Excellent points, and I agree this is probably the best clinical optimization we can do today.
But even after optimization, some patients still fail unexpectedly. That tells us there may be another layer or missed variable we are not mapping well enough.
For me, the bigger question is simple:
Can we stop looking only at isolated variables and start studying the surgical stress-response cycle as a full system, before, during, and after major surgery?
Very interesting and it’s also something I’ve considered over my career. The question becomes what do you test for pre/postop and how do you do it?
I take care of a lot of recalcitrant diabetic and other chronic pressure wounds. I don’t even consider bringing any patient in this situation to the OR until they’ve been clinically “optimized.” The things we are aware of come from the nutrition panel of labs including prealbumin, albumin, transferrin (which are adjuncts for protein and caloric reserves); iron, total iron binding capacity (TIBC), ferritin, and CBC (adjuncts for the body’s ability to produce blood cells, iron reserves, and chronic inflammation). These are the quick and easy labs. If you’re worried about inflammation, sometimes erythrocyte sedimentation rate and C-reactive protein (ESR/CRP) is important as well.
Beyond that are the slew of minerals responsible for wound healing - zinc, magnesium, manganese, calcium, chromium, copper - but these are not always readily available and can take weeks to come back.
There are other aspects I work on clinically to ensure success in the OR, such as smoking cessation, postop specialty bed, pressure offloading, proper wound care. But this doesn’t account for the patient’s preop reserve nor provide an understanding of their allostatic load. What do you envision for this? I’d love to learn more and discuss!
Excellent points, and I agree this is probably the best clinical optimization we can do today.
But even after optimization, some patients still fail unexpectedly. That tells us there may be another layer or missed variable we are not mapping well enough.
For me, the bigger question is simple:
Can we stop looking only at isolated variables and start studying the surgical stress-response cycle as a full system, before, during, and after major surgery?
Very interesting and it’s also something I’ve considered over my career. The question becomes what do you test for pre/postop and how do you do it?
I take care of a lot of recalcitrant diabetic and other chronic pressure wounds. I don’t even consider bringing any patient in this situation to the OR until they’ve been clinically “optimized.” The things we are aware of come from the nutrition panel of labs including prealbumin, albumin, transferrin (which are adjuncts for protein and caloric reserves); iron, total iron binding capacity (TIBC), ferritin, and CBC (adjuncts for the body’s ability to produce blood cells, iron reserves, and chronic inflammation). These are the quick and easy labs. If you’re worried about inflammation, sometimes erythrocyte sedimentation rate and C-reactive protein (ESR/CRP) is important as well.
Beyond that are the slew of minerals responsible for wound healing - zinc, magnesium, manganese, calcium, chromium, copper - but these are not always readily available and can take weeks to come back.
There are other aspects I work on clinically to ensure success in the OR, such as smoking cessation, postop specialty bed, pressure offloading, proper wound care. But this doesn’t account for the patient’s preop reserve nor provide an understanding of their allostatic load. What do you envision for this? I’d love to learn more and discuss!
Spannender Artikel, aber die KI Bilder sind so schlecht. Das Thema hätte eine bessere visuelle Aufarbeitung verdient.
Die ersten Versionen sind nie komplett perfekt.
Genau solche Rückmeldungen helfen mir, das Thema Schritt für Schritt besser und professioneller aufzubauen. Danke dafür.