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Elucidation of the novel role of ethnicity and diabetes in poorer outcomes after cardiac surgery in a multiethnic Southeast Asian cohort

Moorthy V, Liu W, Chan SP, Chew STH, Ti LK

J Diabetes, 2020 Jan;12(1):58-65.
PMID: 31210000 DOI: 10.1111/1753-0407.12961

BACKGROUND: Although diabetes is associated with ethnicity and worse cardiac surgery outcomes, no research has been done to study the effect of both diabetes and ethnicity on cardiac surgery outcomes in a multiethnic Southeast Asian cohort. Hence, this study aimed to delineate the association of ethnicity on outcomes after cardiac surgery among diabetics in a multiethnic Southeast Asian population.
METHODS: Perioperative data from 3008 adult patients undergoing elective cardiac surgery from 2008 to 2011 at the two main heart centers in Singapore was analyzed prospectively, and confirmatory analysis was conducted with the generalized structural equation model.
RESULTS: Diabetes was significantly associated with postoperative acute kidney injury (AKI) and postoperative hyperglycemia. Postoperative AKI, Malay ethnicity, and blood transfusion were associated with postoperative dialysis. Postoperative AKI and blood transfusion were also associated with postoperative arrhythmias. In turn, postoperative dialysis and arrhythmias increased the odds of 30-day mortality by 7.7- and 18-fold, respectively.
CONCLUSIONS: This study identified that diabetes is directly associated with postoperative hyperglycemia and AKI, and indirectly associated with arrhythmias and 30-day mortality. Further, we showed that ethnicity not only affects the prevalence of diabetes, but also postoperative diabetes-related outcomes.
Fulltext Perioperative temperature management: a survey of 6 Asia-Pacific countries

Koh W, Chakravarthy M, Simon E, Rasiah R, Charuluxananan S, Kim TY, et al.

BMC Anesthesiol, 2021 08 16;21(1):205.
PMID: 34399681 DOI: 10.1186/s12871-021-01414-6

BACKGROUND: Anesthesia leads to impairments in central and peripheral thermoregulatory responses. Inadvertent perioperative hypothermia is hence a common perioperative complication, and is associated with coagulopathy, increased surgical site infection, delayed drug metabolism, prolonged recovery, and shivering. However, surveys across the world have shown poor compliance to perioperative temperature management guidelines. Therefore, we evaluated the prevalent practices and attitudes to perioperative temperature management in the Asia-Pacific region, and determined the individual and institutional factors that lead to noncompliance.
METHODS: A 40-question anonymous online questionnaire was distributed to anesthesiologists and anesthesia trainees in six countries in the Asia-Pacific (Singapore, Malaysia, Philippines, Thailand, India and South Korea). Participants were polled about their current practices in patient warming and temperature measurement across the preoperative, intraoperative and postoperative periods. Questions were also asked regarding various individual and environmental barriers to compliance.
RESULTS: In total, 1154 valid survey responses were obtained and analyzed. 279 (24.2%) of respondents prewarm, 508 (44.0%) perform intraoperative active warming, and 486 (42.1%) perform postoperative active warming in the majority of patients. Additionally, 531 (46.0%) measure temperature preoperatively, 767 (67.5%) measure temperature intraoperatively during general anesthesia, and 953 (82.6%) measure temperature postoperatively in the majority of patients. The availability of active warming devices in the operating room (p
The rising tsunami of poor muscle health and sarcopenia in Asia-Pacific: Time for focused attention and targeted interventions

Chew STH, Nguyen HTT, Joshi S, Kamaruzzaman SB, Landi F, Manuel MV, et al.

Arch Gerontol Geriatr, 2024 Feb;117:105275.
PMID: 37988852 DOI: 10.1016/j.archger.2023.105275
Fulltext Tackling undernutrition in the Asian healthcare setting: a Southeast Asian expert consensus

Regional Nutrition Working Group (RNWG), Ng DHL, Albay A, Chew STH, Glencorse C, Inciong JF, et al.

Asia Pac J Clin Nutr, 2018 11 30;27(6):1161-1174.
PMID: 30485913 DOI: 10.6133/apjcn.201811_27(6).0001

BACKGROUND AND OBJECTIVES: Malnutrition is under-recognized and under-treated in Asia due to resource constraints, lack of awareness and knowledge among healthcare professionals and patients, and lack of standardized procedures for malnutrition management. While international guidelines for the management of malnutrition are available, they may not be easily applicable to the patient population and healthcare settings within Southeast Asia. This paper provides consensus recommendations, developed by the Regional Nutrition Working Group, to foster evidence-based nutritional care in Southeast Asia to improve patient outcomes.
METHODS AND STUDY DESIGN: The group convened and discussed evidence-based recommendations and clinical experiences in the management of malnutrition in hospitalized and community-dwelling adults, and the relevance of oral nutritional supplements in clinical practice. Supported by a literature search from January 2007-September 2017, consensus statements on key aspects of malnutrition management were developed.
RESULTS: Malnutrition management should be considered as an integral part of patient care and managed by a multidisciplinary team. Hospitalized patients and outpatients should be screened for risk of malnutrition with validated tools. Nutrition intervention, including oral, enteral, or parenteral nutrition, should be accessible and individualized to all patients who are malnourished or at risk of malnutrition. Education on nutrition care is imperative for healthcare professionals, patients and caregivers.
CONCLUSION: These consensus recommendations provide practical guidance to improve nutrition practice within healthcare in Southeast Asia. With collaborative efforts from the clinical community, professional societies and policy makers, this regional effort may also facilitate change in the nutrition practice at the institutional and national level.