease-specific mortality but does not extend life expectancy. Thus more colonoscopies, colectomies and chemotherapy are practiced in the screened population with no long-term value and increased costs11. Along the same line, the present study indicates that a number of patients undergoing prolonged highly expensive surgery, do not obtain the expected benefit in terms of survival or personal autonomy. Complications and death after major surgery are related to three main factors: surgical complexity, physiological limitations and comorbidity. Thus, it doesn’t seem realistic to put only emphasis on the prevention of complications6 because after prolonged surgery, which often combines these three major risk determinants, these will happen anyway. In our study over three quarters of patients developed at least one surgical complication, often above the Clavien-Dindo category II, and almost a fifth required a reoperation. Thus, prolonged surgery not only represents a technical challenge but also a significant physiological stress associated with the ensuing complications and reoperations. These extreme demands on the patient’s homeostasis can only be met if preoperative health is at its best, hence the relevance of serum albumin concentrations and the ASA score to predict early and late survival. The well-known value of serum albumin as a prognostic variable12,13,14,15 was again confirmed in the present investigation. In addition, a significant association was found between pre- and early postoperative serum albumin concentrations and the ASA score, suggesting that serum albumin is a good indicator of both health status and the ability of the surgical patient to mount an appropriate physiological response to aggressive surgery. Multivariate analysis disclosed that postoperative serum albumin concentrations had an even greater prognostic relevance than preoperative concentrations.
People with penises have an average of 11 erections per day and three to five more each night, but everyone is different. There are numerous...
Read More »
When it comes to chocolate, it is common knowledge that the craving signifies a deficiency in magnesium. Since cacao is considered the food with...
Read More »Recent studies16, 17 have shown that serum albumin concentration on the first postoperative day after esophagectomy or pancreatectomy were the most powerful predictive variable for postoperative complications and death. Our findings confirm these reports and, in addition, reveal that postoperative serum albumin has clear-cut association with long-term survival and dependency. The drop of serum albumin concentrations after surgery is probably related to two main factors: 1) the ability of the patient to restore a normal extracellular water volume, and 2) albumin escape to the interstitial and/or third space due to lymphatic leakage or the presence of inflammatory or septic focus18,19,20. Postoperative hypoalbuminaemia has been linked to an altered distribution of the albumin molecule from the intravascular to the interstitial space by convective transcapillary transport facilitated by fluid loads21, 22. Thus, albumin kinetics depend to a large extent on the ability of the patient to restore the extracellular fluid volume to normal through appropriate renal and hemodynamic responses. Mullins et al.23 investigated the relationship between the fractional increase of blood volume after a rapid saline infusion and the development of complications after non-cardiac surgery. Patients with the highest increase in intravascular volume had a better postoperative course than those showing a preferential volume shift to the interstitial space. The latter experienced a more pronounced drop in serum albumin concentrations. Multivariate analysis has been used preferentially to predict either mortality or complications in the inpatient setting24. Our study has extended this to mid and long-term results, showing that commonly used parameters to assess postoperative risks are also useful to predict long-term outcomes. The biological profile of patients with the highest immediate and long-term risk is the one aged 70 or more, with a low pre- and postoperative serum albumin concentration and a III-IV ASA score requiring more than a week admission in the intensive care unit, particularly if surgery was carried out for cancer. A postoperative ICU stay of over 7 days was found to be particularly lethal in the elderly as previously reported25. As pointed out in Pucher’s et al. study26; postoperative complications and the need for reoperation did also have an impact on long-term survival in our cohort, but at variance with this study, our findings suggest that these are weak predictive variables when compared to more stronger predictors such as ASA score, stay in the ICU and albumin kinetics. Value-based and patient-centered surgical care implies that surgeons should pay attention to outcomes that matter most to patients. In a recent study, Berian et al.27 reported that two-thirds of patients 65 years and older undergoing inpatient surgery did loss their autonomy according to definitions close to the ones used in the present study. Loss of independency was strongly associated with increasing age, postoperative complications and the ASA score, findings that were reproduced in the present series.
In summary, quality of life (QOL) in healthcare is weighed heavily by patient perception of both their objective and subjective well-being. Sep 29,...
Read More »
What are the 7 pillars of clinical governance? Clinical Effectiveness. Any treatment used must provide the best outcome for the patient: ... Risk...
Read More »In conclusion, lengthy surgery is associated with high rates of postoperative complications, short and long-term mortality and dependency from the healthcare system. A sound cost-benefit analysis should be considered when envisaging complex surgery, either for benign or malignant conditions, particularly in patients with serious comorbidities, in order to obtain the best possible outcomes from expensive and time-consuming surgical interventions.
While you might not be too keen on it, you can leave a wet diaper alone through the night, and simply change it in the morning. The only need to do...
Read More »
Citronella. Citronella essential oil helps to ease stress. This in turn can lower blood pressure.
Read More »
Fish and seafood Cod, flounder, halibut, whitefish, catfish, salmon, tuna steaks and shrimp are good choices for your kidney diet.
Read More »
If you're hitting the bathroom every hour or so, your bladder might be trying to tell you something. Jamin Brahmbhatt, M.D., a urologist with...
Read More »
Promotion
Promotion
Promotion