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Levnadsvanor och
operation
My Wikstroumlm Sjukskoumlterska Haumllsoenheten Roumlkfrioperation
Faktorer som paringverkar resultatet av operationen bull Sjukdomen Raumltt diagnos
bull Interventionen Baumlst teknik operationsmetod
bull Organisationen Kliniska riktlinjer vidareutbildning
kvalitetsaumlkring bull Patienten aringlder fysiska och psykiskt
status andra sjukdommar bull Levnadsvanor tobak alkohol oumlvervikt
undernaumlring och fysisk aktivitet
bull Vi har inte raringd att inte anvaumlnda den
kunskap vi har bull Patienterna har en raumlttighet att faring del av
den kunskap vi har om livsstilsrelaterade haumllsorisker och hur de kan undvikas
Patientsaumlkerhet bull Erbjuda patienterna kunskap om
sambanden mellan operation och levnadsvanor
bull Hjaumllp och stoumld att aumlndra ohaumllsosamma levnadsvanor
En jaumlmlik varingrd
2015 Ny patientlag
Vi kan inte fortsaumltta att operera om vi inte Informerar patienterna om levnadsvanornas betydelse foumlr
operationsresultatet Erbjuda dem hjaumllp med foumlraumlndringar av deras levnadsvanor
Motiverat tillstaringnd
Operationen aumlr ofta en vaumlckarklocka
En moumljlighet att se oumlver sina levnadsvanor
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Faktorer som paringverkar resultatet av operationen bull Sjukdomen Raumltt diagnos
bull Interventionen Baumlst teknik operationsmetod
bull Organisationen Kliniska riktlinjer vidareutbildning
kvalitetsaumlkring bull Patienten aringlder fysiska och psykiskt
status andra sjukdommar bull Levnadsvanor tobak alkohol oumlvervikt
undernaumlring och fysisk aktivitet
bull Vi har inte raringd att inte anvaumlnda den
kunskap vi har bull Patienterna har en raumlttighet att faring del av
den kunskap vi har om livsstilsrelaterade haumllsorisker och hur de kan undvikas
Patientsaumlkerhet bull Erbjuda patienterna kunskap om
sambanden mellan operation och levnadsvanor
bull Hjaumllp och stoumld att aumlndra ohaumllsosamma levnadsvanor
En jaumlmlik varingrd
2015 Ny patientlag
Vi kan inte fortsaumltta att operera om vi inte Informerar patienterna om levnadsvanornas betydelse foumlr
operationsresultatet Erbjuda dem hjaumllp med foumlraumlndringar av deras levnadsvanor
Motiverat tillstaringnd
Operationen aumlr ofta en vaumlckarklocka
En moumljlighet att se oumlver sina levnadsvanor
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
bull Vi har inte raringd att inte anvaumlnda den
kunskap vi har bull Patienterna har en raumlttighet att faring del av
den kunskap vi har om livsstilsrelaterade haumllsorisker och hur de kan undvikas
Patientsaumlkerhet bull Erbjuda patienterna kunskap om
sambanden mellan operation och levnadsvanor
bull Hjaumllp och stoumld att aumlndra ohaumllsosamma levnadsvanor
En jaumlmlik varingrd
2015 Ny patientlag
Vi kan inte fortsaumltta att operera om vi inte Informerar patienterna om levnadsvanornas betydelse foumlr
operationsresultatet Erbjuda dem hjaumllp med foumlraumlndringar av deras levnadsvanor
Motiverat tillstaringnd
Operationen aumlr ofta en vaumlckarklocka
En moumljlighet att se oumlver sina levnadsvanor
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Patientsaumlkerhet bull Erbjuda patienterna kunskap om
sambanden mellan operation och levnadsvanor
bull Hjaumllp och stoumld att aumlndra ohaumllsosamma levnadsvanor
En jaumlmlik varingrd
2015 Ny patientlag
Vi kan inte fortsaumltta att operera om vi inte Informerar patienterna om levnadsvanornas betydelse foumlr
operationsresultatet Erbjuda dem hjaumllp med foumlraumlndringar av deras levnadsvanor
Motiverat tillstaringnd
Operationen aumlr ofta en vaumlckarklocka
En moumljlighet att se oumlver sina levnadsvanor
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
2015 Ny patientlag
Vi kan inte fortsaumltta att operera om vi inte Informerar patienterna om levnadsvanornas betydelse foumlr
operationsresultatet Erbjuda dem hjaumllp med foumlraumlndringar av deras levnadsvanor
Motiverat tillstaringnd
Operationen aumlr ofta en vaumlckarklocka
En moumljlighet att se oumlver sina levnadsvanor
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Vi kan inte fortsaumltta att operera om vi inte Informerar patienterna om levnadsvanornas betydelse foumlr
operationsresultatet Erbjuda dem hjaumllp med foumlraumlndringar av deras levnadsvanor
Motiverat tillstaringnd
Operationen aumlr ofta en vaumlckarklocka
En moumljlighet att se oumlver sina levnadsvanor
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Motiverat tillstaringnd
Operationen aumlr ofta en vaumlckarklocka
En moumljlighet att se oumlver sina levnadsvanor
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Katinka Nordgaard
Fakta 80 vill ha hjaumllp fraringn sjukhuset foumlre operationen med att foumlraumlndra sina levnadsvanor tobak alkohol och oumlvervikt
Patient attityd
Foumlrvaumlntningar bull Vi aumlr raumldda att patienterna inte aumlr motiverade foumlr
ett roumlkstopp
Boel T et al Ugeskr Laeger 2004
Patientens
Erfarenheter Foumlrvaumlntningar
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Fraringga Erbjud Empati Ett erbjudande - naringgot positivt - inte skuld skam
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Vad kaumlnner du till om roumlkning och hur det kan
paringverka operationsresultatet
Erbjud alla operationspatienter hjaumllp med roumlkfrihet i samband med operation
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Samband mellan roumlkning och operationskomplikationer
Mer aumln 300 studier paringvisar att roumlkning aumlr foumlrknippat med postoperativa komplikationer
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Evidens 1 Roumlkfri 6-8 veckor foumlre operationen (Moumlller et al 2002)
1 Roumlkfri 4 veckor preop + 4 veckor postoperativt (Lindstroumlm et al Ann Surg 2008)
2 Roumlkfri operations dagen + 6-8 veckor postoperativt (Naringsell et al JBJS 2010)
Att roumlka faumlrre cigaretter reducerade inte komplikationsrisken
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Roumlkare Houmlft och knaumloperationer 6-8 veckors preoperativt roumlkstopp
Komplikationer Ingen effekt av att roumlka mindre
Moslashller A et al
Moslashller A et al Lancet 2002
Evidence
0
10
20
30
40
50
60
Interventionsgrupp Kontrollgrupp
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Varfoumlr aumlr det olaumlmpligt att roumlka i samband med operation
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Kolmonoxid ger en syrebrist
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Nikotinets kaumlrlparingverkan Nikotin orsakar en reducerad genombloumldning i perifervaumlvnad
Nikotinersaumlttningsmedel aumlr moumljligt att anvaumlnda
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Koagulationsfaktorer
Fibrin nivaringn aumlr houmlgre hos roumlkare Roumlkning oumlkar risken foumlr tromboser
19 Hans Gilljam
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Immunfoumlrsvar Vita blodkropparna har en saumlmre funktion hos roumlkare
Saringrlaumlkning Roumlkare har en saumlnkt produktion
av kollagen
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Benlaumlkning Upp emot 70 foumlrlaumlngd laumlkningstid Dessutom har man rapporterat en fyrdubblad risk foumlr utebliven benlaumlkning i anslutning till vissa ingrepp
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Haumlnder det att du dricker alkohol
Vet du att alkoholen kan paringverka ditt operations resultat
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
En alkoholkonsumtion oumlver 2 standardglas (agrave 12 gram alkohol) per dag ger foumlrdubblad risk foumlr postoperativa komplikationer Komplikationerna beror paring alkoholens belastning paring flera organsystem
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Hjaumlrt-lungkomplikationer
Bloumldningar
Postoperativa infektioner
Foumlrsaumlmrad ben- och saringrlaumlkningsfoumlrmaringga Mera studier behoumlvs avseende dos och andra sjukdomar
Alkoholens paringverkan i samband med operation
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Alkohol ndash operation 55 studier ndash houmlgkonsumenter (oumlver 2 standardglas dag) Oumlkad risk foumlr komplikationer foumlrsta 30 postoperativa dagarna
0102030405060708090
Oumlkad risk
Preoperative alcoholconsumption and postoperative complications a systematic review and meta-analysis Ann Surg 2013258(6)930-42
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Alkoholbehandling
till houmlgkonsumenter 4-8 veckor innan operation minskade komplikationerna med 70 Moslashller AM et al Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 20127
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Riskbruk av alkohol
houmlgkonsumtion gt14 standardglas per vecka foumlr maumln gt 9 standardglas per vecka foumlr kvinnor intensivkonsumtion - berusningsdrickande gt4 standardglas under tvaring timmar foumlr maumln gt 3 standardglas under tvaring timmar foumlr kvinnor
Houmlgkonsumtion Ingen konsumtion
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Ett raringdgivande samtal om alkohol kan uppmaumlrksamma patienten paring sambandet mellan alkoholintag och risk foumlr komplikationer i samband med operation och motivera till aumlndrade vanor
Det viktiga samtalet paring mottagningen
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Fysisk aktivitet infoumlr operation Kortare varingrdtid Snabbare aringterhaumlmtning Minskad risk foumlr postoperativa komplikationer Laumlgre kostnader Bra komplement vid roumlkavvaumlnjning Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Exempel paring traumlningseffekter -Oumlkad blodvolym -Oumlkat antal roumlda syretransporterande blodkroppar -Vidgade artaumlrer -Saumlnkt blodtryck -Saumlnkt vilopuls -Oumlkad slagvolym -Oumlkad hjaumlrtmuskelmassa -Oumlkat antal kapillaumlrer -Oumlkat antal mitokondrier (vilket foumlrbaumlttrar musklernas effektivitet) -Oumlkad insulinkaumlnslighet (jaumlmnare blodsockernivaring) -Foumlraumlndring i blodfetternas sammansaumlttning (houmlgre nivaringer av HDL-kolesterol och laumlgre LDL)
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Kost Oumlvervikt och operation
Sjuklig fetma innebaumlr en houmlgre risk (136 vs 69 ) foumlr postoperativa komplikationer fraringn hjaumlrta lungor njurar och saringr samt en houmlgre doumldligheten och en oumlkad kostnad aumln hos normalviktiga i samband med ryggkirurgi Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Undernaumlring och undervikt kan haumlnga ihop med ohaumllsosamma matvanor och innebaumlra en betydande riskfaktor foumlr postoperativ sjuklig- och doumldlighet inte minst vid frakturkirurgi saumlrskilt houmlftfraktur Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Framgaringngs faktorer Skapa enkla rutiner
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Skaringnes universitetssjukvaringrd
Haumllsoenheten levandsvanor och operation Roumlkfrihet i samband med operation anvaumlnd
bevakningskorgen i Melior SUSsekrCamilla Dahl
Alkohol remiss eller egenremiss FAR till Dietist Haumllsoenheten Claesgatan 7 214 26 Malmouml Tele 040-623 95 29
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Referenslista Socialstyrelsen Nationella riktlinjer foumlr sjukdomsfoumlrebyggande metoder ndash tobak alkohol fysisk aktivitet och matvanor Stockholm 2011 Roumlkning och operation Moslashller AM Villebro N Pedersen T Toslashnnesen H Effect of preoperative smoking intervention on postoperative complications a randomised clinical trial Lancet 2002359(9301)114-7 Moumlller et al 2002 A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindstroumlm D Sadr Azodi O Wladis A Toslashnnesen H Linder S Naringsell H et al Effects of a perioperative smoking cessation intervention on postoperative complications a randomized trial Ann Surg 2008248(5)739-45 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23 Naringsell et al JBJS 2010 httpjbjsorgarticleaspxarticleid=6038 Thomsen et al Cochrane 2010 Cochrane Review httpwwwncbinlmnihgovpubmed20614429
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Alkohol och operation Tonnesen H Rosenberg J Nielsen HJ Rasmussen V Hauge C Pedersen IK et al Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers randomised controlled trial BMJ 1999 318(7194)1311-16 httpwwwncbinlmnihgovpubmed10323814 Tonnesen H Nielsen PR Lauritzen JB Moller AM Smoking and alcohol intervention before surgery evidence for best practice Br J Anaesth 2009 102(3)297-306 httpbjaoxfordjournalsorgcontent1023297short Nath B Li Y Carroll JE Szabo G Tseng JE Shah SA Alcohol exposure as a risk factor for adverse outcomes in elective surgery J Gastrointest Surg 2010 141732-1741 httpwwwncbinlmnihgovpubmed20839071 Bradley KA Rubinsky AD Sun H Bryson CL Bishop MJ Blough DKet al Alcohol screening and risk of postoperative complications in male VA patients undergoing major non-cardiac surgery J Gen Intern Med 2011 26(2)162-9 httpwwwncbinlmnihgovpubmed20878363 Harris AHS Reeder R Ellerbe L Bradley KA Rubinsky AD Giori NJ Preoperative alcohol screening scores Association with complications in med undergoing total joint arthroplasty J Bone Joint Surg Am 2011 93321-7 Oppedal K Moslashller AM Pedersen B Toslashnnesen H Preoperative alcohol cessation prior to elective surgery Cochrane Database Syst Rev 2012 Jul 117CD008343 doi10100214651858CD008343pub2 Daniel Moumlnsted Shabanzadeh Lars Tue Soumlrensen Alcohol drinking does not affekt postoperative surgical site infection or anastomotic leakage A systematic review and meta-analysis J Gastrointest Surg 2013 Marie Eliasen Marie Gronkjaer et al Preoperative Alcohol consumption and Postoperative complications A systematic rewiev and Meta-Analysis Annals of Surgery 2013
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Fysisk aktivitet och operation Cavenaghi S Ferreira LL Marino LHC Lamari NM Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery Rev Bras Cir Cardiovasc 2011 26455ndash461 Dronkers JJ Chorus AMJ van Meeteren NLU Hopman-Rock M The association of preoperative physical fitness and physical activity with outcome after scheduled major abdominal surgery Anaesthesia 2013 6867ndash73 Hoogeboom T J Dronkers J J HulzebosEHJ and MeeterenaN LU vanMerits of exercise therapy before and after major surgery Curr Opin Anaesthesiol 2014 Apr 27(2) 161ndash166 Hulzebos EH Smit Y Helders PP Preoperative physical therapy for elective cardiac surgery patients Cochrane Database Syst Rev 2012 Nov Hulzebos EHJ Helders PJM Favieacute NJ et al Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery a randomized clinical trial JAMA 2006 2961851ndash1857 Kennedy GD Rajamanickam V Orsquoconnor ES et al Optimizing surgical care of colon cancer in the older adult population Ann Surg 2011 253508ndash514 Morano MT Arauacute jo AS Nascimento FB et al Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection a pilot randomized controlled trial Arch Phys Med Rehabil 2013 9453ndash58 Nagarajan K Bennett A Agostini P Naidu B Is preoperative physiotherapypulmonary rehabilitation beneficial in lung resection patients Interact Cardiovasc Thorac Surg 2011 13300ndash302 OrsquoDoherty AF West M Jack S Grocott MPW Preoperative aerobic exercise training in elective intra-cavity surgery a systematic review Br J Anaesth 2013 110679ndash689 Revenig LM Canter DJ Taylor MD et al Too frail for surgery Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes J AmColl Surg 2013 217665ndash670 e1 Rosenfeldt F Braun L Spitzer O et al Physical conditioning and mental stress reduction a randomised trial in patients undergoing cardiac surgery BMC Complement Altern Med 2011 1120 Rotboslashll NielsenP et al Prehabilitation and early rehabilitation after spinal surgery randomized clinical trial Clin Rehabil 2010 Ussher MH Taylor A Faulkner G Exercise inetrventions for smoking cessation Cochrane Database Syst Rev 2012 Jan Valkenet K van de Port IGL Dronkers JJ et al The effects of preoperative exercise therapy on postoperative outcome a systematic review Clin Rehabil 2011 2599ndash111 Zhu F Lee A Chee YE Fast-track cardiac care for adult cardiac surgical patients Cochrane database Syst Rev 2012 10CD003587
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
Oumlvervikt och operation Kalanithi PA Arrigo R amp Boakye M Morbid obesity increases cost and complication rates in arthrodesis 2012 Spine Volume 37 number 11 pp 982-988 Sadr Azodi O Lindstroumlm D Adami J Bellocco R Linder S Wladis A Impact of body mass index and tobacco smoking on outcome after open appendicectomy Br J Surg 200895(6)751-7 Lindstroumlm D Sadr Azodi O Bellocco R Wladis A Linder S Adami J The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery Hernia200711(2)117-23
Undernaumlring och operation Braga M Gianotti L Nespoli L Radaelli G di Carlo V Nutritional approach in malnourished surgical patients a prospective randomized study Arch Surg 2002137174-80 Pearson L ASA_classificaition can help identify impacct of hip surery in high risk patients American Academy of orthopaedic Surgeons 2010 04 02 von Friesendorff 2008
