Daniel Jin Keat Lee

Introduction: Sarcopenia and low skeletal muscle index (SMI) are associated with high major morbidity and mortality following emergency laparotomy (EL). Existing preoperative risk models often focus on short-term outcomes. This study aimed to develop a personalised preoperative score using SMI to predict 1-year mortality in older patients undergoing EL. Methods: This was a retrospective study conducted in patients aged ≥65 years who underwent EL from January 2016 to December 2022. Patients who underwent EL for trauma, vascular surgery or cholecystectomy were excluded. The cut-off values for low SMI were 2 /m ² for males and females, respectively. Univariate and multivariate logistic regression analyses were performed to identify the predictors of 1-year mortality. Receiver operating characteristic (ROC) curve and Hosmer–Lemeshow test were used to evaluate the model performance. Results: A total of 477 patients (training cohort: n = 334, validation cohort: n = 143) were included in the analysis. Of these patients, 41.5% had sarcopenia. The incidences of Clavien–Dindo grade III morbidity, grade IV morbidity, in-hospital mortality and 1-year mortality were 6.7%, 8.0%, 6.3% and 18.5%, respectively. Multivariate analyses showed that sarcopenia (odds ratio [OR] 4.42, 95% confidence interval [CI] 1.69–11.57), American Society of Anesthesiologists score (OR 2.37, 95% CI 1.23–4.54) and clinical frailty scale (OR 1.83, 95% CI 1.30–2.59) were independent predictors for 1-year mortality. The area under the ROC curve was 0.79 (95% CI 0.71–0.88) and 0.73 (95% CI 0.58–0.87) in the training and validation cohorts, respectively. Hosmer–Lemeshow test was not statistically significant. Conclusion: We developed an easy-to-use preoperative calculator to predict 1-year mortality in older patients undergoing EL.

Background: Ageing population is a worldwide phenomenon with correspondingly higher proportion of older patients being treated in the hospital setting. Sarcopenia, which increases with age, has serious negative implications on health, hospitalisation, and overall postoperative recovery. There is no mutual consensus on perioperative management of sarcopenia in surgical patients in Singapore. The purpose of this study is to create greater clarity pertaining to the recognition of sarcopenia, the application of assessment criteria of sarcopenia and perioperative management of surgical patients in Singapore. Methods: A modified Delphi consensus consisting of a panel of experts from Singapore forming a multidisciplinary team, including surgeons, geriatricians, anesthesiologists, physiotherapists, and dieticians. Eight recommendations were proposed by the steering committee. Literature search from MEDLINE, Embase, and Scopus for articles up till June 2023 were performed to support recommendation statements. The expert panel voted on agreement to recommendation statements and graded the level of evidence supporting each statement through surveys to achieve consensus, set at 85% a priori. Results: The panellists underwent two rounds of anonymized, independent voting before reaching consensus for all eight statements. After the first round, seven statements reached consensus, including the corresponding grading for level of evidence. The statement which did not achieve consensus was revised with supporting literature and after the second round of survey, all eight statements and level of evidence reached consensus, completing the Delphi process. These eight statements covered themes to (1) encourage the identification of sarcopenia, (2) guide preoperative, and (3) postoperative management of sarcopenia. Conclusion: With the varying approaches in perioperative management, poor understanding of and identification of sarcopenia can result in suboptimal management of sarcopenia in surgical patients. Given the abundance of evidence linking beneficial impact on recovery and postoperative complications with prudent management of sarcopenia, it is imperative and urgent to achieve awareness and consensus.

Background: Multimodal analgesia is now widely practised to minimise postoperative opioid consumption while optimising pain control. The aim of this meta-analysis was to assess the analgesic efficacy of erector spinae plane block (ESPB) in patients undergoing laparoscopic abdominal surgeries. This will be determined by perioperative opioid consumption, subjective pain scores, and incidences of postoperative nausea and vomiting. Methods: The authors systemically searched electronic databases for randomised controlled trials (RCTs) published up to February 2023 comparing ESPB with other adjuvant analgesic techniques in laparoscopic abdominal surgeries. Nine randomised controlled trials encompassing 666 subjects were included in our study. Results: ESPB was shown to reduce postoperative opioid consumption [mean difference (MD) of −5.95 mg (95% CI: −8.86 to −3.04; PI ²=89%], intraoperative opioid consumption MD of −102.4 mcg (95% CI: −145.58 to −59.21; PI ²=39%, and incidence of nausea [RR 0.38 (95% CI: 0.25–0.60; PI ²=0%] and vomiting [RR 0.32 (95% CI: 0.17–0.63; P=0.0009); I ²=0%] in laparoscopic abdominal surgeries. Subgroup analysis on laparoscopic colorectal surgeries further showed reduction in postoperative pain scores MD of −0.68 (95% CI: −0.94 to −0.41); PI ²=0%]. Conclusions: This study concludes that ESPB is a valuable technique with proven efficacy to potentially promote faster postoperative recovery through optimising pain control while minimising opioid requirements.

Laparoscopic ventral hernia repair (LVHR) has been increasing in popularity over the years. Seroma formation is a common complication of LVHR. The aim of this study is to review the current evidence on seroma prevention strategies following LVHR.