Publications by authors named "Alberto Bicudo-Salomao"
Background: The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs.
Aims: To emphasize the most important points of a multimodal perioperative care protocol.
Objective: Hospital costs in surgery constitute a burden for the health system in all over the world. Multimodal protocols such as the ACERTO project enhance postoperative recovery. The aim of this study was to analyze the hospital costs in patients undergoing major digestive surgical procedures with or without the perioperative care strategies proposed by the ACERTO project.
View Article and Find Full Text PDFThe ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs.
View Article and Find Full Text PDFObjective: to compare hospital costs and clinical outcomes in inguinal and incisional hernioplasty before and after implementation of the ACERTO project in a university hospital.
Methods: retrospective study of 492 patients undergoing either inguinal hernioplasty (n=315) or incisional hernioplasty (n=177). The investigation involved two phases: between January 2002 and December 2005, encompassing cases admitted before the implementation of the ACERTO protocol (PRE-ACERTO period), and the other phase, with cases operated between January 2006 and December 2011, after the implementation of the protocol (ACERTO period).
Objective: To investigate the use of "ultra-early" postoperative feeding (oral liquid diet offered in the post-anesthetic recovery room) in patients undergoing common general surgical procedures and to assess the volume of intravenous fluids, as well as the rate of complications and the length of hospital stay.
Methods: Prospective, observational study, which assessed the compliance with the "ultra-early" feeding, the reduction of preoperative fasting time, the perioperative venous hydration volume, the length of stay and the operative morbidity.
Results: 154 patients with a mean age of 46 ± 15 years were followed.
Article Synopsis
- Perioperative care using the ACERTO protocol can significantly enhance surgical outcomes for patients undergoing elective colorectal operations, particularly regarding morbidity and mortality risks.
- A cohort study of 234 patients revealed that preoperative fasting for ≤4 hours and the correct infusion of intravenous fluids were critical in reducing the risk of surgical site infections (SSI) and other complications, demonstrating protective effects against negative postoperative outcomes.
- Key risk factors identified for complications included malnutrition, the complexity of rectal surgeries, and a high NNIS risk index, highlighting the importance of managing these factors in the perioperative care process.
Objective: to present recommendations based on the ACERTO Project (Acceleration of Total Post-Operative Recovery) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures.
Methods: review of relevant literature from 2006 to 2016, based on a search conducted in the main databases, with the purpose of answering guiding questions previously formulated by specialists, within each theme of this guideline. We preferably used randomized controlled trials, systematic reviews and meta-analyzes but also selected some cohort studies.
Objective:: to assess the level of knowledge among bariatric surgeons, about the recommendations of the ACERTO Project, correlating their assumptions on their perioperative prescriptions and the reality, according to the patients charts.
Method:: we conducted a prospective, longitudinal, observational study comparing the assumptions of bariatric surgeons obtained through responses on a specific questionnaire with the reality found in clinical data from the hospital records. We analyzed the following variables: preoperative fasting, early postoperative feeding, intravenous hydration, perioperative antibiotic prophylaxis, use of abdominal drains, type of analgesia, and prophylaxis of nausea and vomiting.
Article Synopsis
- Many trauma-related deaths occur days to weeks post-injury, primarily due to infections and organ failure from acute protein malnutrition.
- Nutritional therapy is essential and should be integrated into resuscitation protocols for patients with severe trauma and burns.
- Early nutritional support, ideally within 48 hours, is crucial and can be administered enterally or parenterally depending on the patient's condition, with an added focus on "feeding" in trauma care guidelines.
The early provision of nutrients as part of specialized therapy for critically ill patients admitted for critical medical and surgical conditions is recommended by various international guidelines. Enteral nutrition is the first option and should be initiated 24-48 h after admission to an intensive care unit. Even after gastrointestinal anastomosis, early oral or enteral feeding is not only safe but also associated with enhanced recovery and fewer complications.
View Article and Find Full Text PDFPurpose: To evaluate the protective effects of glutamine administered before renal ischemia-reperfusion on plasma antioxidant protection, and lung and renal tissue injury.
Methods: 33 rats underwent right nephrectomy. On the eighth postoperative day, animals were randomized into three groups (n=11): glutamine, control and sham.
Article Synopsis
- The study analyzed postoperative outcomes at University Hospital Julio Muller before and after the ACERTO multimodal protocol was implemented, comparing data from nearly 6,000 patients over two distinct periods.
- Results showed significant improvements post-implementation, including a reduction in hospital stay length, blood transfusions per patient, and rates of surgical site infections and operative complications.
- The overall conclusion is that the ACERTO protocol led to better surgical outcomes, making surgeries safer and more efficient, ultimately reducing hospital stays and complications.
Context: Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery.
Objective: To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients.
Objective: To evaluate the outcomes after the implementation of a multimodal protocol (ACERTO protocol) with patients undergoing colorectal operations.
Methods: Fifty-three patients (37 M and 16 F; 57 [18-82] years old) submitted to various colorectal operations were prospectively studied in two different periods of time: from January 2004 through July 2005 (n=25, conventional group) and from August 2005 through June 2008 (n=28; ACERTO group). The patients received either the traditional perioperative management (including mechanical bowel cleansing) or a multidisciplinary protocol of perioperative care (without mechanical bowel cleansing) established by the ACERTO protocol.
Purpose: To investigate the effects of perioperative administration of diet containing probiotics on the immune response, anastomotic resistance, and colonic mucosal trophism in rats underwent left-sided colonic anastomosis.
Methods: Sixty adults Wistar rats were randomized to two groups (A and B) with 30 animals each to receive or not a diet supplemented with probiotics (Streptococcus thermophilus e Lactobacillus helveticus) during pre- and postoperative period. They underwent laparotomy followed by left colon section and immediate anastomosis.
Purpose: To evaluate the effects of intraluminal injection of glutamine on the serum trolox equivalent antioxidant capacity in an experimental model of ischemia-reperfusion of the liver observing the applicability of modifications on the original assay method.
Methods: Thirty Wistar rats underwent laparotomy to perform a 20 cm blind sac of small bowel and occlusion of the hepatic hilo for 30 minutes and reperfusion for 5 minutes. Into the gut sac it was injected glutamine (glutamine group, n=10) or distilled water (control group, n=10).
Background: Standard body mass index cut-off points for malnutrition are routinely used for adults independently of their age. The hypothesis of this study was that a cut-off point higher than the usual for the diagnosis of malnutrition might be more precise to access the nutritional risk of aged surgical patients.
Aim: To evaluate the morbimortality in aged surgical patients and its association with nutritional status assessed by body mass index using either the standard and a higher cut-off point for malnutrition.
Purpose: Investigated the effect of intraluminal short-chain fatty acids (SCFA) on the intestinal mucosa in the presence of ischemia-reperfusion injury (IRI).
Methods: Six blind sacs of the small bowel (3 at the jejunum and 3 at the ileum) were created in ten Wistar rats. The lateral sacs of both bowel regions were subjected to IRI (15/15 minutes) while the medial sacs were let free to receive blood supply.