Katinka Nordgaard Sjuksköterska, KBT terapeut

Katinka Nordgaard Sjuksköterska, KBT terapeut

Faktorer som påverkar resultatet av operationen Sjukdomen Interventionen Rätt diagnos Bäst teknik / operationsmetod Organisationen Kliniska riktlinjer, vidareutbildning, kvalitetsäkring Patienten ålder, kön, längd, vikt, psykiskt status, civilstånd, bostad, utbildning. Andra sjukdommar: hjärt-, lungsjukdom, DM, etc Levnadsvanor tobak, alkohol, övervikt, undernäring och fysisk aktivitet

Referenslista Socialstyrelsen Nationella riktlinjer för sjukdomsförebyggande metoder tobak, alkohol fysisk aktivitet och matvanor. Stockholm 2011 Rökning och operation Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002;359(9301):114-7. Möller et al 2002. A preoperative smoking intervention decreased postoperative complications in elective knee or hip replacement Lindström D, Sadr Azodi O, Wladis A, Tønnesen H, Linder S, Nåsell H, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248(5):739-45. Lindström 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. Hernia.2007;11(2):117-23. Nåsell et al. JBJS 2010. http://jbjs.org/article.aspx?articleid=6038 Thomsen et al. Cochrane 2010 Cochrane Review. http://www.ncbi.nlm.nih.gov/pubmed/20614429

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 http://www.ncbi.nlm.nih.gov/pubmed/10323814 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 http://bja.oxfordjournals.org/content/102/3/297.short 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, 14:1732-1741 http://www.ncbi.nlm.nih.gov/pubmed/20839071 Bradley KA, Rubinsky AD, Sun H, Bryson CL, Bishop MJ, Blough DK,et 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. http://www.ncbi.nlm.nih.gov/pubmed/20878363 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; 93:321-7 Oppedal K, Møller AM, Pedersen B, Tønnesen H. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev. 2012 Jul 11;7:CD008343. doi:10.1002/14651858.cd008343.pub2. Daniel Mönsted Shabanzadeh, Lars Tue Sörensen. 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; 26:455 461. 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; 68:67 73. Hoogeboom T J., Dronkers J J.,. HulzebosEHJ, and MeeterenaN L.U. van,merits of exercise therapy before and after major surgery. Curr Opin Anaesthesiol. 2014 Apr; 27(2): 161 166. Hulzebos EH, Smit Y, Helders PP. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev. 2012 Nov. Hulzebos EHJ, Helders PJM, Favie 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; 296:1851 1857. Kennedy GD, Rajamanickam V, O connor ES, et al. Optimizing surgical care of colon cancer in the older adult population. Ann Surg 2011; 253:508 514. Morano MT, Arau 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; 94:53 58. Nagarajan K, Bennett A, Agostini P, Naidu B. Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? Interact Cardiovasc Thorac Surg 2011; 13:300 302. O Doherty AF, West M, Jack S, Grocott MPW. Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review. Br J Anaesth 2013; 110:679 689. 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; 217:665 670; 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; 11:20. Rotbøll Nielsen.P 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; 25:99 111. Zhu F, Lee A, Chee YE. Fast-track cardiac care for adult cardiac surgical patients. Cochrane database Syst Rev 2012; 10:CD003587.

Övervikt och operation Kalanithi, P.A., Arrigo, R. & Boakye, M Morbid obesity increases cost and complication rates in arthrodesis. 2012 Spine Volume 37, number 11 pp 982-988 Sadr Azodi O, Lindström 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. 2008;95(6):751-7. Lindström 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. Hernia.2007;11(2):117-23. Undernäring 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. 2002;137:174-80. 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 fortsätta att operera om vi inte: Informerar patienterna om levnadsvanornas betydelse för operationsresultatet Erbjuda dem hjälp med förändringar av deras levnadsvanor

Utbildning av personal Enkla rutiner Snabb handläggning

Hälsoenheten Division 5 Remiss Levnadsvanor och Kirurgi Verksamhetsområde Remittent Nedre GI Lap- bukvägg Personnummer Patientens namn Önskar hjälp med följande levnadsvana/or Rökfrihet Viktreduktion med beteendeterapi Alkohol Fysisk aktivitet Tolkbehov Preoperativ information om vinster med rökfrihet samt erbjudande om hjälp med att bli rökfri Absolut krav inför operation Målvikt Ja Språk kg 4 veckor rökfrihet 6 veckor rökfrihet

Framgångs faktorer Ledningens stöd Aktiv kunskapsspridning Utbilda personalen Var med på APL berätta om er verksamhet Ordna utbildningstillfällen Använd nätet, handouts Återkoppla Skapa enkla rutiner

Nätbaserade personal utbildningar Finns även på Kunskapsguiden http://www.kunskapsguiden.se/missbruk/k urser/sidor/alkohol-och-rokfrioperation.aspx

Motiverat tillstånd Operationen är ofta en väckarklocka för patienten. Det är dags att se över sina levnadsvanor!

Tack Katinka.Nordgaard@skane.se 040 62 39 627 Svarar gärna på frågor