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Diep C, Lee S, Xue Y, Xiao M, Pivetta B, Daza JF, Jung JJ, Wijeysundera DN, Ladha KS. Preoperative depression and outcomes after metabolic and bariatric surgery: A systematic narrative review. Obes Rev 2024:e13743. [PMID: 38572605 DOI: 10.1111/obr.13743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/08/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
Preoperative depression is prevalent among patients undergoing metabolic and bariatric surgery (MBS) and is a potentially modifiable risk factor. However, the impact of preoperative depression on MBS outcomes has not been systematically reviewed. A search of MEDLINE, Embase, Cochrane, and PsychINFO (inception to June 2023) was conducted for studies reporting associations between preoperative depression and any clinical or patient-reported outcomes after MBS. Eighteen studies (5 prospective and 13 retrospective) reporting on 5933 participants were included. Most participants underwent gastric bypass or sleeve gastrectomy. Meta-analyses were not conducted due to heterogeneity in reported outcomes; findings were instead synthesized using a narrative and tabular approach. Across 13 studies (n = 3390) the associations between preoperative depression and weight loss outcomes at 6-72 months were mixed overall. This may be related to differences in cohort characteristics, outcome definitions, and instruments used to measure depression. A small number of studies reported that preoperative depression was associated with lower quality of life, worse acute pain, and more perioperative complications after surgery. Most of the included studies were deemed to be at high risk of bias, resulting in low or very low certainty of evidence according to the Risk of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool. While the impact of preoperative depression on weight loss after MBS remains unclear, there is early evidence that depression has negative consequences on other patient-important outcomes. Adequately powered studies using more sophisticated statistical methods are needed to accurately estimate these associations.
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Affiliation(s)
- Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maggie Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Bianca Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
| | - James J Jung
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada
- Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
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Gandotra S, Daza JF, Diep C, Mitani AA, Ladha KS, Wijeysundera DN. Psychological Distress After Inpatient Noncardiac Surgery: A Secondary Analysis of the Measurement of Exercise Tolerance Before Surgery Prospective Cohort Study. Ann Surg 2024; 279:450-455. [PMID: 37477019 DOI: 10.1097/sla.0000000000006031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To describe the incidence and natural progression of psychological distress after major surgery. BACKGROUND The recovery process after surgery imposes physical and mental burdens that put patients at risk of psychological distress. Understanding the natural course of psychological distress after surgery is critical to supporting the timely and tailored management of high-risk individuals. METHODS We conducted a secondary analysis of the "Measurement of Exercise Tolerance before Surgery" multicentre cohort study (Canada, Australia, New Zealand, and the UK). Measurement of Exercise Tolerance before Surgery recruited adult participants (≥40 years) undergoing elective inpatient noncardiac surgery and followed them for 1 year. The primary outcome was the severity of psychological distress measured using the anxiety-depression item of EQ-5D-3L. We used cumulative link mixed models to characterize the time trajectory of psychological distress among relevant patient subgroups. We also explored potential predictors of severe and/or worsened psychological distress at 1 year using multivariable logistic regression models. RESULTS Of 1546 participants, moderate-to-severe psychological distress was reported by 32.6% of participants before surgery, 27.3% at 30 days after surgery, and 26.2% at 1 year after surgery. Psychological distress appeared to improve over time among females [odds ratio (OR): 0.80, 95% CI: 0.65-0.95] and patients undergoing orthopedic procedures (OR: 0.73, 95% CI: 0.55-0.91), but not among males (OR: 0.87, 95% CI: 0.87-1.07) or patients undergoing nonorthopedic procedures (OR: 0.95, 95% CI: 0.87-1.04). Among the average middle-aged adult, there were no time-related changes (OR: 0.94, 97% CI: 0.75-1.13), whereas the young-old (OR: 0.89, 95% CI: 0.79-0.99) and middle-old (OR: 0.87, 95% CI: 0.73-1.01) had small improvements. Predictors of severe and/or worsened psychological distress at 1 year were younger age, poor self-reported functional capacity, smoking history, and undergoing open surgery. CONCLUSIONS One-third of adults experience moderate to severe psychological distress before major elective noncardiac surgery. This distress tends to persist or worsen over time among select patient subgroups.
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Affiliation(s)
- Sakshi Gandotra
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Calvin Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aya A Mitani
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Daza JF, Wijeysundera HC, Diep C, Ladha KS, Cuthbertson BH, Wijeysundera DN. Healthcare Costs of New Functional Impairment in the Year after Noncardiac Surgery. Anesthesiology 2023; 139:902-904. [PMID: 37874043 DOI: 10.1097/aln.0000000000004674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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Daza JF, Chesney TR, Alibhai SMH, Kennedy ED, Lebovic G, Lightfoot D, Mbadjeu Hondjeu AR, Morales JF, Pivetta B, Jolley R, Racz E, Wilmshurst L, Wijeysundera DN. Clinical tools to assess functional capacity before elective non-cardiac surgery: a scoping review protocol. JBI Evid Synth 2023; 21:1632-1647. [PMID: 37006169 DOI: 10.11124/jbies-22-00397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVE The objective of this scoping review is to map the evidence on clinical tools to assess functional capacity prior to elective non-cardiac surgery. INTRODUCTION Functional capacity is a strong prognostic indicator before surgery, which can be used to identify patients at elevated risk of postoperative complications, yet, there is no consensus on which clinical tools should be used to assess functional capacity in patients prior to non-cardiac surgery. INCLUSION CRITERIA This review will consider any randomized or non-randomized studies that evaluate the performance of a functional capacity assessment tool in adults (≥18 years) prior to non-cardiac surgery. For studies to be included, the tool must be used clinically for risk stratification. We will exclude studies on lung and liver transplant surgery, as well as ambulatory procedures performed under local anesthesia. METHODS The review will be conducted in line with the JBI methodology for scoping reviews. A peer-reviewed search strategy will be used to query relevant databases (ie, MEDLINE, Embase, EBM Reviews). Additional sources of evidence will include databases of non-peer-reviewed literature and the reference lists of included studies. Two independent reviewers will identify eligible studies in 2 stages: stage 1, based on titles and abstracts; and stage 2, based on full texts. Information on study details, measurement properties, pragmatic qualities, and/or clinical utility metrics will be charted in duplicate onto standardized data collection forms. The results will be presented using descriptive summaries, frequency tables, and visual plots that highlight the extent of evidence and remaining gaps in the validation process of each tool. REVIEW REGISTRATION Open Science Framework https://osf.io/6nfht.
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Affiliation(s)
- Julian F Daza
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tyler R Chesney
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
- Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Gerald Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David Lightfoot
- Health Sciences Library, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Arnaud R Mbadjeu Hondjeu
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Juan F Morales
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Bianca Pivetta
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rachel Jolley
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Racz
- Patient and Family Partner Program, Unity Health Toronto, Toronto, ON, Canada
| | - Luke Wilmshurst
- Patient and Family Partner Program, Unity Health Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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Daza JF, Bartoszko J, Van Klei W, Ladha KS, McCluskey SA, Wijeysundera DN. Improved Re-estimation of Perioperative Cardiac Risk Using the Surgical Apgar Score: A Retrospective Cohort Study. Ann Surg 2023; 278:65-71. [PMID: 35801710 DOI: 10.1097/sla.0000000000005509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether the Surgical Apgar Score (SAS) improves re-estimation of perioperative cardiac risk. BACKGROUND The SAS is a novel risk index that integrates three relevant and easily measurable intraoperative parameters (blood loss, heart rate, mean arterial pressure) to predict outcomes. The incremental prognostic value of the SAS when used in combination with standard preoperative risk indices is unclear. METHODS We conducted a retrospective cohort study of adults (18 years and older) who underwent elective noncardiac surgery at a quaternary care hospital in Canada (2009-2014). The primary outcome was postoperative acute myocardial injury. The SAS (range 0-10) was calculated based on intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate documented in electronic medical records. Incremental prognostic value of the SAS when combined with the Revised Cardiac Risk Index was assessed based on discrimination (c-statistic), reclassification (integrated discrimination improvement, net reclassification index), and clinical utility (decision curve analysis). RESULTS The cohort included 16,835 patients, of whom 607 (3.6%) patients had acute postoperative myocardial injury. Addition of the SAS to the Revised Cardiac Risk Index improved risk estimation based on the integrated discrimination improvement [2.0%; 95% confidence interval (CI): 1.5%-2.4%], continuous net reclassification index (54%; 95% CI: 46%-62%), and c-index, which increased from 0.68 (95% CI: 0.65-0.70) to 0.75 (95% CI: 0.73-0.77). On decision curve analysis, addition of the SAS to the Revised Cardiac Risk Index resulted in a higher net benefit at all decision thresholds. CONCLUSIONS When combined with a validated preoperative risk index, the SAS improved the accuracy of cardiac risk assessment for noncardiac surgery. Further research is needed to delineate how intraoperative data can better guide postoperative decision-making.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Justyna Bartoszko
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada
| | - Wilton Van Klei
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
| | - Stuart A McCluskey
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital-University Health Network, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
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Abstract
PURPOSE OF REVIEW Present an approach for surgical decision-making in cancer that incorporates geriatric assessment by building upon the common categories of tumor, technical, and patient factors to enable dual assessment of disease and geriatric factors. RECENT FINDINGS Conventional preoperative assessment is insufficient for older adults missing important modifiable deficits, and inaccurately estimating treatment intolerance, complications, functional impairment and disability, and death. Including geriatric-focused assessment into routine perioperative care facilitates improved communications between clinicians and patients and among interdisciplinary teams. In addition, it facilitates the detection of geriatric-specific deficits that are amenable to treatment. We propose a framework for embedding geriatric assessment into surgical oncology practice to allow more accurate risk stratification, identify and manage geriatric deficits, support decision-making, and plan proactively for both cancer-directed and non-cancer-directed therapies. This patient-centered approach can reduce adverse outcomes such as functional decline, delirium, prolonged hospitalization, discharge to long-term care, immediate postoperative complications, and death. SUMMARY Geriatric assessment and management has substantial benefits over conventional preoperative assessment alone. This article highlights these advantages and outlines a feasible strategy to incorporate both disease-based and geriatric-specific assessment and treatment when caring for older surgical patients with cancer.
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Affiliation(s)
- Tyler R Chesney
- Division of General Surgery, Department of Surgery
- Li Ka Shing Knowledge Institute
| | - Julian F Daza
- Division of General Surgery, Department of Surgery
- Institute of Health Policy, Management, and Evaluation, University of Toronto
| | - Camilla L Wong
- Li Ka Shing Knowledge Institute
- Division of Geriatric Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Daza JF, Cuthbertson BH, Myles PS, Shulman MA, Wijeysundera DN, Wijeysundera DN, Pearse RM, Myles PS, Abbott TEF, Shulman MA, Torres E, Ambosta A, Melo M, Mamdani M, Thorpe KE, Wallace S, Farrington C, Croal BL, Granton JT, Oh P, Thompson B, Hillis G, Beattie WS, Wijeysundera HC, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Kirabiyik Y, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Day L, Pazmino-Canizares J, Belliard R, Lee L, Dobson K, Stanbrook M, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, McAllister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G. Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian H Cuthbertson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Chesney TR, Wong C, Tricco AC, Wijeysundera DN, Ladha KS, Kishibe T, Dubé S, Puts MTE, Alibhai SMH, Daza JF. Frailty assessment tools for use by surgeons when evaluating older adults prior to surgery: a scoping review protocol. BMJ Open 2022; 12:e061951. [PMID: 35896291 PMCID: PMC9335057 DOI: 10.1136/bmjopen-2022-061951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Despite growing evidence, uncertainty persists about which frailty assessment tools are best suited for routine perioperative care. We aim to understand which frailty assessment tools perform well and are feasible to implement. METHODS AND ANALYSIS Using a registered protocol following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA), we will conduct a scoping review informed by the Joanna Briggs Institute Guide for Scoping Reviews and reported using PRISMA extension for Scoping Reviews recommendations. We will develop a comprehensive search strategy with information specialists using the Peer Review of Electronic Search Strategies checklist, and implement this across relevant databases from 2005 to 13 October 2021 and updated prior to final review publication. We will include all studies evaluating a frailty assessment tool preoperatively in patients 65 years or older undergoing intracavitary, non-cardiac surgery. We will exclude tools not assessed in clinical practice, or using laboratory or radiologic values alone. After pilot testing, two reviewers will independently assess information sources for eligibility first by titles and abstracts, then by full-text review. Two reviewers will independently chart data from included full texts using a piloted standardised electronic data charting. In this scoping review process, we will (1) index frailty assessment tools evaluated in the preoperative clinical setting; (2) describe the level of investigation supporting each tool; (3) describe useability of each tool and (4) describe direct comparisons between tools. The results will inform ready application of frailty assessment tools in routine clinical practice by surgeons and other perioperative clinicians. ETHICS AND DISSEMINATION Ethic approval is not required for this secondary data analysis. This scoping review will be published in a peer-review journal. Results will be used to inform an ongoing implementation study focused on geriatric surgery to overcome the current lack of uptake of older adult-oriented care recommendations and ensure broad impact of research findings.
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Affiliation(s)
- Tyler R Chesney
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Camilla Wong
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality JBI Centre of Excellence, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Karim Shiraz Ladha
- Department of Anesthesiology and Pain Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Samuel Dubé
- Division of Gynecologic Oncology, Université de Montréal, Montreal, Quebec, Canada
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Julian F Daza
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Wijeysundera DN, Alibhai SMH, Ladha KS, Puts MTE, Chesney TR, Daza JF, Ehtesham S, Hladkowicz E, Lebovic G, Mazer CD, van Vlymen JM, Wei AC, McIsaac DI. Functional Improvement Trajectories After Surgery (FIT After Surgery) study: protocol for a multicentre prospective cohort study to evaluate significant new disability after major surgery in older adults. BMJ Open 2022; 12:e062524. [PMID: 35732384 PMCID: PMC9226941 DOI: 10.1136/bmjopen-2022-062524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Older adults prioritise surviving surgery, but also preservation of their functional status and quality of life. Current approaches to measure postoperative recovery, which focus on death, complications and length of hospitalisation, may miss key relevant domains. We propose that postoperative disability is an important patient-centred outcome to measure intermediate-to-long recovery after major surgery in older adults. METHODS AND ANALYSIS The Functional Improvement Trajectories After Surgery (FIT After Surgery) study is a multicentre cohort study of 2000 older adults (≥65 years) having major non-cardiac surgery. Its objectives are to characterise the incidence, trajectories, risk factors and impact of new significant disability after non-cardiac surgery. Disability is assessed using WHO Disability Assessment Schedule (WHODAS) 2.0 instrument and participants' level-of-care needs. Disability assessments occur before surgery, and at 1, 3, 6, 9 and 12 months after surgery. The primary outcome is significantly worse WHODAS score or death at 6 months after surgery. Secondary outcomes are (1) significantly worse WHODAS score or death at 1 year after surgery, (2) increased care needs or death at 6 months after surgery and (3) increased care needs or death at 1 year after surgery. We will use multivariable logistic regression models to determine the association of preoperative characteristics and surgery type with outcomes, joint modelling to characterise longitudinal time trends in WHODAS scores over 12 months after surgery, and longitudinal latent class mixture models to identify clusters following similar trajectories of disability. ETHICS AND DISSEMINATION The FIT After Surgery study has received research ethics board approval at all sites. Recruitment began in December 2019 but was placed on hold in March 2020 because of the COVID-19 pandemic. Recruitment was gradually restarted in October 2020, with 1-year follow-up expected to finish in 2023. Publication of the primary results is anticipated to occur in 2024.
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Affiliation(s)
- Duminda N Wijeysundera
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Internal Medicine, University Health Network, Toronto, Ontario, Canada
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karim S Ladha
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tyler R Chesney
- Division of General Surgery, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julian F Daza
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sahar Ehtesham
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Emily Hladkowicz
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gerald Lebovic
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet M van Vlymen
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
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10
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Lee MH, Leda M, Buchan T, Malik A, Rigobon A, Liu H, Daza JF, O'Brien K, Stein M, Hing NNF, Siemeiniuk R, Sekercioglu N, Evaniew N, Foroutan F, Ross H, Alba AC. Prognostic value of blood pressure in ambulatory heart failure: a meta-analysis and systematic review. Ambulatory blood pressure predicts heart failure prognosis. Heart Fail Rev 2022; 27:455-464. [PMID: 33682033 DOI: 10.1007/s10741-021-10086-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 01/14/2023]
Abstract
Previous primary studies have explored the association between blood pressure (BP) and mortality in ambulatory heart failure (HF) patients reporting varying and contrasting associations. The aim is to determine the pooled BP prognostic value and explore potential reasons for between-study inconsistency. We searched Medline, Cochrane, EMBASE and CINAHL from January 2005 to October 2018 for studies with ≥ 50 events (mortality and/or hospitalization) and included BP in a multivariable model in ambulatory HF patients. We pooled hazard ratios (random effects model) for systolic BP (SBP) or diastolic BP (DBP) effect on mortality and/or hospitalization risk. We used a priori defined sub-group analyses to explore heterogeneity and GRADE approach to assess the certainty of the evidence. Seventy-one eligible articles (239,467 screened) at low to moderate risk of bias included 235,752 participants. Higher SBP was associated with reduced all-cause mortality (HR 0.93, 95%CI 0.91-0.95, I2 = 87.13%, moderate certainty), all-cause hospitalization events (HR 0.91, 95%CI 0.88-0.93, I2 = 44.4%, high certainty) and their composite endpoint (HR 0.93 per 10 mmHg, 95%CI 0.91-0.94, I2 = 86.3%, high certainty). DBP did not demonstrate a statistically significant effect for all outcomes. The association strength was significantly weaker in studies following patients with either LVEF > 40%, higher average SBP (> 130 mmHg), increasing age and diabetes. All other a priori subgroup hypotheses did not explain between study differences. Higher ambulatory SBP is associated with reduced risk of all-cause mortality and hospitalization. Patients with lower BP and reduced LVEF are in a high-risk group of developing adverse events with moderate certainty of evidence.
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Affiliation(s)
- Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Mariela Leda
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Tayler Buchan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Abdullah Malik
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Alanna Rigobon
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Helen Liu
- University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | - Nathan Evaniew
- Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Heather Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Ana Carolina Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
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11
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Park LJ, Daza JF, Li V, Workneh A, Zuk V, Claasen MPA, Hallet J, Martel G, Sapisochin G, Serrano PE. Prognostic factors of overall survival in patients with recurrent disease following liver resection for colorectal cancer metastases: A multicenter external validation study. J Surg Oncol 2022; 125:872-879. [DOI: 10.1002/jso.26796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/09/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Lily J. Park
- Division of General Surgery, Department of Surgery McMaster University Hamilton Ontario Canada
| | - Julian F. Daza
- Division of General Surgery, Department of Surgery University of Toronto Toronto Ontario Canada
| | - Vivian Li
- Division of General Surgery, Department of Surgery McMaster University Hamilton Ontario Canada
| | - Aklile Workneh
- Liver and Pancreas Unit, Department of Surgery The Ottawa Hospital, University of Ottawa Ottawa Canada
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Canada
| | - Victoria Zuk
- Division of General Surgery Sunnybrook Health Sciences Centre–Odette Cancer Centre Toronto Ontario Canada
| | - Marco P. A. Claasen
- Division of General Surgery, Department of Surgery University of Toronto Toronto Ontario Canada
- Department of Surgery, Division of HPB and Transplant Surgery Erasmus MC Transplant Institute, University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Julie Hallet
- Division of General Surgery, Department of Surgery University of Toronto Toronto Ontario Canada
- Division of General Surgery Sunnybrook Health Sciences Centre–Odette Cancer Centre Toronto Ontario Canada
| | - Guillaume Martel
- Liver and Pancreas Unit, Department of Surgery The Ottawa Hospital, University of Ottawa Ottawa Canada
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Canada
| | - Gonzalo Sapisochin
- Division of General Surgery, Department of Surgery University of Toronto Toronto Ontario Canada
- Multi‐Organ Transplant and HPB Surgical Oncology, Division of General Surgery Toronto General Hospital, University of Toronto Toronto Ontario Canada
| | - Pablo E. Serrano
- Division of General Surgery, Department of Surgery McMaster University Hamilton Ontario Canada
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12
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Lau K, Malik A, Foroutan F, Buchan TA, Daza JF, Sekercioglu N, Orchanian-Cheff A, Alba AC. Resting Heart Rate as an Important Predictor of Mortality and Morbidity in Ambulatory Patients With Heart Failure: A Systematic Review and Meta-Analysis. J Card Fail 2020; 27:349-363. [PMID: 33171294 DOI: 10.1016/j.cardfail.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Resting heart rate is a risk factor of adverse heart failure outcomes; however, studies have shown controversial results. This meta-analysis evaluates the association of resting heart rate with mortality and hospitalization and identifies factors influencing its effect. METHODS AND RESULTS We systematically searched electronic databases in February 2019 for studies published in 2005 or before that evaluated the resting heart rate as a primary predictor or covariate of multivariable models of mortality and/or hospitalization in adult ambulatory patients with heart failure. Random effects inverse variance meta-analyses were performed to calculate pooled hazard ratios. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess evidence quality. Sixty-two studies on 163,445 patients proved eligible. Median population heart rate was 74 bpm (interquartile range 72-76 bpm). A 10-bpm increase was significantly associated with increased risk of all-cause mortality (hazard ratio 1.10, 95% confidence interval 1.08-1.13, high quality). Overall, subgroup analyses related to patient characteristics showed no changes to the effect estimate; however, there was a strongly positive interaction with age showing increasing risk of all-cause mortality per 10 bpm increase in heart rate. CONCLUSIONS High-quality evidence demonstrates increasing resting heart rate is a significant predictor of all-cause mortality in ambulatory patients with heart failure on optimal medical therapy, with consistent effect across most patient factors and an increased risk trending with older age.
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Affiliation(s)
- Kimberley Lau
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Malik
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farid Foroutan
- McMaster University, Hamilton, Ontario, Canada; Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Tayler A Buchan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | | | | | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ana C Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada.
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13
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Daza JF, Solis NM, Parpia S, Gallinger S, Moulton CA, Belley-Cote EP, Levine MN, Serrano PE. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases. Eur J Surg Oncol 2019; 45:1341-1348. [DOI: 10.1016/j.ejso.2019.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
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14
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Daza JF, Tan CM, Fielding RJ, Brown A, Farrokhyar F, Yang I. Propofol administration by endoscopists versus anesthesiologists in gastrointestinal endoscopy: a systematic review and meta-analysis of patient safety outcomes. Can J Surg 2019; 61:8117. [PMID: 30067180 DOI: 10.1503/cjs.008117] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With a growing demand for endoscopic services, the role of anesthesiologists in endoscopy units must be reassessed. The aim of this study was to compare patient outcomes in non-anesthesiologist-administered propofol (NAAP) versus anesthesiologist-administered propofol (AAP) during routine endoscopy. METHODS We systematically searched MEDLINE, CINAHL, Embase, Web of Science, CENTRAL and the grey literature for studies comparing NAAP and AAP. Primary outcomes included endoscopy- and sedation-related complications. Secondary outcomes included measures of endoscopy quality and of patient and endoscopist satisfaction. We reported treatment effects using random-effects models. RESULTS Of 602 articles identified, 5 met the inclusion criteria. Most studies included only patients with an American Society of Anesthesiologists (ASA) classification of I or II. Non-anesthesiologist-administered propofol did not result in increased rates of airway intervention (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.29 to 3.95; 3443 patients) or hypotension (OR 1.47, 95% CI 0.40 to 5.41; 17 978 patients) but did result in higher rates of bradycardia (OR 3.68, 95% CI 1.65 to 8.17; 17 978 patients). Nonanesthesiologists administered lower propofol dosages than anesthesiologists (mean difference -61.79, 95% CI -114.46 to -9.12; 3443 patients), and their patients more commonly experienced awareness with recall (OR 19.99, 95% CI 7.88 to 50.76; 2090 patients). However, NAAP neither compromised patient willingness to repeat the procedure (OR 0.42, 95% CI 0.10 to 1.83; 2367 patients) nor lengthened total procedure time (mean difference -0.08, 95% CI -3.51 to 3.34; 2367 patients). CONCLUSION Endoscopists may safely administer propofol without compromising procedural quality in patients classified as ASA I or II undergoing routine endoscopy. The results of this meta-analysis are limited by a lack of available high-quality studies. Further, large-scale studies are needed for definitive conclusions.
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Affiliation(s)
- Julian F Daza
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Carolyn M Tan
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Ryan J Fielding
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Allison Brown
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Forough Farrokhyar
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Ilun Yang
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
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15
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Daza JF, Tan CM, Yang I. Author response: Response to: Propofol administration by endoscopists versus anesthesiologists in gastrointestinal endoscopy: a systematic review and meta-analysis of patient safety outcomes. Can J Surg 2018. [PMID: 30247867 DOI: 10.1503/cjs.1861502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Julian F. Daza
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Daza); the Department of Medicine, University of
Toronto, Toronto, Ont. (Tan); and the Department of Surgery, McMaster University, Hamilton, Ont. (Yang)
| | - Carolyn M. Tan
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Daza); the Department of Medicine, University of
Toronto, Toronto, Ont. (Tan); and the Department of Surgery, McMaster University, Hamilton, Ont. (Yang)
| | - Ilun Yang
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Daza); the Department of Medicine, University of
Toronto, Toronto, Ont. (Tan); and the Department of Surgery, McMaster University, Hamilton, Ont. (Yang)
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16
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Daza JF, Tan CM, Yang I. Author response: Response to: Propofol administration by endoscopists versus anesthesiologists in gastrointestinal endoscopy: a systematic review and meta-analysis of patient safety outcomes. Can J Surg 2018; 61:E17-E18. [PMID: 30247867 PMCID: PMC6153106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Affiliation(s)
- Julian F. Daza
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Daza); the Department of Medicine, University of
Toronto, Toronto, Ont. (Tan); and the Department of Surgery, McMaster University, Hamilton, Ont. (Yang)
| | - Carolyn M. Tan
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Daza); the Department of Medicine, University of
Toronto, Toronto, Ont. (Tan); and the Department of Surgery, McMaster University, Hamilton, Ont. (Yang)
| | - Ilun Yang
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Daza); the Department of Medicine, University of
Toronto, Toronto, Ont. (Tan); and the Department of Surgery, McMaster University, Hamilton, Ont. (Yang)
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17
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Daza JF, Tan CM, Fielding RJ, Brown A, Farrokhyar F, Yang I. Propofol administration by endoscopists versus anesthesiologists in gastrointestinal endoscopy: a systematic review and meta-analysis of patient safety outcomes. Can J Surg 2018; 61:226-236. [PMID: 30067180 PMCID: PMC6066388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND With a growing demand for endoscopic services, the role of anesthesiologists in endoscopy units must be reassessed. The aim of this study was to compare patient outcomes in non-anesthesiologist-administered propofol (NAAP) versus anesthesiologist-administered propofol (AAP) during routine endoscopy. METHODS We systematically searched MEDLINE, CINAHL, Embase, Web of Science, CENTRAL and the grey literature for studies comparing NAAP and AAP. Primary outcomes included endoscopy- and sedation-related complications. Secondary outcomes included measures of endoscopy quality and of patient and endoscopist satisfaction. We reported treatment effects using random-effects models. RESULTS Of 602 articles identified, 5 met the inclusion criteria. Most studies included only patients with an American Society of Anesthesiologists (ASA) classification of I or II. Non-anesthesiologist-administered propofol did not result in increased rates of airway intervention (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.29 to 3.95; 3443 patients) or hypotension (OR 1.47, 95% CI 0.40 to 5.41; 17 978 patients) but did result in higher rates of bradycardia (OR 3.68, 95% CI 1.65 to 8.17; 17 978 patients). Nonanesthesiologists administered lower propofol dosages than anesthesiologists (mean difference -61.79, 95% CI -114.46 to -9.12; 3443 patients), and their patients more commonly experienced awareness with recall (OR 19.99, 95% CI 7.88 to 50.76; 2090 patients). However, NAAP neither compromised patient willingness to repeat the procedure (OR 0.42, 95% CI 0.10 to 1.83; 2367 patients) nor lengthened total procedure time (mean difference -0.08, 95% CI -3.51 to 3.34; 2367 patients). CONCLUSION Endoscopists may safely administer propofol without compromising procedural quality in patients classified as ASA I or II undergoing routine endoscopy. The results of this meta-analysis are limited by a lack of available high-quality studies. Further, large-scale studies are needed for definitive conclusions.
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Affiliation(s)
- Julian F Daza
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Carolyn M Tan
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Ryan J Fielding
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Allison Brown
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Forough Farrokhyar
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
| | - Ilun Yang
- From the Michael G. DeGroote School of Medicine - Niagara Regional Campus, McMaster University, St. Catharines, Ont.(Daza, Tan, Brown); the Department of Surgery, McMaster University, Hamilton, Ont. (Fielding, Farrokhyar, Yang); and the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Brown, Farrokhyar)
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