Martin Hübner

University Hospital of Lausanne

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Co-Authors

Nicolas Demartines

University Hospital of Lausanne

228

Fabian Grass

University Hospital of Lausanne

Dieter Hahnloser

University of Lausanne

Basile Pache

University of Lausanne

Markus Schäfer

University of Luxembourg

Daniel Clerc

University of Lausanne

Olivia Sgarbură

Université de Montpellier

Hugo Teixeira Farinha

University Hospital of Lausanne

Olivier Gléhen

Hospices Civils de Lyon

David Martín

Laboratoire de Physique Nucléaire et de Hautes Énergies

Cooperative Institutions

St James's University Hospital

673

University of Leeds

655

University of Birmingham

473

University of Lausanne

228

University Hospital of Lausanne

219

University College London

209

Istituti di Ricovero e Cura a Carattere Scientifico

192

University of Edinburgh

179

NIHR Birmingham Biomedical Research Centre

175

Inserm

160

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Noise in the operating room coincides with surgical difficulty

BJS Open (2024)

Sarah Peisl Daniel Sánchez‐Taltavull Hugo Guillen-Ramirez Franziska Tschan Norbert K. Semmer

Abstract Background Noise in the operating room has been shown to distract the surgical team and to be associated with postoperative complications. It is, however, unclear whether complications after noisy operations are the result of objective or subjective surgical difficulty or the consequence of distraction of the operating room team by noise. Methods Noise level measurements were prospectively performed during operations in four Swiss hospitals. Objective difficulty for each operation was calculated based on surgical magnitude as suggested by the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), duration of operation and surgical approach. Subjective difficulty and distraction were evaluated by a questionnaire filled out by the operating room team members. Complications were assessed 30 days after surgery. Using regression analyses, the relationship between objective and subjective difficulty, distraction, intraoperative noise and postoperative complications was tested. Results Postoperative complications occurred after 121 (38%) of the 294 procedures included. Noise levels were significantly higher in operations that were objectively and subjectively more difficult (59.89 versus 58.35 dB(A), P < 0.001) and operations that resulted in postoperative complications (59.05 versus 58.77 dB(A), P = 0.004). Multivariable regression analyses revealed that subjective difficulty as reported by all members of the surgical team, but not distraction, was highly associated with noise and complications. Only objective surgical difficulty independently predicted noise and postoperative complications. Conclusion Noise in the operating room is a surrogate of surgical difficulty and thereby predicts postoperative complications.

Surgical team

Surgical procedures

10.1093/bjsopen/zrae098

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Altersabhängige Unterschiede von Wanddicke und Durchmesser des M. sphincter ani internus: Eine MRT-Studie an kontinenten Nulliparae

Geburtshilfe und Frauenheilkunde (2006)

Martin Hübner RU Margulies DE Fenner James A. Ashton‐Miller JOL DeLancey

Einleitung: Der interne Analsphinkter (IAS) gewährleistet 75% des zur Kontinenzerhaltung nötigen maximalen analen Ruheverschlussdruckes. Das Gesetz von Laplace, σ=(P · r) / d, beschreibt die Beziehung zwischen Dicke (d), Radius (r), Druck (P) und der Wandspannung pro Fläche (σ). Ziel dieser Studie war es, 1) Dicke und Durchmesser des IAS von jüngeren und älteren Frauen in MRT-Scans zu bestimmen, und 2) die Wandspannung des IAS anhand aus der Literatur bekannter analer Ruhemanometriedrücke abzuschätzen [1].

10.1055/s-2006-952771

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Anal Cancer Screening: 10-Year Experience of a Specialized Outpatient Clinic

Cancers (2025)

Iolanda Espirito Santo Amaniel Kefleyesus Camille Chilou Seraina Faes Daniel Clerc

In 2012, the Department of Visceral Surgery of the Lausanne University Hospital CHUV implemented a dedicated high-resolution anoscopy (HRA) outpatient clinic for surveillance and follow-up purposes. This 10-year longitudinal study analyzed 537 patients (2214 visits) using a structured screening protocol. Dysplastic lesions were detected in 49% of patients, predominantly low-grade squamous intraepithelial lesions (LSILs, 74%). Among LSIL cases, 6% progressed to high-grade squamous intraepithelial lesions (HSILs) within 24 months, reaching 25% cumulative progression at 36 months. Of HSIL patients, 3% developed carcinoma in situ after 48 months. Notably, no invasive carcinoma was observed during the follow-up. Four patients diagnosed with squamous cell carcinoma at initial screening were treated with chemoradiotherapy, and one required salvage surgery. Independent risk factors for the presence of higher-stage precancerous lesions (≥HSILs) were the presence of high-risk HPV genotypes (OR 14.5, 95% CI 5-42.2, p < 0.001), detectable HIV viral load (OR 5.4, 95% CI 1.8-16.7, p = 0.003), and symptoms at the first screening visit (OR 3.2, 95% CI 1.1-9.9, p = 0.04). HIV-positive status was associated with a trend towards an increased risk of progression (OR 2.79, p = 0.073). These findings highlight the importance of systematic follow-up and early intervention in high-risk populations to prevent anal cancer progression.

Outpatient clinic

Cancer screening

10.3390/cancers17020193

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Feasibility of a prehabilitation program before major abdominal surgery

British journal of surgery (2021)

David Martín Cyril Besson Basile Pache Anna Michel Sandrine Geinoz

Abstract Objective Prehabilitation programs claim to improve exercise capacity and postoperative outcomes. The study aim was to assess the feasibility of a prehabilitation program and its effects on fitness and clinical outcomes after major abdominal surgery. Methods In this prospective pilot study, patients were assigned to high-intensity physical exercise training with 3 training sessions per week for 3 weeks preoperatively. Feasibility of this intervention was assessed based on recruitment and adherence to the training program. Impact on fitness (VO2 AT) was evaluated and correlated with complications and length of stay (LOS). Results Of 980 eligible patients, 87 patients (8.9%) were approached for inclusion. Main obstacles to not approach patients were insufficient time (< 3 weeks) prior to scheduled surgery (n = 276, 28.2%) or screening failure (n = 312, 31.8%). Out of these 87 patients, 24 (28%) declined to participate, 43 (49%) met exclusion criteria and 20 (23%) were included. Six patients (30%) could not complete the prehabilitation program due to contra-indication for exercise training evidenced during the test (n = 3), lack of motivation (n = 2) and modification of the planned operating date (n = 1). VO2 AT increased from 9.8 to 11.5 ml/min/kg (p = 0.050). There were no correlations between the change in VO2 AT and postoperative complications (r = -0.133, p = 0.649) and LOS (r = -0.94, p = 0.750). Conclusion Prehabilitation programs are difficult to implement and many patients are either not eligible or not motivated. Future efforts should concentrate on those patients who are most likely to benefit from these time- and cost-intensive interventions.

Prehabilitation

10.1093/bjs/znab202.095

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Preoperative CT-based sarcopenia does not affect outcomes in patients undergoing liver surgery

HPB (2021)

David Martín Yaël Maeder Kenya Kobayashi M. Schneider J. Koerfer

Preoperative care

10.1016/j.hpb.2021.08.303

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ASO Visual Abstract: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy to Treat Pseudomyxoma Peritonei of Ovarian Origin: A Retrospective French RENAPE Group Study

Annals of Surgical Oncology (2024)

Alexis Trécourt Naoual Bakrin Olivier Gléhen Witold Gertych Laurent Villeneuve

Pseudomyxoma Peritonei

Surgical oncology

Hyperthermic Intraperitoneal Chemotherapy

Intraperitoneal Chemotherapy

10.1245/s10434-024-14925-6

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[Management of acute and chronic anal pain].

PubMed (2024)

Camille Chilou Dieter Hahnloser Martin Hübner Fabian Grass

Anal pain can be acute (most commonly related to anal fissure, perianal abcess or fistula, perianal vein thrombosis) or chronic (functional or neuropathic) including levator ani syndrome, proctalgia fugax, pudendal nevralgia and coccygodynia. History and clinical examination are keys to diagnose acute causes. Diagnosis of chronic anal pain on the other hand is more challenging and based on thorough history and analysis of symptoms. The aim of this article is to discuss the main etiologies and treatments of acute and chronic anal pain, including an update on the management and treatment of hemorrhoidal disease and postoperative pain management.

Acute Pain

10.53738/revmed.2024.20.878.1151

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Requirements for a successful Enhanced Recovery After Surgery (ERAS) program - A multicenter international survey among ERAS nurses.

Authorea (Authorea) (2024)

Basile Pache Martin Hübner David Martín Valérie Addor Olle Ljungqvist

ABSTRACT INTRODUCTION Nurses are the linchpin of Enhanced Recovery After Surgery (ERAS) program, as they are in direct contact with patients and various caregivers. The aim of the present survey was to assess ERAS key factors and challenges from a nurse perspective. METHODS Qualitative study among ERAS dedicated nurses and ERAS Interactive Audit System (EIAS) administrators using an online questionnaire (Survey Monkey®) yielding 29 questions. The survey focused on challenges and drawbacks encountered during ERAS training, implementation and daily clinical practice. Closed multiple choice- and open-end questions and semantic differential scales (0-10) were used. Panelists received 3 reminders within 4 and 8 weeks after invitation. RESULTS 123 out of 306 invited nurses completed the sur¬vey (response rate 40%). Overall, the success of the institutional ERAS program was rated a 6.9±2/10. Improving both patient outcomes (90%) and satisfaction (69%) were rated as main motivators for ERAS implementation, while time restraints (50%) and logistics (43%) were identified as main barriers. The study revealed a wide heterogeneity in coordination and management strategies (ERAS meetings, work models, teaching strategies). Sustained staff education before (9.1/10 ) and after (9.1/10) implementation, a dedicated ERAS coordinator (8.9/10) and regular meetings (8.3/10 scale) were rated as key factors for a successful program. Difficulty of implementation, maintenance and data acquisition were all rated >5/10. CONCLUSION Despite heterogeneity in coordination and management, ERAS program is evaluated assuccessfully from a nurse perspective. Continuous staff education and coordination beyond the implementation period appear to be of utmost importance for a sustained program.

10.22541/au.170664591.14673250/v1

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Optimierung des perioperativen Managements - Enhanced Recovery After Surgery (ERAS ® )

Andrea Schoke Cornelia Künzli Christine Zehntner Martin Hübner Stefan Breitenstein

Qualitat und Wirtschaftlichkeit medizinischer Behand lungen gewinnen in unserem gesundheitspolitischen Um feld zunehmend an Bedeutung. In diesem Zusam menhang stand in der Chirurgie bisher die Weiter entwicklung von innovativen Operationsmethoden im Vordergrund. Seit einiger Zeit setzt sich nun aber die Erkenntnis durch, dass fur das PatientenOutcome aus ser der optimierten chirurgischen Operationstechnik auch die prozessualen und interdisziplinaren Aspekte im perioperativen Behandlungsablauf eine ganz wichtige Rolle spielen. Es ist mittlerweile uberzeugend nachge wiesen (evidenzbasiert), dass chirurgische Behandlungs erfolge ganz wesentlich von interdisziplinarer Zusam menarbeit im gesamten perioperativen Ablauf abhangen (Abb. 1 ) [1]. «Enhanced Recovery After Surgery» oder kurz ERAS® heisst das moderne, integrative, periopera tive Behandlungskonzept, das vor einigen Jahren von einer skandinavischen Gruppe von Chirurgen entwickelt wurde und aktuell, insbesondere in der Viszeralchir urgie, international zunehmend Akzeptanz findet [2]. Das ERAS®Konzept entwickelte sich aus dem vorgangi gen Begriff der «FastTrackChirurgie», die 1995 vom Danen Henrik Kehlet beschrieben wurde. Bei ERAS® wird nun der Fokus auf die verbesserte postoperative Er holung und nicht mehr nur auf die Geschwindigkeit des Behandlungsablaufs ausgerichtet. Die Viszeralchirurgie am Universitatsspital Lausanne (CHUV, Direktor Prof. Nicolas Demartines) ist die erste Klinik in der Schweiz, die sich der ERAS®Society angeschlossen hat, das Kon zept konsequent umsetzt und die Daten online und pro spektiv in der internationalen ERAS®Datenbank erfasst. Uber Workshops gibt die Lausanner Gruppe ihre Er fahrungen und das Wissen zur Implementierung des ERAS®Konzepts an interessierte Kliniken wie die uns rige weiter. Aus Uberzeugung, dass ERAS® fur unsere Pa tienten eine gute Sache ist, und mit viel Enthusiasmus haben wir uns dieser Herausforderung gestellt.

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[Enhanced Recovery After Surgery--optimal management of the surgical patient].

PubMed (2014)

Didier Roulin Catherine Blanc Nicolas Demartines Martin Hübner

Enhanced Recovery After Surgery (ERAS) is a multimodal, standardized and evidence-based perioperative care pathway. With ERAS, postoperative complications are significantly lowered, and, as a secondary effect, length of hospital stay and health cost are reduced. The patient recovers better and faster allowing to reduce in addition the workload of healthcare providers. Despite the hospital discharge occurs sooner, there is no increased charge of the outpatient care. ERAS can be safely applied to any patient by a tailored approach. The general practitioner plays an essential role in ERAS by assuring the continuity of the information and the follow-up of the patient.

Outpatient surgery

Patient Care

Perioperative nursing

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