Ageing and Surgery

Question 1

what does post operative course and care entail

Answer 1

considering changing physiology and often increased frailty

Question 2

how can you communicate to patients the risk of treatment

Answer 2

through tests analysing risk such as
- NSQIP
P-Possum

Question 3

what is surgical stress

Answer 3

the way our body handles to multiple factors when undergoing surgery

Question 4

surgical stress factors

Answer 4

anaesthetist 
theater staff
severity of injury 
surgeon 
type and length of operation 
comorbidity and genetics

Question 5

example of a systemic response to surgery

Answer 5

increased sympathetic activation of the heart leading to tachycardia.

Question 6

what are ASA grades and there relavence

Answer 6

• 1 is fit and well
• 2/ little comorbidity
• 3 / more comorbidity
• 4 / life threatening comorbidity
• 5 / pathologists are more interested in this

the closer to one you are before an operation the better by changing things such as medication or even current levels of fitness

Question 7

effects pre surgery on sarcopenia

Answer 7

sarcopenia increased presence in elderly and in sedentary individuals - worsening the outcomes of surgery

lack of exercise and activity leading to weaker muscle resilience eg getting out of bed

Question 8

effects post surgery of sarcopenia

Answer 8

loss of muscle and already apparent reduced muscle leads to reduction in independence and possible bed bound patients. increasing the risk of complications such as infections and pressure sores

Question 9

example of sarcopenia on surgery complications

Answer 9

sarconpenia contributed to the rate of post operative complications and anastomatic leaks in patients having a primary anastomosis.The study showed an increased risk of nearly 15 times the risk of the wound not healing and therby contributing to possible complications in recovery.

Question 10

what have cancer studies shown post resection on anabolism and anaerobic threshold

Answer 10

cancer blunts anabolism and reduces threshold and how resections have potentilla restored these things.

suggesting if anything can be done pre surgery to improve muscle function and give the patients a better chance of recovering post surgery and going into the operation.

Question 11

what is rehabilitation

Answer 11

“the process of enhancing one’s functional and mental capacity to buffer against the potential deleterious effects of a significant stressor”

By Carli F, Zavorsky GS

Question 12

when is prehabilitation not possible

Answer 12

an Emergancy operation

Question 13

examples of rehabilitation interventions to optimise functional capacity

Answer 13

modifiable / cessation of drinking and smoking and altering and improving current medication such as angina

improving cardio, respiratory and muscle function to reduce surgical stress and decrease sarconpinc potential effects on outcome

all coming together to improve functional capacity

Question 14

importance of peri-operative nutrition

Answer 14

elderly often have sub optimal nutrition through diet or absorbitive problems which may contribute to sarcopenia

Question 15

factors effecting peri-operative nutrition

Answer 15

lines itself from a inflammatory response causing catabolism may cause mechanical obstruction and block the go tract for example. such as cancer

treatments may effect appetite such as chemotherapy. causing nausea effecting nutrient uptake.

socioeconomic status

Question 16

factors effecting post operative nutrition

Answer 16

limited food in hospitals not playing to peoples appetites or likings or even meal timings.

Question 17

how to combat loss of lean muscle mass lost after surgery

Answer 17

getting mobile and fed with education on correct nutrition to carry forwards.

Question 18

how would you know if someone is malnourished

Answer 18

assess BMI <18.5 or 20 if over 65

loss of weight without trying >4kg in 3 weeks

reduced diet of normal over preceding week

any of these with a albumin or vitamin d deficiency should lead to intervention

Question 19

interval training on fitness pre operation

Answer 19

increases in aerobic fitness from things such as VO2 max have shown patients to be fitter going into operations than those who don’t partake - in studies

Question 20

what are the problems with improving fitness before time to treat

Answer 20

narrow window for intervention eg max of four weeks for cancer decsion. not leaving a great deal of room to improve fitness

however can include tailored training to ensure it doesn’t do more harm than good

Question 21

do different conditions respond differently to interventions

Answer 21

eg interval training effects on both colorectal cancer and prostate cancer. with colorectal showing no change and prostate a vast one.

Question 22

does psychological prehabilitation help

Answer 22

pre operative CBT has shown to help surgeries such as the knee in pain outcomes / through motivation and support.

with systematic reviews showing no overall benefit to surgical outcome.

Question 23

what are the evidance gaps in prehabiliation

Answer 23

pre op exercise can improve fitness but what type is best

for how long

hospital or home (expensive at hospitals but will they adhere at home)

will it work in all cancer types

even though it improves fitness doe sit translate into improved outcomes

should more focus be on nutrient and psychological