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Hughes MJ, Hackney RJ, Lamb PJ, Wigmore SJ, Deans DAC, Skipworth RJE. Author's Reply: Prehabilitation Before Major Abdominal Surgery. World J Surg 2021; 45:911-912. [PMID: 33399881 DOI: 10.1007/s00268-020-05889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Michael J Hughes
- Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - Rosie J Hackney
- Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Peter J Lamb
- Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Stephen J Wigmore
- Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - D A Christopher Deans
- Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Richard J E Skipworth
- Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
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Tran DL, Maiorana A, Davis GM, Celermajer DS, d'Udekem Y, Cordina R. Exercise Testing and Training in Adults With Congenital Heart Disease: A Surgical Perspective. Ann Thorac Surg 2020; 112:1045-1054. [PMID: 33285131 DOI: 10.1016/j.athoracsur.2020.08.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/16/2020] [Accepted: 08/31/2020] [Indexed: 01/18/2023]
Abstract
In the current era, the majority of children born with congenital heart disease (CHD) will survive well into adulthood because of major advances in surgical techniques, as well as in critical and medical care. However, reoperation and palliative surgical interventions are increasingly common in the adults with CHD. Tools to risk stratify patients effectively and therapies to improve outcomes are required to optimize the management of adult patients with CHD during the preoperative and postoperative periods and beyond. Exercise testing is an invaluable tool to guide risk stratification. In addition, exercise training in patients with CHD may decrease postoperative complications by enhancing physiological reserve and also has an important role in physical rehabilitation. This review aims to provide individualized recommendations on exercise prescription in patients with CHD in the preoperative and postoperative settings. The response to exercise testing and prognostic implications is also discussed.
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Affiliation(s)
- Derek L Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia; Discipline of Exercise and Sport Science, University of Sydney, Camperdown, Australia; Heart Research Institute, Newtown, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia; Allied Health Department, Fiona Stanley Hospital, Murdoch, Australia
| | - Glen M Davis
- Discipline of Exercise and Sport Science, University of Sydney, Camperdown, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia; Heart Research Institute, Newtown, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Parkville, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Parkville, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, University of Sydney, Camperdown, Australia; Heart Research Institute, Newtown, Australia; Murdoch Children's Research Institute, Parkville, Australia.
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care. Perioper Med (Lond) 2020; 9:37. [PMID: 33292657 PMCID: PMC7704118 DOI: 10.1186/s13741-020-00168-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. METHODS A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. RESULTS Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). CONCLUSIONS These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy.
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padua, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital - Torino, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, V Fazzi Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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Kulinski K, Smith NA. Surgical prehabilitation using mobile health coaching in patients with obesity: A pilot study. Anaesth Intensive Care 2020; 48:373-380. [PMID: 33104444 DOI: 10.1177/0310057x20947731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many patients spend months waiting for elective procedures, and many have significant modifiable risk factors that could contribute to an increased risk of perioperative morbidity and mortality. The minimal direct contact that usually occurs with healthcare professionals during this period represents a missed opportunity to improve patient health and surgical outcomes. Patients with obesity comprise a large proportion of the surgical workload but are under-represented in prehabilitation studies. Our study piloted a mobile phone based, multidisciplinary, prehabilitation programme for patients with obesity awaiting elective surgery. A total of 22 participants were recruited via the Wollongong Hospital pre-admissions clinic in New South Wales, Australia, and 18 completed the study. All received the study intervention of four text messages per week for six months. Questionnaires addressing the self-reported outcome measures were performed at the start and completion of the study. Forty percent of participants lost weight and 40% of smokers decreased their cigarette intake over the study. Sixty percent reported an overall improved health score. Over 80% of patients found the programme effective for themselves, and all recommended that it be made available to other patients. The cost was A$1.20 per patient per month. Our study showed improvement in some of the risk factors for perioperative morbidity and mortality. With improved methods to increase enrolment, our overall impression is that text message-based mobile health prehabilitation may be a feasible, cost-effective and worthwhile intervention for patients with obesity.
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Affiliation(s)
- Kasia Kulinski
- Department of Anaesthesia, Prince of Wales Hospital, Randwick, Australia
| | - Natalie A Smith
- Department of Anaesthesia, Wollongong Hospital, Wollongong, Australia.,School of Medicine, University of Wollongong, Wollongong, Australia
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Abstract
In this article, we review the evidence underpinning the broader prehabilitation concept and the target behavioural and lifestyle risk factors including their perioperative impact and evidence for prehabilitation intervention. We also identify principles for delivering prehabilitation in practice, alongside lessons for the perioperative setting from well-established allied interventions; cardiac and pulmonary rehabilitation.
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Affiliation(s)
- James Durrand
- Northern School of Anaesthesia and Intensive Care Medicine, Newcastle-upon-Tyne, UK and PhD student, Northumbria University Department of Sport, Exercise and Rehabilitation, Newcastle-upon-Tyne, UK
| | - Sally J Singh
- Biomedical Research Centre-Respiratory Centre for Exercise and Rehabilitation Science, Leicester, UK
| | - Gerry Danjoux
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK, honorary professor, Hull York Medical School, York, UK and visiting professor Teesside University School of Health and Social Care, Middlesbrough, UK
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Oh J, Song IK, Nam JS, Lee SW, Lee EH, Choi IC. Sarcopenia as a prognostic factor for outcomes after isolated tricuspid valve surgery. J Cardiol 2020; 76:585-592. [PMID: 32736904 DOI: 10.1016/j.jjcc.2020.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/16/2020] [Accepted: 06/02/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sarcopenia, characterized by decreased skeletal muscle mass, is a comprehensive and objective marker of frailty and is associated with poor postoperative outcomes in adult surgery patients. We aimed to evaluate the prognostic implications of preoperative sarcopenia assessed by chest computed tomography in patients undergoing isolated tricuspid valve surgery. METHODS This observational study retrospectively reviewed records of 144 consecutive adult patients who underwent isolated tricuspid valve surgery between January 2010 and December 2016. Preoperative chest computed tomography scans were used to measure the area of the erector spinae muscle and pectoralis muscle which was then indexed to height in meters squared. The total skeletal muscle index was defined as the sum of the right and left cross-sectional areas of the erector spinae muscle index and the pectoralis muscle index. Sarcopenia was defined as any total skeletal muscle index below the 50th sex-specific percentile. Multivariable Cox proportional hazard models were used to identify the independent association between preoperative sarcopenia and major 30-day postoperative complications. RESULTS A total of 53 (36.8%) patients suffered from complications. Major 30-day postoperative complications occurred more frequently in patients with sarcopenia than in those without sarcopenia [46.6% (34/73) vs. 26.8% (19/71), p = 0.022]. With multivariable analyses, sarcopenia was independently associated with incidence of major 30-day postoperative complications (hazard ratio 2.24, 95% confidence interval 1.27-3.94, p = 0.005). CONCLUSIONS Our study demonstrates a significant association between preoperative total skeletal muscle index and major 30-day postoperative complications in patients undergoing isolated tricuspid valve surgery.
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Affiliation(s)
- Jimi Oh
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - In-Kyung Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Sik Nam
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcomes Analysis and Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lee
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcomes Analysis and Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Ho Lee
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcomes Analysis and Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Laboratory for Perioperative Outcomes Analysis and Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Prehabilitation before major intra-abdominal cancer surgery: A systematic review of randomised controlled trials. Eur J Anaesthesiol 2020; 36:933-945. [PMID: 31188152 PMCID: PMC6855314 DOI: 10.1097/eja.0000000000001030] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Supplemental Digital Content is available in the text BACKGROUND Although prehabilitation programmes for patients undergoing major intra-abdominal cancer surgery have been shown to improve pre-operative physical fitness, the conclusions regarding any postoperative benefits are inconsistent. OBJECTIVES The aim of this study was to evaluate the content of and the outcome measures used in studies of prehabilitation programmes for these patients. It was hypothesised that the content of prehabilitation programmes is often therapeutically invalid, and that the postoperative outcomes assessed are inadequate to evaluate the impact of complications. DESIGN A systematic review of randomised controlled trials. DATA SOURCES Studies published between January 2009 and January 2019 were retrieved from PubMed, Embase and PEDro. ELIGIBILITY CRITERIA Studies were included when they investigated the effects of prehabilitation in patients undergoing intra-abdominal surgery for cancer, reported pre-operative and/or postoperative outcome measures and were conducted as a randomised controlled trial. Studies for which the full text was not available were excluded, as were studies of patients undergoing nonabdominal cancer surgery. RESULTS Eight studies (565 patients) were included. Therapeutic validity was low in five studies. Most studies included low-risk surgical patients and considerable variation was observed between prehabilitation programmes in terms of supervision, training context, frequency, intensity, duration and training type. Objective monitoring of training progression was typically not performed, and most trials did not include nutritional or psychological support. Postoperative complications were reported in seven studies, but no study reported the impact of postoperative complications, nor on long-term postoperative outcomes. CONCLUSION The content of prehabilitation programmes was heterogeneous. Studies with a high therapeutic validity found unequivocal evidence that prehabilitation had beneficial effects on postoperative outcomes. Future research should focus on adequate selection and inclusion of high-risk surgical patients and provide personalised and probably multimodal (partly) supervised prehabilitation, with objective monitoring of progress. Measuring the incidence and impact of postoperative complications may contribute to demonstrating the clinical value of prehabilitation.
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Pesce de Souza F, Massierer D, Anand Raje U, Tansey CM, Boruff J, Janaudis-Ferreira T. Exercise interventions in solid organ transplant candidates: A systematic review. Clin Transplant 2020; 34:e13900. [PMID: 32391965 DOI: 10.1111/ctr.13900] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Exercise training may be recommended to solid organ transplant (SOT) candidates to improve fitness and tolerance before surgery. We aimed to determine the acceptance, safety, and effectiveness of exercise interventions in SOT candidates. METHODS Online databases were searched. Studies of any design were included. Outcomes of interest were acceptance, safety, exercise capacity, and health-related quality of life. RESULTS Twenty-three articles were included. Acceptance ranged from 16% to 100%. In the fifteen studies that assessed adverse events, none mentioned any adverse events occurring during the study. Five out of seven studies reported an increase in maximal exercise capacity post-exercise in the intervention group (range of mean change: 0.45 to 2.9 mL/kg). Eight out of fourteen studies reported an increase in 6-minute walking distance in the intervention group after the training period (range of mean change: 40-105 m). Two articles showed an improvement in the mental composite scores as well as in the physical composite scores post-exercise in the intervention group. CONCLUSION There was a lack of significant findings among most randomized controlled trials. Exercise training is acceptable and safe for selective SOT candidates. The effects of exercise training on exercise capacity and quality of life in SOT candidates are unclear.
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Affiliation(s)
| | - Daniela Massierer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Health Outcomes Research (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Uma Anand Raje
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Catherine M Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Health Outcomes Research (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center Montreal, QC, Canada
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Thomas G, West MA, Browning M, Minto G, Swart M, Richardson K, McGarrity L, Jack S, Grocott MPW, Levett DZH. Why women are not small men: sex-related differences in perioperative cardiopulmonary exercise testing. Perioper Med (Lond) 2020; 9:18. [PMID: 32518637 PMCID: PMC7271469 DOI: 10.1186/s13741-020-00148-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023] Open
Abstract
Background The use of preoperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative outcomes is increasingly prevalent. CPET-derived information enables personalised perioperative care and enhances shared decision-making. Sex-related differences in physical fitness are reported in non-perioperative literature. However, little attention has been paid to sex-related differences in the context of perioperative CPET. Aim We explored differences in the physical fitness variables reported in a recently published multi-centre study investigating CPET before colorectal surgery. We also report the inclusion rate of females in published perioperative CPET cohorts that are shaping guidelines and clinical practice. Methods We performed a post hoc analysis of the trial data of 703 patients who underwent CPET prior to major elective colorectal surgery. We also summarised the female inclusion rate in peer-reviewed published reports of perioperative CPET. Results Fitness assessed using commonly used perioperative CPET variables—oxygen consumption at anaerobic threshold (AT) and peak exercise—was significantly higher in males than in females both before and after correction for body weight. In studies contributing to the development of perioperative CPET, 68.5% of the participants were male. Conclusion To our knowledge, this is the first study to describe differences between males and females in CPET variables used in a perioperative setting. Furthermore, there is a substantial difference between the inclusion rates of males and females in this field. These findings require validation in larger cohorts and may have significant implications for both sexes in the application of CPET in the perioperative setting.
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Affiliation(s)
- G Thomas
- Department of Intensive Care, Spaarne Hospital, Haarlem, The Netherlands
| | - M A West
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Anaesthesia Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK
| | - M Browning
- Department of Anaesthesia, Maidstone and Tunbridge Wells NHS Trust, Hermitage Lane, Maidstone, Kent, UK
| | - G Minto
- Directorate of Anaesthesia, Derriford Hospital, 9th Floor Terence Lewis Building, Plymouth, UK.,Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - M Swart
- Department of Anaesthesia and Critical Care Medicine, Torbay Hospital, Torquay, UK
| | - K Richardson
- STRAPH Research Group, School of Sport and Exercise Sciences, University of Kent, Canterbury, UK.,Anaesthesia and Intensive Care Medicine, Medway Maritime Hospital, Gillingham, UK
| | - L McGarrity
- Department of Anaesthesia, University Hospital Crosshouse, Kilmarnock, East Ayrshire, Scotland, UK
| | - S Jack
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Mailpoint 810, Tremona Road, Southampton, SO16 6YD UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Mailpoint 27, D Level, Centre Block, Tremona Road, Southampton, SO16 6YD UK
| | - M P W Grocott
- Anaesthesia Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Mailpoint 810, Tremona Road, Southampton, SO16 6YD UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Mailpoint 27, D Level, Centre Block, Tremona Road, Southampton, SO16 6YD UK
| | - D Z H Levett
- Anaesthesia Perioperative and Critical Care Research Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Mailpoint 810, Tremona Road, Southampton, SO16 6YD UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Mailpoint 27, D Level, Centre Block, Tremona Road, Southampton, SO16 6YD UK
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Cavalheri V, Granger CL. Exercise training as part of lung cancer therapy. Respirology 2020; 25 Suppl 2:80-87. [PMID: 32567236 DOI: 10.1111/resp.13869] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/04/2020] [Accepted: 05/10/2020] [Indexed: 12/13/2022]
Abstract
Exercise training is playing an increasing role in lung cancer care. Lung cancer is associated with significant burden to the individual and healthcare system. There is now substantial evidence that exercise training is safe, feasible and effective at improving several outcomes in people with lung cancer, especially in those with NSCLC. Exercise is beneficial across the lung cancer disease and treatment pathway, including in patients with early stage disease before and after surgery, and in patients with advanced disease. This review describes the impact of lung cancer and lung cancer treatment on patient health outcomes and summarizes the aims, safety, feasibility and effects of exercise training in the context of both early stage and advanced stage lung cancer. The paper also includes a discussion of current topical discussion areas including the use of exercise in people with bone metastases and the potential effect of exercise on suppression of tumour growth. Finally, seven clinical questions are included, which are a priority to be addressed by future research over the next decade as we strive to progress the field of lung cancer and improve patient outcomes.
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Affiliation(s)
- Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,Allied Health, South Metropolitan Health Service, Perth, WA, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Khrapov KN, Kovalev MG, Sedov SS. Preparation for anesthesia of patients with concomitant lung pathology and a high risk of developing postoperative pulmonary complications. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2020. [DOI: 10.21292/2078-5658-2020-17-2-20-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- K. N. Khrapov
- Pavlov First Saint Petersburg State Medical University
| | - M. G. Kovalev
- Pavlov First Saint Petersburg State Medical University
| | - S. S. Sedov
- Pavlov First Saint Petersburg State Medical University
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Moore J, Merchant Z, Rowlinson K, McEwan K, Evison M, Faulkner G, Sultan J, McPhee JS, Steele J. Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester's 'Prehab4cancer'. Eur J Surg Oncol 2020; 47:524-532. [PMID: 32439265 DOI: 10.1016/j.ejso.2020.04.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 01/10/2023] Open
Abstract
Patients undergoing major cancer interventions such as major surgical resection, chemotherapy, radiotherapy, and immunotherapy are prone to the adverse effects of their cancer, as well as to the side effects of the treatments designed to cure them. The Prehabilitation process supports cancer patients in preparing for the physiological challenges of their cancer treatments, whilst aiming to shorten recovery time, reduce peri-operative complications and improve compliance with non-surgical treatments. Prehabilitation will be most useful in older patients. Greater Manchester Integrated Care system is the first regional system in the UK to introduce delivery of system-wide, large scale physical activity supported multi-modal prehabilitation and recovery programme, Prehab4Cancer as a standard of care for cancer patients. It builds upon the successful implementation of Enhanced Recovery After Surgery + programme to improve surgical care in Greater Manchester. During this review we describe the journey to develop a system wide prehabilitation model for patients with cancer. Prehab4Cancer to date has focused on robust co-design, development, and implementation of an effective service model with attention paid to stakeholder engagement. This has led to receipt of high numbers of referrals from across Greater Manchester for the all the cancer groups involved. The successful implementation of the P4C pathway in GM presents a best practice model that might be adopted by other local and combined authority areas nationally.
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Affiliation(s)
- John Moore
- Consultant in Intensive Care and Anaesthesia, Manchester University Hospital NHS Foundation Trust, Clinical Director GM Cancer Prehab4Cancer, University of Manchester, Manchester Metropolitan University, UK.
| | - Zoe Merchant
- Programme Lead GM Cancer Prehab4Cancer/Specialist Occupational Therapist, UK
| | | | - Karen McEwan
- Primary Care Lead for GM Cancer Prehab4Cancer, UK
| | - Matthew Evison
- Consultant in Respiratory Medicine, Manchester University Hospital, UK
| | - Gemma Faulkner
- Consultant Colorectal Surgeon, Royal Bolton Hospital, UK
| | - Javed Sultan
- Consultant Upper GI Surgeon, Salford Royal Hospital, UK
| | | | - James Steele
- UK Active Research Institute and Solent University, UK
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Rose GA, Adamson MJ, Davies RG, Appadurai IR, Bailey DM. High-intensity exercise training improves perioperative risk stratification in the high-risk patient. Physiol Rep 2020; 8:e14409. [PMID: 32378338 PMCID: PMC7202981 DOI: 10.14814/phy2.14409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/22/2023] Open
Abstract
Exercise prehabilitation prior to major surgery can improve cardiorespiratory fitness (CRF) and clinical outcome. However, in patients deemed "high--risk" for surgery, the feasibility, optimum training modality and its intensity, duration, and frequency are yet to be defined. We assessed the cardiorespiratory fitness of a 70-year-old female patient requiring major thoraco-abdominal surgery for reconstruction of her esophagus. Cardiopulmonary exercise testing (CPET) on a cycle ergometer was used to determine CRF. A baseline CPET confirmed poor CRF and placed her in a high surgical risk group. This was followed by 16 weeks of unsupervised, home-based, moderate-intensity steady-state (MISS) training followed by 10 weeks of high-intensity interval training (HIIT) under the combined supervision of an exercise physiologist and clinician in hospital. Following MISS training, CPET metrics failed to improve: peak oxygen uptake decreased (14.7-13.7 ml O2 ·kg-1 ·min-1 ; -7%) together with peak power (73-70 W; -4%) and anaerobic threshold (AT) increased (7.8-8.3 ml O2 ·kg-1 ·min-1 ; +6%). However, HIIT resulted in impressive improvement in CRF. Peak oxygen uptake (13.7-18.6 ml O2 ·kg-1 ·min-1 ; +36%), AT (8.3-10.5 ml O2 ·kg-1 ·min-1 ; +27%), peak power (70-102 W; +46%), minute ventilation (35.8-57.7 L·min-1 ; +61%), and peak heart rate (100-133 b·min-1 ; +33%) all increased. Ventilatory equivalents for carbon dioxide at AT ( V ˙ E / V ˙ CO2 -AT) improved (30-28; -7%). The improvement in CRF resulted in surgical reclassification from high to low risk. In conclusion, preoperative HIIT training can confer a marked improvement in CRF in an elderly surgical patient and is associated with a corresponding reduction in perioperative risk.
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Affiliation(s)
- George A. Rose
- Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | | | | | | | - Damian M. Bailey
- Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
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65
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Santa Mina D, Alibhai SM. Prehabilitation in geriatric oncology. J Geriatr Oncol 2020; 11:731-734. [DOI: 10.1016/j.jgo.2019.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/17/2019] [Accepted: 05/16/2019] [Indexed: 01/12/2023]
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66
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Bongers BC, Dejong CHC, den Dulk M. Enhanced recovery after surgery programmes in older patients undergoing hepatopancreatobiliary surgery: what benefits might prehabilitation have? Eur J Surg Oncol 2020; 47:551-559. [PMID: 32253075 DOI: 10.1016/j.ejso.2020.03.211] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/05/2020] [Accepted: 03/21/2020] [Indexed: 12/14/2022] Open
Abstract
Due to an aging population and the related growing number of less physically fit patients with multiple comorbidities, adequate perioperative care is a new and rapidly developing clinical science that is becoming increasingly important. This narrative review focuses on enhanced recovery after surgery (ERAS®) programmes and the growing interest in prehabilitation programmes to improve patient- and treatment-related outcomes in older patients undergoing hepatopancreatobiliary (HPB) surgery. Future steps required in the further development of optimal perioperative care in HPB surgery are also discussed. Multidisciplinary preoperative risk assessment in multiple domains should be performed to identify, discuss, and reduce risks for optimal outcomes, or to consider alternative treatment options. Prehabilitation should focus on high-risk patients based on evidence-based cut-off values and should aim for (partly) supervised multimodal prehabilitation tailored to the individual patient's risk factors. The program should be executed in the living context of these high-risk patients to improve the participation rate and adherence, as well as to involve the patient's informal support system. Developing tailored (multimodal) prehabilitation programmes for the right patients, in the right context, and using the right outcome measures is important to demonstrate its potential to further improve patient- and treatment-related outcomes following HPB surgery.
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Affiliation(s)
- Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Cornelis H C Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany.
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany.
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67
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McKenna NP, Bews KA, Al-Refaie WB, Colibaseanu DT, Pemberton JH, Cima RR, Habermann EB. Assessing Malnutrition Before Major Oncologic Surgery: One Size Does Not Fit All. J Am Coll Surg 2020; 230:451-460. [PMID: 32113029 DOI: 10.1016/j.jamcollsurg.2019.12.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND There are multiple definitions for malnutrition, without evidence of superiority of any one definition to assess preoperative risk. Therefore, to aid in identification of patients that might warrant prehabilitation, we aimed to determine the optimal definition of malnutrition before major oncologic resection for 6 cancer types. METHODS The American College of Surgeons NSQIP database was queried for patients undergoing elective major oncologic operations from 2005 to 2017. Nutritional status was evaluated using the European Society for Parenteral and Enteral Nutrition definitions, NSQIP's variable for >10% weight loss during the previous 6 months, and the WHO BMI classification system. Multivariable logistic regression was performed to evaluate the adjusted effect of nutritional status on mortality and major morbidity. RESULTS We identified 205,840 operations (74% colorectal, 10% pancreatic, 9% lung, 3% gastric, 3% esophageal, and 2% liver). A minority (16%) of patients met criteria for malnutrition (0.6% severe malnutrition, 1% European Society for Parenteral and Enteral Nutrition 1, 2% European Society for Parenteral and Enteral Nutrition 2, 6% NSQIP, and 6% mild malnutrition), 31% were obese, and the remaining 54% had a normal nutrition status. Both mortality and major morbidity varied significantly between the nutrition groups (both p < 0.0001). An interaction between nutritional status and cancer type was observed in the models for mortality and major morbidity (interaction term p < 0.0001 for both), indicating the optimal definition of malnutrition varied by cancer type. CONCLUSIONS The definition of malnutrition used to assess postoperative risk is specific to the type of cancer being treated. These findings can be used to enhance nutritional preparedness in the preoperative setting.
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Affiliation(s)
- Nicholas P McKenna
- Department of Surgery, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Katherine A Bews
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Waddah B Al-Refaie
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC
| | - Dorin T Colibaseanu
- Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL
| | - John H Pemberton
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | - Robert R Cima
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | - Elizabeth B Habermann
- Department of Surgery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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68
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Ruzycki SM, Prystajecky M, Driedger MR, Kachra R. Peri-operative cardiac biomarker screening: a narrative review. Anaesthesia 2020; 75 Suppl 1:e165-e173. [PMID: 31903570 DOI: 10.1111/anae.14920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 12/26/2022]
Abstract
Peri-operative risk estimation has traditionally focused on assessing the likelihood of postoperative morbidity and mortality using pre-operative functional assessment. Although this strategy is currently recommended by most major society guidelines, contemporary evidence suggests that cardiac biomarker measurement has important advantages over pre-operative functional assessment. These advantages include superior predictive discrimination and inclusion of the postoperative course in risk estimation. In this review, we provide an overview of the evidence supporting the peri-operative utilisation, compare risk estimation methods and discuss which patients may benefit most from cardiac biomarker screening. We also discuss protocols for biomarker screening and management of patients with abnormal results.
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Affiliation(s)
- S M Ruzycki
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - M Prystajecky
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - M R Driedger
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
| | - R Kachra
- Division of General Internal Medicine, Department of Medicine, University of Calgary, AB, Canada
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69
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Molenaar CJL, Papen-Botterhuis NE, Herrle F, Slooter GD. Prehabilitation, making patients fit for surgery - a new frontier in perioperative care. Innov Surg Sci 2019; 4:132-138. [PMID: 33977122 PMCID: PMC8059351 DOI: 10.1515/iss-2019-0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Optimizing a patients’ condition before surgery to improve the postoperative outcome can be achieved by using prehabilitation; preoperative interventions focusing on modifiable risk factors to improve the physical, nutritional, and mental status of the patient. A multimodal, multidisciplinary approach induces a synergistic effect between the various interventions and affects the outcome postoperatively. While awaiting higher-quality evidence, the worldwide implementation of prehabilitation programs has started, resulting in a true revolution in perioperative care.
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Affiliation(s)
| | | | - Florian Herrle
- Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Gerrit D Slooter
- Department of Surgical Oncology, Máxima MC, 5500MB, Veldhoven, the Netherlands, E-mail:
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70
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Karlsson E, Dahl O, Rydwik E, Nygren-Bonnier M, Bergenmar M. Older patients' attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery-a gap between awareness and action. Support Care Cancer 2019; 28:3945-3953. [PMID: 31863214 PMCID: PMC7316666 DOI: 10.1007/s00520-019-05237-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022]
Abstract
Purpose Time for preoperative optimisation prior to colorectal cancer surgery is limited and older people tend to decline exercise interventions. This study sought to describe attitudes towards, and perceptions of, preoperative physical activity and exercise in older people prior to colorectal cancer surgery. Methods This is a qualitative interview study, analysed with inductive content analysis. Seventeen participants scheduled for colorectal surgery were recruited as a purposeful sample from two hospitals in Stockholm, Sweden. Individual semi-structured interviews were conducted, face-to-face (n = 8) or by telephone (n = 9). Results Nine participants were male, median age was 75 years (range 70–91). The theme, ‘a gap between awareness and action’, was identified based on two main categories: ‘Attitudes towards preoperative physical exercise have a multifactorial base’ and ‘Preoperative physical exercise is possible with a push in the right direction’. The material described a gap between awareness of the benefits of physical activity and reports of performing physical activity. The reasons for the gap between thoughts and action in this respect seem to be multifactorial. Support from others emerged as an important possibility for overcoming the gap. Conclusions A gap between the patients’ awareness and action appeared in our material. Understanding this can guide healthcare professionals (HCPs) as to the support needed preoperatively. Advice on physical exercise before surgery should be specific, and individually tailored support for action should be offered. This support should also consider the individual’s current physical activity and preoperative attitude towards physical exercise.
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Affiliation(s)
- Emelie Karlsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
| | - Oili Dahl
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
| | - Elisabeth Rydwik
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,FOU nu, Research and Development unit for the elderly, Stockholm County Council, 177 21, Järfälla, Sweden
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.,Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Mia Bergenmar
- Department of Oncology-Pathology, Karolinska Institutet, 171 76, Stockholm, Sweden.,Department of Nursing Science, Sophiahemmet University, 114 86, Stockholm, Sweden
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71
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Loughney L, Cahill R, O’Malley K, McCaffrey N, Furlong B. Compliance, adherence and effectiveness of a community-based pre-operative exercise programme: a pilot study. Perioper Med (Lond) 2019; 8:17. [PMID: 31827773 PMCID: PMC6886214 DOI: 10.1186/s13741-019-0126-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pre-operative exercise training improves HR components of fitness and HRQoL following hospital-based programmes. OBJECTIVE To assess compliance and adherence of a pragmatic community-based preoperative exercise programme and its effect on health-related (HR) components of fitness and health-related quality of life (HRQoL). METHODS Thirty-two surgical oncological participants (15 prostate cancer and 17 colorectal cancer (CRC)) were recruited and assessed to measure HR components of fitness (strength and functional exercise capacity) and HRQoL. An exercise programme was prescribed in the time available prior to surgery with repeat assessments pre-operatively. RESULTS Twenty-four participants (14 prostate cancer and 10 CRC) completed the full study (75% compliance). Exercise training was delivered over a median interquartile range (IQR) of 4 (3-4) weeks and 2 (1-3) weeks for the prostate cancer and CRC participants, with > 80% adherence. From baseline to post-exercise intervention, there were significant improvements in lower body strength in the prostate cancer group (p = 0.045), the CRC group (p = 0.001), and in both groups overall (p = .001). Additionally, there were statistically significant improvements in HRQoL: global health status for CRC group (p = 0.025) and for both groups overall (p = 0.023); emotional health subscale for the prostate cancer group (p = 0.048) and for both groups overall (p = 0.027); nausea/vomiting/pain subscale for the CRC group (p = 0.005) and for both groups overall (p = 0.030); and for health scale status for the prostate cancer group (p = 0.019) and for both groups overall (p = 0.006). CONCLUSION This community-based pre-operative exercise programme showed acceptable compliance and adherence rates, and significantly increased upper and lower body strength and HRQoL. Pre-operative exercise training should be considered as early as possible in the surgical-oncology pathway and respected within patient scheduling.
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Affiliation(s)
- Lisa Loughney
- MedEx Wellness, School of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland
| | - Ronan Cahill
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Section of Surgery and Surgical Science, University College Dublin, Dublin, Ireland
| | - Kiaran O’Malley
- Department of Urology Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Noel McCaffrey
- MedEx Wellness, School of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland
| | - Brona Furlong
- MedEx Wellness, School of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland
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72
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Smith NA, Batterham M, Peoples GE, Shulman MA. The clinical, functional and disability characteristics of patients with severe obesity presenting for non-bariatric surgery. Anaesth Intensive Care 2019; 47:522-531. [PMID: 31779477 DOI: 10.1177/0310057x19887976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical and functional characteristics of patients with severe obesity who present for non-bariatric surgery have rarely been described. For this study, 293 such patients (mean body mass index 42 kg/m2) were investigated using their medical records, a 6-minute walk test, N-terminal pro B-type natriuretic peptide measurement, and the World Health Organization Disability Assessment Schedule 2.0 measure of disability. Cardiorespiratory disease and diabetes were common, with blood tests revealing a high probability of additional unexpected and undiagnosed renal and cardiac disease in a significant proportion of patients. One-third of patients had natriuretic peptide values that identify early left ventricular dysfunction in the community, with 16% above a value described as useful in predicting adverse outcomes for elective surgical patients. Only 10% of patients walked a distance within 10% of that predicted in six minutes, and 22% did not complete the test. Over one-third of patients (34%) had a clinically significant level of disability, with those unable to walk for six minutes describing higher levels of disability. Functional capacity as measured by the 6-minute walk test was significantly lower than would be expected from age, gender, and weight alone, and was related to age and degree of disability but not body mass index. We describe a severely obese population presenting for non-bariatric surgery who had significant levels of comorbid disease, functional impairment, and disability that were not apparent on routine preoperative assessment.
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Affiliation(s)
- Natalie A Smith
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Marijka Batterham
- Statistical Consulting Centre, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, Australia
| | | | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
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73
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Northgraves MJ, Arunachalam L, Madden LA, Marshall P, Hartley JE, MacFie J, Vince RV. Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial. Support Care Cancer 2019; 28:3197-3206. [PMID: 31712950 PMCID: PMC7256075 DOI: 10.1007/s00520-019-05098-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022]
Abstract
Background and objectives To investigate the feasibility of delivering a functional exercise-based prehabilitation intervention and its effects on postoperative length of hospital stay, preoperative physical functioning and health-related quality of life in elective colorectal surgery. Materials and methods In this randomised controlled feasibility trial, 22 elective colorectal surgery patients were randomly assigned to exercise prehabilitation (n = 11) or standard care (n = 11). Feasibility of delivering the intervention was assessed based on recruitment and compliance to the intervention. Impact on postoperative length of hospital stay and complications, preoperative physical functioning (timed up and go test, five times sit to stand, stair climb test, handgrip dynamometry and 6-min walk test) and health-related quality of life were also assessed. Results Over 42% of patients (84/198) screened were deemed ineligible for prehabilitation due to insufficient time existing prior to scheduled surgery. Of those who were eligible, approximately 18% consented to the trial. Median length of hospital stay was 8 [range 6–27] and 10 [range 5–12] days respectively for the standard care and prehabilitation groups. Patterns towards preoperative improvements for the timed up and go test, stair climb test and 6-min walk test were observed for all participants receiving prehabilitation but not standard care. Conclusions Despite prehabilitation appearing to convey positive benefits on physical functioning, short surgical wait times and patient engagement represent major obstacles to implementing exercise prehabilitation programmes in colorectal cancer patients. Electronic supplementary material The online version of this article (10.1007/s00520-019-05098-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew J Northgraves
- Hull Health Trials Unit, University of Hull, Hull, UK.,Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK
| | | | - Leigh A Madden
- Department of Biomedical Science, School of Life Sciences, University of Hull, Hull, UK
| | - Philip Marshall
- Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK
| | | | - John MacFie
- Combined Gastroenterology Research Unit, Scarborough Hospital, Scarborough, UK
| | - Rebecca V Vince
- Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, UK.
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van Beijsterveld CA, Heldens AF, Bongers BC, van Meeteren NL. Variation in Preoperative and Postoperative Physical Therapist Management of Patients Opting for Elective Abdominal Surgery. Phys Ther 2019; 99:1291-1303. [PMID: 31343705 DOI: 10.1093/ptj/pzz095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/20/2018] [Accepted: 02/24/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence about the role of physical therapy in perioperative care pathways to improve postoperative outcomes is growing. However, it is unclear whether research findings have been translated into daily practice. OBJECTIVE The objectives of this study were to describe the current content and between-hospital variability of perioperative physical therapist management for patients undergoing colorectal, hepatic, or pancreatic resection in the Netherlands and to compare currently recommended state-of-the-art physical therapy with self-reported daily clinical physical therapist management. DESIGN This was a cross-sectional survey study. METHODS Hospital physical therapists were asked to complete an online survey about pre- and postoperative physical therapy at their hospital. To explore the variability of perioperative physical therapist management between hospitals, frequency variables were clustered to determine the level of uniformity. Latent class analysis was performed to identify clusters of hospitals with certain homogeneous characteristics on a 19-item dichotomous scale. RESULTS Of 82 eligible Dutch hospitals, 65 filled out the survey (79.3%). Preoperative physical therapy was performed in 34 hospitals (54.0%; 2/65 responding hospitals were excluded from the data analysis). Postoperative physical therapy was performed in all responding hospitals, focusing mainly on regaining independent physical functioning. Latent class analysis identified a 3-class model. Hospitals in classes I and II were more likely to provide preoperative physical therapist interventions than hospitals in class III. LIMITATIONS The use of self-reported answers can lead to bias. CONCLUSIONS There was a wide degree of variability between hospitals regarding pre- and postoperative clinical physical therapist practice for patients opting for major abdominal surgery. Three different classes of daily practice were identified. Further translation of key research findings into clinical physical therapist practice is advised, especially for hospitals in which the physical therapist is not involved preoperatively. Moreover, improving uniformity by developing up-to-date clinical guidelines is recommended.
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Affiliation(s)
- Christel A van Beijsterveld
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.,Department of Physical Therapy, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Aniek F Heldens
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University.,Department of Physical Therapy, Maastricht University Medical Center
| | - Bart C Bongers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI) and Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University.,SOMT University of Physical Therapy, Amersfoort, the Netherlands
| | - Nico L van Meeteren
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.,Top Sector Life Sciences and Health (Health∼Holland), the Hague, the Netherlands
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75
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Lai Y, Wang X, Zhou K, Su J, Che G. Impact of one-week preoperative physical training on clinical outcomes of surgical lung cancer patients with limited lung function: a randomized trial. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:544. [PMID: 31807526 DOI: 10.21037/atm.2019.09.151] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To investigate the influence of preoperative physical training combining aerobic and breathing exercises on surgical lung cancer patients with impaired lung function. Methods A total of 68 patients with predicted postoperative FEV1% <60% were equally and randomly assigned into one-week physical training combining aerobic and breathing exercises (intervened group: IG) or routine preoperative preparation (control group: CG). Then, 6-min walking distance (6-MWD), in-hospital length of stay (LOS), and other clinical variables were included and recorded. Results An increase of 22.6±27.0 m of 6-MWD was observed in IG, compared to 2.7±27.6 m in CG (between-group difference: 19.9 m, 95% CI: 6.7 to 33.2, P=0.004), but no difference was found in lung function. The emotional function of EORTC-QLQ-30 was significantly improved in IG after the training regimen, compared to CG. Meanwhile, the intervened patients (IG) had significantly lower postoperative pulmonary complication (PPC) rate (11.8%, 4/34 vs. 35.3%, 12/34, P=0.022), shorter postoperative LOS [median: 5.0 interquartile (4.0-7.0) vs. 8.0 (7.0-10.0) days, P<0.001] and lower costs, including total cost [48,588.7 (44,999.1-52,693.3) vs. 52,445.3 (49,002.9-61,994.0) ¥, P=0.016], material cost [23,350.8 (18,300.6-26,421.9) vs. 25,730.0 (21,328.7-29,250.2) ¥, P=0.048] and drug cost [7,230.0 (6,661.9-8,347.4) vs. 11,388.6 (7,963.0-16,314.3) ¥, P<0.001]. Conclusions The preoperative physical training combining aerobic and breathing exercises can improve exercise capacity, decrease the occurrence of PPCs, and shorten LOS with lower in-hospital cost; it thus shows potential to be an effective preparation strategy for surgical lung cancer patients with limited lung function.
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Affiliation(s)
- Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Department of Thoracic Surgery, Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianhuan Su
- Rehabilitation Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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76
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van Egmond MA, van der Schaaf M, Klinkenbijl JHG, Twisk JWR, Engelbert RHH, van Berge Henegouwen MI. The pre- and postoperative course of functional status in patients undergoing esophageal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 46:173-179. [PMID: 31445767 DOI: 10.1016/j.ejso.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/03/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To optimally target physiotherapy treatment, knowledge of the pre- and postoperative course of functional status in patients undergoing esophagectomy is required. The aim of this prospective longitudinal study was to investigate the course of functional status in patients with esophageal cancer before and after esophagectomy. MATERIALS AND METHODS Functional status outcome measures of patients with esophageal cancer who underwent surgery between March 2012 and June 2016 were prospectively measured at 3 months and at 1 day before surgery and at 1 week and at 3 months after surgery. Analysis of repeated measurements with the mixed model approach was used to study changes over time. RESULTS Hundred fifty-five patients were measured at 3 months and at 1 day before surgery, of which 109 (70.3%) at 1 week and 60 (38.7%) at 3 months after surgery. Mean (SD) age at surgery was 63.5 years (9.3), and 122 patients (78.7%) were male. The incidence of postoperative complications was 83 (53.5%). Three months postoperatively, functional status measures returned to baseline levels, except from handgrip strength (beta [95% CI] -6.2 [-11.3 to -1.1]; P = 0.02) and fatigue (4.7 [0.7to 8.7]; P = 0.02). No differences were observed in the course of functional status between patients with and without postoperative complications. CONCLUSION Functional status of patients undergoing esophagectomy returned to baseline values three months after surgery, despite the high incidence of postoperative complications. This requires rethinking the concept of prehabilitation, where clearly not all patients benefit from high functional status to prevent postoperative complications.
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Affiliation(s)
- Maarten A van Egmond
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, European School of Physiotherapy, Faculty of Health, Amsterdam, Netherlands.
| | - Marike van der Schaaf
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands
| | - Jean H G Klinkenbijl
- Gelre Hospital Apeldoorn-Zutphen, Department of Surgery, Apeldoorn, Netherlands; University of Amsterdam, Amsterdam, Netherlands
| | - Jos W R Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands
| | - Mark I van Berge Henegouwen
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
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77
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Abstract
PURPOSE OF REVIEW With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of 'prehabilitation' with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention. RECENT FINDINGS Literature search revealed a huge amount of publications in particular within the last 12 months. Although a single definition of both frailty and prehabilitation is still to be made, various players in the perioperative setting obviously are becoming increasingly convinced about a possible benefit of the program - referring to different components and measures performed. Although physiologically advantages seem obvious, there is hardly any reliable data on clinical outcomes resulting from properly performed studies. This applies especially to octogenarians; thus those at risk for adverse events the concept originally addresses. SUMMARY Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients. However, further studies on effectiveness in a highly heterogeneous population and agreement on a common concept are mandatory before a final judgement can be given.
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78
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Lumb AB. Pre-operative respiratory optimisation: an expert review. Anaesthesia 2019; 74 Suppl 1:43-48. [PMID: 30604419 DOI: 10.1111/anae.14508] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/29/2022]
Abstract
Postoperative pulmonary complications are common and cause increased mortality and hospital stay. Smoking and respiratory diseases including asthma, chronic obstructive pulmonary disease and obstructive sleep apnoea are associated with developing postoperative pulmonary complications. Independent risk factors for such complications also include low pre-operative oxygen saturation, or a recent respiratory infection. Postponing surgery in patients who have respiratory infections or inadequately treated respiratory disease, until these can be fully treated, should, therefore, reduce postoperative pulmonary complications. There is evidence from several studies that pre-operative smoking cessation reduces such complications, with no agreed duration at which the benefits become significant; the longer the abstinence, the greater the benefit. Intensive smoking cessation programmes are more effective, and there are long-term benefits, as many patients become permanent non-smokers following their surgery. Supervised exercise programmes normally last 6-8 weeks, and although they reduce overall complications, the evidence of benefit for postoperative pulmonary complications is mixed. High-intensity interval training can improve fitness in just 2 weeks, and so may be more useful for surgical patients. Specific respiratory pre-operative interventions, such as deep breathing exercises and incentive spirometry, can help when used as components of a package of respiratory care. Pre-operative inspiratory muscle training programmes that involve inspiration against a predetermined respiratory load may also reduce some postoperative pulmonary complications. Pre-operative exercise programmes are recommended for patients having major surgery, or in those where pre-operative testing has shown low levels of cardiorespiratory fitness; interval training or respiratory interventions are more feasible as these reduce complications after a shorter pre-operative intervention.
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Affiliation(s)
- A B Lumb
- St James' University Hospital, Leeds, UK.,University of Leeds, UK
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79
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Bril SI, Pezier TF, Tijink BM, Janssen LM, Braunius WW, de Bree R. Preoperative low skeletal muscle mass as a risk factor for pharyngocutaneous fistula and decreased overall survival in patients undergoing total laryngectomy. Head Neck 2019; 41:1745-1755. [PMID: 30663159 PMCID: PMC6590286 DOI: 10.1002/hed.25638] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/18/2018] [Accepted: 12/10/2018] [Indexed: 12/18/2022] Open
Abstract
Background Low skeletal muscle mass (SMM) is associated with postoperative complications, prolonged hospital stay, and short overall survival (OS) in surgical oncology. We aimed to investigate this association in patients undergoing total laryngectomy (TL). Methods A retrospective study was performed of patients undergoing TL. SMM was measured using CT or MRI scans at the level of the third cervical vertebra (C3). Results In all, 235 patients were included. Low SMM was observed in 109 patients (46.4%). Patients with low SMM had more pharyngocutaneous fistulas (PCFs) than patients with normal SMM (34.9% vs 20.6%; P = .02) and prolonged hospital stay (median, 17 vs 14 days; P < .001). In multivariate analysis, low SMM (hazards ratio, 1.849; 95% confidence interval, 1.202‐2.843) and high N stage were significant prognosticators of decreased OS. Conclusion Low SMM is associated with PCF and prolonged hospital stay in patients undergoing TL. Low SMM is an independent prognostic factor for shorter OS.
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Affiliation(s)
- Sandra I Bril
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas F Pezier
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bernard M Tijink
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luuk M Janssen
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Weibel W Braunius
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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80
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Verbree-Willemsen L, Grobben RB, van Waes JAR, Peelen LM, Nathoe HM, van Klei WA, Grobbee DE. Causes and prevention of postoperative myocardial injury. Eur J Prev Cardiol 2019; 26:59-67. [PMID: 30207484 PMCID: PMC6287250 DOI: 10.1177/2047487318798925] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/14/2018] [Indexed: 01/10/2023]
Abstract
Over the past few years non-cardiac surgery has been recognised as a serious circulatory stress test which may trigger cardiovascular events such as myocardial infarction, in particular in patients at high risk. Detection of these postoperative cardiovascular events is difficult as clinical symptoms often go unnoticed. To improve detection, guidelines advise to perform routine postoperative assessment of cardiac troponin. Troponin elevation - or postoperative myocardial injury - can be caused by myocardial infarction. However, also non-coronary causes, such as cardiac arrhythmias, sepsis and pulmonary embolism, may play a role in a considerable number of patients with postoperative myocardial injury. It is crucial to acquire more knowledge about the underlying mechanisms of postoperative myocardial injury because effective prevention and treatment options are lacking. Preoperative administration of beta-blockers, aspirin, statins, clonidine, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and preoperative revascularisation have all been investigated as preventive options. Of these, only statins should be considered as the initiation or reload of statins may reduce the risk of postoperative myocardial injury. There is also not enough evidence for intraoperative measures such blood pressure optimisation or intensified medical therapy once patients have developed postoperative myocardial injury. Given the impact, better preoperative identification of patients at risk of postoperative myocardial injury, for example using preoperatively measured biomarkers, would be helpful to improve cardiac optimisation.
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Affiliation(s)
- Laura Verbree-Willemsen
- Department of Epidemiology, Julius
Center for Health Sciences and Primary Care, University Medical Center Utrecht,
Utrecht University, The Netherlands
| | - Remco B Grobben
- Department of Cardiology, University
Medical Center Utrecht, Utrecht University, The Netherlands
| | - Judith AR van Waes
- Department of Anaesthesiology,
University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Linda M Peelen
- Department of Epidemiology, Julius
Center for Health Sciences and Primary Care, University Medical Center Utrecht,
Utrecht University, The Netherlands
- Department of Anaesthesiology,
University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University
Medical Center Utrecht, Utrecht University, The Netherlands
| | - Wilton A van Klei
- Department of Anaesthesiology,
University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Diederick E Grobbee
- Department of Epidemiology, Julius
Center for Health Sciences and Primary Care, University Medical Center Utrecht,
Utrecht University, The Netherlands
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81
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Zylstra J, Boshier P, Whyte GP, Low DE, Davies AR. Peri-operative patient optimization for oesophageal cancer surgery - From prehabilitation to enhanced recovery. Best Pract Res Clin Gastroenterol 2018; 36-37:61-73. [PMID: 30551858 DOI: 10.1016/j.bpg.2018.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/19/2018] [Indexed: 02/08/2023]
Affiliation(s)
- J Zylstra
- Department of Gastrointestinal Medicine and Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Sport and Exercise Science, Faculty of Science, Liverpool John Moore's University, Liverpool, UK
| | - P Boshier
- Virginia Mason Medical Centre, Seattle, USA
| | - G P Whyte
- School of Sport and Exercise Science, Faculty of Science, Liverpool John Moore's University, Liverpool, UK; Research Institute for Sport & Exercise Science, Liverpool John Moore's University, UK
| | - D E Low
- Virginia Mason Medical Centre, Seattle, USA
| | - A R Davies
- Department of Gastrointestinal Medicine and Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK; Division of Cancer Studies, King's College London, UK.
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82
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Milder DA, Pillinger NL, Kam PCA. The role of prehabilitation in frail surgical patients: A systematic review. Acta Anaesthesiol Scand 2018; 62:1356-1366. [PMID: 30094821 DOI: 10.1111/aas.13239] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Increasing emphasis is being placed on the detection of frailty in the pre-operative setting given its association with surgical morbidity and mortality. Prehabilitation seeks to increase the physiological reserve of frail patients, attenuating the risk of irreversible functional decline following surgery. AIM/HYPOTHESIS This systematic review appraises the evidence available for prehabilitation in frail surgical patients. We proposed that exercise prehabilitation would especially benefit frail patients, with improvements in pre-operative functional capacity, and reductions in complications and length of hospital stay. METHODS A literature search was conducted in MEDLINE, PubMed and CINAHL databases. Studies were included if they consisted of a prehabilitation intervention in frail patients undergoing surgery and specified a frailty model/index. Eight studies were included for analysis, 2 of which are ongoing studies. RESULTS In 3 studies, prehabilitation consisted of an exercise intervention alone. There was a high feasibility of prehabilitation and a trend to improved pre-operative function, however, no evidence of improved post-operative functional recovery was there. In 2 studies, prehabilitation consisted of both exercise and nutritional interventions. Reductions in mortality and duration of hospital stay were reported, but the quality of evidence was judged to be very low. There was a lack of evidence of improved outcomes following pre-operative inspiratory muscle training in frail patients. DISCUSSION This systematic review focuses on prehabilitation in frail surgical patients and reports that evidence supporting any outcome is limited, despite high feasibility and acceptability. There is a need for large randomised controlled trials to better establish the effects of prehabilitation in frail patients.
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Affiliation(s)
| | - Neil L. Pillinger
- Department of Anaesthetics Royal Prince Alfred Hospital University of Sydney Camperdown NSW Australia
- The University of Sydney Sydney Medical School NSW Australia
| | - Peter C. A. Kam
- Department of Anaesthetics Royal Prince Alfred Hospital University of Sydney Camperdown NSW Australia
- The University of Sydney Sydney Medical School NSW Australia
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83
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Twomey R, Bebb G, Culos-Reed SN. Health-related quality of life after curative-intent treatment of non-small cell lung cancer: can exercise lessen the burden? ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:S76. [PMID: 30613651 DOI: 10.21037/atm.2018.10.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rosie Twomey
- Faculty of Kinesiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Gwyn Bebb
- Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Tom Baker Cancer Centre, Alberta Health Services, Alberta, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Tom Baker Cancer Centre, Alberta Health Services, Alberta, Canada
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84
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Keen C, Fowler-Davis S, McLean S, Manson J. Physiotherapy practice in pulmonary hypertension: physiotherapist and patient perspectives. Pulm Circ 2018; 8:2045894018783738. [PMID: 29956561 PMCID: PMC6055281 DOI: 10.1177/2045894018783738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/21/2018] [Indexed: 11/15/2022] Open
Abstract
Pulmonary hypertension (PH) is a life-limiting disease affecting circulation to the lungs. The primary symptom of PH is breathlessness, yet research has shown that patients with PH can exercise safely and can benefit from exercise to improve exercise capacity and maintain quality of life. This study aimed to investigate the nature of physiotherapy delivered to patients with PH in the UK. This was a two-phase sequential, exploratory, mixed-methods study. Interviews were conducted with seven lead physiotherapists at specialist pulmonary hypertension centers and three patients. Survey data came from 63 physiotherapists caring for patients with PH in specialist and non-specialist settings. The findings from the two phases were triangulated and analyzed. Findings showed that physiotherapists and patients see the benefit and potential of physical activity for patients with PH to maintain functional wellbeing. However, current physiotherapy provision focuses on acute inpatient care and planning for discharge and is not therefore aligned with research evidence and clinical guidelines. In the absence of inpatient rehabilitation facilities, physiotherapists will occasionally access existing community services, e.g. pulmonary rehabilitation; however, specialist knowledge of this rare condition can be lacking in local services. There is aspiration among physiotherapists and patients for a new approach which supports patients from diagnosis with PH to end of life. This includes promoting and delivering rehabilitation and exercise interventions to achieve better health outcomes, in line with patient needs. Treatment would be commissioned and delivered within existing national health systems with physiotherapists developing strategies for health improvement.
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Affiliation(s)
- Carol Keen
- Sheffield
Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield,
UK
| | | | | | - Jane Manson
- Sheffield
Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield,
UK
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85
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Eckstein ML, Lawrence JB, Otto C, Kotsch P, Messerschmidt J, Bracken RM, Moser O. Impairments of postural control, functional performance and strength in morbidly obese patients awaiting bariatric surgery in comparison to healthy individuals. J Phys Ther Sci 2018; 30:663-668. [PMID: 29765176 PMCID: PMC5940468 DOI: 10.1589/jpts.30.663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/05/2018] [Indexed: 12/05/2022] Open
Abstract
[Purpose] There is a lack of information evaluating specific markers of performance in
patients awaiting bariatric surgery. We aimed to assess the postural control, functional
performance, strength and endurance performance for morbidly obese patients awaiting
bariatric surgery compared to lean controls. [Subjects and Methods] All parameters were
assessed by modified Y-balance test, timed-up-and-go-test, maximum strength testing on
resistance exercise equipment and cardio-pulmonary exercise testing on a cycle ergometer
in 10 morbidly obese patients awaiting bariatric surgery and 10 age- and sex-matched lean
controls. [Results] It was found that significant differences existed for overall modified
Y-balance test in morbidly obese patients awaiting bariatric surgery versus lean controls
(0.37 ± 0.03 vs. 0.47 ± 0.02 cm.cm−1), timed-up-and-go-test (9.33 ± 1.23 vs.
7.85 ± 1.73 sec) and several variables of cardio-pulmonary exercise testing. Overall
absolute strength expressed in kilogram was similar, yet when relativized to body weight
strength differences were notable (0.4 ± 0.17 vs. 0.83 ± 0.32 kg.kg−1).
[Conclusion] The results of this study demonstrate the need for comprehensive functional
assessment prior to surgery with an identified demand for subsequent tailored physical
training prescription that should begin before surgery.
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Affiliation(s)
- Max Lennart Eckstein
- Diabetes Research Group, Medical School, Swansea University: SA2 8PP Swansea, Singleton Park, Wales, United Kingdom.,Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, United Kingdom.,University Outpatient Clinic, Center of Sports Medicine & Sports Orthopedics, University of Potsdam, Germany
| | - Jimmy Bradley Lawrence
- University Outpatient Clinic, Center of Sports Medicine & Sports Orthopedics, University of Potsdam, Germany
| | - Christoph Otto
- University Outpatient Clinic, Center of Sports Medicine & Sports Orthopedics, University of Potsdam, Germany.,Fritz Stephan GmbH, Germany
| | - Peggy Kotsch
- University Outpatient Clinic, Center of Sports Medicine & Sports Orthopedics, University of Potsdam, Germany
| | - Janin Messerschmidt
- University Outpatient Clinic, Center of Sports Medicine & Sports Orthopedics, University of Potsdam, Germany.,Department of Medicine II, Department of Hematology, University Hospital Wuerzburg, Germany
| | - Richard Michael Bracken
- Diabetes Research Group, Medical School, Swansea University: SA2 8PP Swansea, Singleton Park, Wales, United Kingdom.,Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, United Kingdom
| | - Othmar Moser
- Diabetes Research Group, Medical School, Swansea University: SA2 8PP Swansea, Singleton Park, Wales, United Kingdom.,Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, United Kingdom.,University Outpatient Clinic, Center of Sports Medicine & Sports Orthopedics, University of Potsdam, Germany
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